Associations between local area deprivation and physical activity in cognitively impaired people: an accelerometry study.

Abstract

Empowering people with cognitive impairment (PwCI) to maintain physical activity (PA) supports functional independence. PwCI participate in less PA than recommended; disease-specific factors (e.g. cognitive changes) do not sufficiently explain this. In older adults, most habitual PA takes place in the home or local neighbourhoods. Targeting PA in both the home and local community may be more impactful than creating external opportunities (e.g. exercise classes). Regular participation in PA requires time, money, security, and access. Area deprivation may contribute to inequalities in PA participation through environmental factors; less deprived areas may have safer walkable routes and more immediate socialisation opportunities which support PA. Understanding the complex relationship between local area deprivation and PA may support personalised care for PwCI. We aimed to explore associations between local area deprivation in the North East of England and PA in PwCI and cognitively-intact older adults (controls). We recruited 82 PwCI (mild cognitive impairment, dementia) and 26 controls. Daily step count was measured using an accelerometer worn on the lower back continuously for seven days. We derived mean daily step counts for each individual day. Individuals' neighbourhoods were linked to UK government area deprivation statistics. Hierarchical Bayesian models assessed the association between area deprivation and daily step count in PwD and healthy older adults. Preliminary results indicated that greater area deprivation is associated with lower daily steps for cognitively-healthy older adults (12,308 (8,302-19,111) steps/day for controls in least deprived areas, vs 9,349 (5,178-17,444) steps/day in most deprived areas), but not for PwCI (9,018 (7,042-11,565) steps/day for PwCI in least deprived areas vs 9,124 (6,553-12,435) steps/day in most deprived areas), who had consistently low step counts across neighbourhoods (Figure 1). Cognitive impairment may impose a barrier to maintenance of habitual PA which supersedes the positive or negative influences of area deprivation on PA in cognitively healthy older adults. Findings are limited by lack of regional diversity and statistical power; further research should examine area deprivation across the whole of the UK to ensure accurate representation of area deprivation. PA interventions should consider multiple socio-ecological factors, including personal, organisational, environmental and policy-related components.