Initial Status and Change in Cognitive Function Mediate the Association Between Academic Education and Physical Activity in Adults Over 50 Years of Age

Higher levels of academic education are associated with higher levels of physical activity throughout the lifespan. However, the mechanisms underlying this association are unclear. Cognitive functioning is a potential mediator of this association because higher levels of education are associated with better cognitive function, which is related to greater engagement in physical activity. Here, we used large-scale longitudinal data from 105,939 adults 50 years of age or older (55% women) from the Survey of Health, Ageing, and Retirement in Europe to investigate whether initial status and change in cognitive function mediate the relationship between education and change in physical activity. Education and physical activity were self-reported. Cognitive function was assessed based on delayed recall and verbal fluency. Academic education was assessed at the first measurement occasion. The other measures were collected seven times between 2004 and 2019. The mediating role of cognitive function was tested using longitudinal mediation analyses combined with growth curve models. We found that higher levels of education were associated with higher levels and slower decreases in cognitive function, which in turn predicted a lower decrease in physical activity across time. These results support the presence of an indirect effect of education on physical activity trajectories by affecting the intercept and slope of cognitive function. Specifically, these findings suggest that both the initial status and change in cognitive function mediate the association between academic education and change in physical activity. In addition, results revealed that, across the aging process, differences in cognitive function and physical activity widen between the low and high educated. In other words, this study demonstrates the long-lasting effect of education on cognitive function and physical activity. Public Significance Statement The beneficial effects of education on cognition and physical activity are well-replicated. Yet, little is known about the mechanisms underlying these associations. Based on a large-scale longitudinal European study in adults aged 50 years or older, we show that both the initial status of cognitive function and its change underpin the relationship between education and physical activity across time. Our results shed light on education that engenders positive trajectories of cognition that in turn impact physical activity. These findings highlight the lon