Older adults with regular activity routines are happier and perform better on cognitive tests

Summary: Getting up early and staying active throughout the day helps older adults do better on cognitive tests, a new study reports.

Source: University of Pittsburgh

Older adults who consistently wake up early and stay active throughout the day are happier and perform better on cognitive tests than those with erratic activity patterns, according to a new study led by University of Pittsburgh researchers.

The results, published online in JAMA Psychiatrysuggest that activity patterns—not just activity intensity—are important for healthy aging and mental health.

“It has something to do with starting early, staying active throughout the day, and following the same routine every day that seems to protect older adults,” said lead author Stephen Smagula, Ph.D., assistant professor of psychiatry and epidemiology at Pitt. “The exciting thing about these findings is that activity patterns are under voluntary control, meaning that intentional changes in daily routine can improve health and well-being.”

To learn more about the daily activity patterns of older adults in the US and to identify associations with mental health and cognition, Smagula and his team recruited 1,800 seniors over the age of 65. Participants wore accelerometers — motion-sensing devices commonly found in smartphones and exercise trackers — on their wrists for seven days to measure activity, and they completed questionnaires to assess depression symptoms and cognitive functioning.

The analysis showed that 37.6% of the participants got up early in the morning, stayed active throughout the day and had a consistent daily routine.

“Many older adults had robust patterns: they get up before 7 a.m. on average and move on; They stay active for about 15 hours each day. They also tend to follow the same pattern day after day,” Smagula said. “Lo and behold, these same adults were happier, less depressed, and had better cognitive function than other participants.”

Another group, comprising 32.6% of participants, had similarly consistent daily patterns, but participants were only active an average of 13.4 hours per day because they got up later in the morning or calmed down earlier in the evening. This group had more symptoms of depression and poorer cognition than the early risers.

“People often think that activity intensity is important for health, but it might be activity duration that’s more important,” Smagula said. “This is a different way of thinking about activity: You might not need to sprint or run a marathon, just engage in activity throughout the day.”

The remaining 29.8% of participants had disordered activity patterns, in which periods of activity were irregular throughout the day and inconsistent across days. These adults had the highest rates of depression and scored the lowest on cognitive tests.

According to Smagula, the relationship between mental health and activity patterns likely goes both ways: depression or cognitive impairment can make it harder to follow a consistent routine, and conversely, a disrupted activity rhythm can worsen these symptoms.

“Our results suggest that activity pattern disorder is very common and associated with health problems in older adults,” explained Smagula. “The relationship is likely two-way, so the good news is that we believe simple changes — things anyone can try — can restore normal activity patterns and thereby improve health.”

Now, Smagula and his team are developing interventions to test their hypothesis that changing behaviors to develop more consistent daily routines will increase cognition and improve mental health in older adults.

Smagula said the first step to developing a consistent routine and getting better sleep is waking up at the same time every day — no matter how tired you are.

“The other thing is to have a realistic plan for staying active throughout the day. It can be really tough — especially when you’re in depression or recovering from an injury — so it’s important to be reasonable with yourself,” he added. “A plan might include making a list of activities you enjoy and setting aside time to see a friend or neighbor.”

Timings, called “timers,” that help set the body’s internal clock can also help create a stable routine. These include sunlight, exercise and food. Pets, who often require food and walks at the same time each day, can be important social timers.

“Most people are aware of the importance of good sleep and exercise, but I think what’s missing from this picture is the daily (circadian) activity pattern,” Smagula said. “Having something to wake up to every morning and having a full day that you find meaningful and rewarding could be important for us to sleep well at night and age well.”

Other authors of the study were Swathi Gujral, Ph.D., Charles F. Reynolds III, MD, and Gehui Zhang, BS, all from Pitt or UPMC; Naima Covassin, Ph.D., of the Mayo Clinic; Jingen Li, MD, Ph.D., from Mayo Clinic and Beijing University of Chinese Medicine; Warren D. Taylor, MD, of Vanderbilt University Medical Center; and Robert T. Krafty, Ph.D., of Emory University.

About this news from aging and cognition research

Author: press office
Source: University of Pittsburgh
Contact: Press Office – University of Pittsburgh
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Original research: Closed access.
“Association of 24-hour activity pattern phenotypes with depression symptoms and cognitive performance in old age” by Stephen F. Smagula et al. JAMA Psychiatry

abstract

Association of 24-hour activity pattern phenotypes with depression symptoms and cognitive performance in old age

meaning

Evidence on the nature and prevalence of 24-hour activity pattern phenotypes in older adults, particularly those related to depressive symptoms and cognition, is needed to guide the development of targeted mechanism research and behavioral interventions.

See also

Goals

To identify subgroups of older adults with similar 24-hour activity rhythm characteristics and to characterize associated depression symptoms and cognitive performance.

Design, setting and participants

A cross-sectional analysis of the 2011-2014 National Health and Nutrition Examination and Survey (NHANES) Accelerometer study was conducted from January to March 2022. NHANES used a multi-level probability sample designed to be representative of non-institutionalized US adults. The main analysis included participants age 65 and older with accelerometer and depression measurements weighted to represent approximately 32 million older adults.

exposures

Latent profiling analysis identified subgroups with similar characteristics of the 24-hour activity pattern measured with extended cosine and nonparametric methods.

Main results and actions

Covariate-adjusted, sample-weighted regressions assessed associations of subgroup membership with (1) depression symptoms, defined as 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater (PHQ-9), and (2) having at least psychometric mild cognitive impairment ( p-MCI) defined as a score less than 1 SD below the mean on a composite cognitive performance score.

Results

The actual clustering sample size was 1800 (weighted: mean [SD] Age, 72.9 [7.3] Years; 57% female participants). Clustering identified 4 subgroups: (1) 677 earlier ascending/robust (37.6%), (2) 587 shorter active period/less modelable (32.6%), (3) 177 shorter active period/very weak ( 9.8%) and (4) 359 late onset/very weak (20.0%). The prevalence of a PHQ-9 score of 10 or greater differed significantly between groups (Cluster 1, 3.5%; Cluster 2, 4.7%; Cluster 3, 7.5%; Cluster 4, 9.0% ;χ² P= 0.004). The prevalence of at least p-MCI differed significantly between the groups (cluster 1, 7.2%; cluster 2, 12.0%; cluster 3, 21.0%; cluster 4, 18.0%; χ² P< 0.001). Five out of 9 depression symptoms differed significantly between the subgroups.

Conclusions and Relevance

In this cross-sectional study, the results suggest that approximately 1 in 5 older adults in the US could be classified into a subgroup with weak activity patterns and later settling-in, and approximately 1 in 10 into a subgroup with weak patterns and shorter activity duration. Future research is needed to examine the biological processes associated with these behavioral phenotypes, including why earlier and robust patterns of activity appear protective and whether changing disrupted patterns improves outcomes.