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Physical Activity, Vascular Health, and Cognitive Impairment—Reply

Physical Activity, Vascular Health, and Cognitive Impairment—Reply In reply We thank Dr Smith for his interest in our study. Dr Smith is correct that our study was an observational study and not an intervention study, that our analyses did not adjust for dietary patterns, and that we used a telephone cognitive assessment. We fully acknowledge the observational nature of our study, which only permits the evaluation of associations and is not causal evidence. We were careful throughout the text to state that we observed strong associations between physical activity and cognitive health and that our findings need confirmation in future studies. However, as Smith and colleagues1(p248) state in the largest meta-analysis of clinical trials of physical activity and cognition to date, randomized controlled trials “are limited by logistical constraints in their ability to sustain interventions over prolonged periods of time.” Thus, our observational study, which has evaluated the association between average physical activity over a year and long-term cognitive decline occurring 3.5 years later among 2809 women, provides important data to address the gap in the clinical trial literature. As for residual confounding by dietary patterns, our main analyses adjusted for alcohol intake, which is a component of both the Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet patterns, as well as multivitamin use, B vitamins, and antioxidant vitamins (vitamin E, vitamin C, and beta carotene). To further address Dr Smith's concerns, we conducted analyses adjusting for Mediterranean diet pattern and observed very little changes from the main analyses. This indicates that healthy diet did not meaningfully confound the association between physical activity and cognitive decline in our study. Finally, we have conducted extensive work that has established the very high validity of our telephone cognitive battery vs traditional in-person techniques. This work is summarized in the article.2 Back to top Article Information Correspondence: Dr Kang, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115 (nhjhk@channing.harvard.edu). Financial Disclosure: None reported. References 1. Smith PJ, Blumenthal JA, Hoffman BM, et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med. 2010;72(3):239-25220223924PubMedGoogle ScholarCrossref 2. Vercambre MN, Grodstein F, Manson JE, Stampfer MJ, Kang JH. Physical activity and cognition in women with vascular conditions. Arch Intern Med. 2011;171(14):1244-125021771894PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Physical Activity, Vascular Health, and Cognitive Impairment—Reply

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Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2011.617
Publisher site
See Article on Publisher Site

Abstract

In reply We thank Dr Smith for his interest in our study. Dr Smith is correct that our study was an observational study and not an intervention study, that our analyses did not adjust for dietary patterns, and that we used a telephone cognitive assessment. We fully acknowledge the observational nature of our study, which only permits the evaluation of associations and is not causal evidence. We were careful throughout the text to state that we observed strong associations between physical activity and cognitive health and that our findings need confirmation in future studies. However, as Smith and colleagues1(p248) state in the largest meta-analysis of clinical trials of physical activity and cognition to date, randomized controlled trials “are limited by logistical constraints in their ability to sustain interventions over prolonged periods of time.” Thus, our observational study, which has evaluated the association between average physical activity over a year and long-term cognitive decline occurring 3.5 years later among 2809 women, provides important data to address the gap in the clinical trial literature. As for residual confounding by dietary patterns, our main analyses adjusted for alcohol intake, which is a component of both the Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet patterns, as well as multivitamin use, B vitamins, and antioxidant vitamins (vitamin E, vitamin C, and beta carotene). To further address Dr Smith's concerns, we conducted analyses adjusting for Mediterranean diet pattern and observed very little changes from the main analyses. This indicates that healthy diet did not meaningfully confound the association between physical activity and cognitive decline in our study. Finally, we have conducted extensive work that has established the very high validity of our telephone cognitive battery vs traditional in-person techniques. This work is summarized in the article.2 Back to top Article Information Correspondence: Dr Kang, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115 (nhjhk@channing.harvard.edu). Financial Disclosure: None reported. References 1. Smith PJ, Blumenthal JA, Hoffman BM, et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med. 2010;72(3):239-25220223924PubMedGoogle ScholarCrossref 2. Vercambre MN, Grodstein F, Manson JE, Stampfer MJ, Kang JH. Physical activity and cognition in women with vascular conditions. Arch Intern Med. 2011;171(14):1244-125021771894PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 9, 2012

Keywords: physical activity,cognitive impairment

References