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QUEST, 1995,47, 395-410

O 1995 American Academy of Kinesiology and Physical Education

Physical Activity and Cognitive


Function in the Elderly
Waneen W. Spirduso and Lesli A. Asplund
A relationship between physical fitness and cognition, although intuitively believable, has been difficult to document. Bamers to clarifying the relationship
are the difficulties in measuring physical fitness and cognitive function, the use
of differential researchdesigns, and failures to identify and differentiate cognitive
functions as well as to account for cognitive learning. Nevertheless, the fitnesscognition relationship, which continues to be reported and studied, seems compelling. It's precise nature, however, remains to be clarified.

It is not surprising that the study of a relationship between fitness and cognition
has received substantial attention from the scientific community over the past 20
years. Any intervention that could be shown to have potential for maintaining
cognition throughout the aging process would be of great importance. Adequate
cognition is critical for personal function and maintenance of independent living.
Even the most mundane actions, such as making a cup of tea, require effective
cognition. For example, without adequately functioning attention and memory mechanisms, it is not possible to boil water for tea, get the cup and saucer, answer the
telephone, and then remember to return to take the boiling water off the stove and
finish making the tea. Without these abilities, social interactions are also impaired.
In turn, social experiences are important both because they bring pleasure and
increase the quality of life and because they provide an essential component of
some coping strategies that adults may use to deal with the many losses that
accompany aging. An inability to maintain the personal functions necessary for
independent living and social interaction contributes to a loss of self-esteem and
dignity and to the subsequent degradation in quality of life.
Adequate cognitive functioning is also a crucial factor in maintaining reasonable health costs in aging, because cognitive awareness and efficiency are necessary
(but not sufficient)to maintain good health habits and medication schedules. Absence
or deterioration of health habits and medication compliance leads to accidents,
falling, and the concomitant pharmacological and physiological emergencies. It is
no wonder, then, that in addition to learning more about the relationship of health,
fitness, and cognition, as well as the psychophysiology of aging, gerontological
study of these relationships have profound implications for the quality of life of
aging individuals and for the national economy.
Waneen W. Spirduso and Lesli A. Asplund are with the Department of Kinesiology
and Health Education at The University of Texas at Austin, Austin, TX 78712.

SPIRDUSO AND ASPLUND

What Is Cognition?
A prerequisite for understanding the relationship between fitness and cognition
is an understanding of cognition. One way to think about cognition is to describe
it as three functions: cognitive supports, cognitive mechanics, and cognitive pragmatics (see Figure 1).

Cognitive Supports
Basic to all types of complex cognition are processes that may be described
as supports: perceptual processes, information processing speed, working memory,
attention, and psychomotor control. Perceptual processes are procedures such as
coding visual, auditory, proprioceptive, and tactile information. lnformation processing speed is the alacrity with which neural impulses travel from neuron to neuron,
node to node, or neural network to network. The practical importance of fast
processing speed is evident when automobile drivers have to respond quickly to
avoid road hazards or other automobiles. Working memory includes holding percep-

Cognitive P r a p a t i c s
WAIS-R Intelligence
Primary Mental ~ b i l i t i e s ~
(verbal meaning space, reasoning,
number, word fluency)

Health
Absence of Disease Symptoms
Subjective Health Rating
Objective Health Rating

4
Cognitive Mechanics
Memory (verbal, visual, etc.)
Association
Comparison
Abstract Reasoning
Spatial Abiity and Manipulation
Synthesis

Exercise
Acute/Chronic
Frequency
Intensity
Duration

?
Cognitive Supports
Attention (mental energy)
Working Memory
Information Processing Speed
Psychomotor (crossing off; tapping)
Perceptual Processes

Fitness
Type Aerobic, anaerobic
Level - (low, average. high)

Unexamined Aspects of CognitionC


Wisdom
Sagacity
Judgment
Insight
Social cognition

Figure 1 -Components of the proposed relationship among health, fitness, and cognition. Each of the three boxes on the left of the figure contains elements of cognitive
function. The boxes on the right represent various measures of health and fitness. The
arrows represent hypothesized relationships between health, fitness, and cognition.Note.
From Physical Dimensions of Aging (p. 251), by W.W. Spirduso, 1995, Champaign, IL:
Human Kinetics. Copyright 1995 by Human Kinetics. Adapted with permission.

COGNITIVE FUNCTION IN THE ELDERLY

397

tions and memories in contact while operating on them. Unlike short-term or primary
memory, working memory is important because it is considered a large contributing
factor to success in other cognitive tasks (Salthouse, 1991). An example of working
memory is mentally adding or multiplying numbers.
Attention is the process of focusing perceptual-motor systems on specific
stimuli or tasks that are to be accomplished. With some tasks, considerable attention
is necessary for successful execution, whereas other tasks require minimal attention.
Research studies often include dual task assessments, which require high levels of
attention by requiring the participant to attend to two tasks at the same time.
Psychomotor control is essential to communicate the results of cognition, and even in
some cases to enable further cognitive processing on a topic. Psychomotor processing
occurs when motor effectors, such as fingers, eye muscles, throat and lip muscles
are integrated with cognitive mechanics to reflect information processing and to
achieve cognitive pragmatics. An example of how psychomotor control furthers
cognitive comprehension is when individuals draw maps to help others understand
the location of a building, or when they write a word on paper to determine whether
they have spelled it correctly, or when they gesture to assist in verbal communication.

Cognitive Mechanics
Cognitive mechanics along with cognitive pragmatics (described below), was
coined by P.B. Baltes and is described in more detail in his Kleeimyer Award
Lecture presented at the 1992 Gerontological Society of America annual convention
(Baltes, 1993). It is a term others have described asfluid intelligence. Cattell (1963)
explains that fluid intelligence reflects the function of neurological structures, which
begin to decline after neural maturation (adolescence) unless some kind of intervention takes place. Fluid intelligence (or cognitive mechanics) can be collectively
thought of as basic information processing, including cognitive functions such as
speed and accuracy of elementary processing, visual and motor short- and longterm memory, discrimination, comparison, and categorization. Information processing speed is the speed and accuracy with which stages of processing are navigated.
Visual and motor short-term memory is the process of remembering items and
relationships for short periods of time, such as remembering a telephone number
long enough to dial. Long-term memory is the process of retrieving information from
long-term storage. Discrimination,for example, occurs when a driver determines that
a light is green instead of red, and the cognitive process of comparison occurs when
a driver determines that the velocity of an oncoming automobile from the right is
faster than the velocity of an automobile approaching from the left. Categorizing
occurs when people observe a fuzzy, living, moving object and decide that it is a
male, pedigreed, poodle, dog, animal.
Cognitive Pragmatics
Baltes (1993) described cognitive pragmatics as cultural knowledge. Others
have termed this type of cognition crystallized intelligence (Cattell, 1963). It includes
the cognitive functions of reading, writing, language comprehension, educational
qualifications, professional skills, and life skills. When tests of cognitive supports,
mechanics, and pragmatics are combined into test batteries, they are generally called
intelligence tests. In the adult population, the two most commonly used intelligence
tests are the Wechsler Adult Intelligence Scale (Wechsler, 1981) and the IPAT
Culture Fair Intelligence Scale (Cattell, 1957).

SPIRDUSO AND ASPLUND

Aging Effects on Cognition


Baltes (1993) and Cattell (1963) suggest that aging affects discrete types of
cognition differently. Cognitive pragmatics, or intelligence as cultural knowledge,
deteriorates very little throughout the life span (Figure 2). Conversely, cognitive
mechanics, or intelligence as basic information processing, and the cognitive supports, deteriorate substantially in many individuals. Baltes (1993) suggests that to
understand the effects of aging on cognitive mechanics or information processing,
it is necessary to study brain functioning at its boundary conditions, or limits of
capacity. That is why a test of reaction time, which requires individuals to remember
categories or make decisions or comparisons as rapidly as possible, has been a very
successful tool for researchers to study aging.
The limits of capacity hypothesis is comparable to Hasher and Zachs's (1979)
hypothesis that cognitive functions can be placed on a continuum from automatic
to effortful, and that aging degrades effortful cognitive function more than automatic
functions. Tasks that require only automatic functions may be described as selfpaced, single tasks, requiring little or no attention. Completion of these tasks can
occur without awareness, performance is uninfluenced by other cognitive functions,
and these tasks require minimal memory. Conversely, speeded or multitasks, which
require intense attention, are influenced by strategy and imagery, and require high
memory capacity, are categorized as requiring effortful cognition, and are most
affected by aging.

The Fitness-Cognition Relationship Hypothesis


The potential relationship between fitness and cognition has attracted considerable attention over the past 20 years, as is exemplified by the number of review
papers that have been published (Chodzko-Zajko, 1991; Chodzko-Zajko & Moore,
1994; Dustman, Emmerson, & Shearer, 1994; Emery & Blumenthal, 1991; Spirduso,

Performance

70

AGE

Figure 2 -Performance on measures of intelligence as cultural knowledge (pragmatics


or crystallized intelligence) and basic information processing (mechanics, or fluid intelligence, and intellectual support processes) across the life span. Note. Adapted from "The
Aging Mind: Potential and Limits," by P.B. Baltes, 1993, The Gerontologist, 33, p. 582.
Copyright 1993 by The Gerontological Society of America. Adapted with permission.

COGNITIVE FUNCTION IN THE ELDERLY

399

1980; Stelmach & Diewart, 1977; Stones & Kozma, 1988; Thomas, Landers, Salazar, & Etnier, 1993; Toole & Abourezk, 1989; Vercruyssen, Cann, Birren,
McDowd, & Hancock, 1990). Several suggestions regarding the relationship emerged
from these reviews. The most conservative position is that fitness may relate to
cognition in the elderly, but only in the case where fitness is entirely absent, as in
a diseased state. Thus, Emery and Blumenthal (1991) may be willing to agree that
people with severe chronic diseases, such as cardiovascular disease, hypertension,
diabetes, or pulmonw disease would also have some impairment in cognitive
function, but their work has not supported a relationship between high levels of
fitness and increased cognitive function. Another position is that a moderate relationship exists between fitness and cognition, but only for complex rather than simple
functions (Dustman et al., 1994), for effortful versus automatic cognitive functions
(Chodzko-Zajko, 1991; Chodzko-Zajko & Moore, 1994), or for information processing speed rather than functions such as memory (Spirduso, 1980; Thomas et al.,
1993). The most optimistic position is that a low to moderate relationship exists for
many types of cognitive mechanics functions (Stelmach & Diewart, 1977; Toole &
Abourezk, 1989; Vercruyssen et al., 1990).

Difficulties in Determining the Fitness-Cognition Relationship


Although almost 20 years have passed since one of the earliest formalized
studies of the relationship between fitness and a representative of cognitive mechanics-information processing speed-was published (Spirduso, 1975), and in the
interim many additional studies have been conducted, the extent and nature of the
relationship has eluded researchers. Many factors confuse the issue: (a) The different
types of cognition have not been delineated and systematically studied by researchers;
(b) cross-sectional and intervention research designs have produced different findings; (c) cognitive task acquisition has not been clearly established and described;
(d) fitness has been either inadequately measured or differently measured in various
studies; (e) either fitness or cognition has been invalidly measured in most studies;
and (f) the age groups across studies have varied markedly, making generalizations
difficult at best.

Cognitive Type
No attempt has been made within or across studies to delineate whether the
cognitive function being tested is a supportive process, a cognitive mechanic (fluid
intelligence), or a cognitive pragmatic (crystallized intelligence). Thus, it is possible
that some researchers found a fitness+ognitive relationship because their tests
representing "cognition" were loaded more heavily on a cognitive type that is more
related to fitness. This issue has not been resolved.

Research Designs
The findings from cross-sectional studies tend to be supportive of the fitnesscognition relationship, whereas those from intervention studies tend not to support
the relationship (Chodzko-Zajko & Moore, 1994; Dustman et al., 1994; Spirduso,
1975). It is probable that a major explanation for these differences is that the fitness levels of participants in these two types of studies are very different. Adults
who participate in cross-sectional studies are very different in V0,max than those who

SPIRDUSO AND ASPLUND

-----------

60 k ~ a s t e r Athletes
s

HkhlgFit-Life-style
- - - - Exercisers
.
0

Pse

Post

Figure 3 -Comparison of master athletes and highly fit lifestyle exercisers to older
sedentary adults at pre- and postassessment for five well-controlled intervention studies
ranging from 4 to 18 months (Blumenthal et al., 1989; Dustman et al., 1984; Hassmen,
Ceci, & Backman, 1992; Hill, Storandt, & Malley, 1993; Panton, Graves, Pollock,
Hagberg, & Chen, 1990).
begin intervention studies. As Figure 3 shows, average ~ 0 , m a xvalues of those
who generally participate in cross-sectional studies of .highly fit versus sedentary
adults average about 45 ml . kg-' . min-', whereas the V0,max of sedentary adults
averages about 22.41 ml . kg-' . min-I. Conversely, when sedentary adults initiate
an exercise program, although they gain on average about 19% in V02max, they
are still well below the values typical for highly fit life-style exercisers. Thus,
researchers employing cross-sectional and intervention designs compare participants
with dramatically different levels of fitness.

Cognitive Task Acquisition


In some cognitive tasks, performance can be improved remarkably by practice.
In others, practice has no effect. Almost no attention has been given to this aspect
of differences across studies of the fitness-cognition relationship. Reaction time
(RT) is an example of an information processing task that can be greatly improved
by practice. For many adults, improvement continues throughout several days
(Clarkson & Kroll, 1978; Spirduso, MacRae, MacRae, Prewitt, & Osbome, 1988).
Thus, investigators who provided participants with very few RT trials were acquiring
evidence of participants' information processing speed at varying points along their
acquisition curve. In intervention studies, the posttests were contaminated by the
degree of retention that occurred, and little is known about aging effects on retention
of unlearned tasks.

Fitness Measurement
Just as cognition has been inadequately defined and measured in many studies
of this topic, so has the measurement of fitness been differently, and in almost all
cases, inadequately measured. As shown in Figure 1, several aspects of fitness must

COGNITIVE FUNCTION IN THE ELDERLY

40 1

be considered when studying the fitness-cognition relationship. The top right side
box in Figure 1 includes three measures of health that have been used in studies of
health and cognition: a self-report of disease history, a rating by the participant of
his or her own health, and a physician or health professional's rating of the participant.
The second box indicates that when exercise is to be related in some way to cognition,
the dimensions of acute/chronic, frequency, intensity, and duration of the exercise
must be included. The third box indicates that the factors of type of exercise (aerobic
or anaerobic), and the level of fitness (low, average, or high) must also be considered
when studying the fitness-cognition relationship.
The measurement of fitness in these studies can be placed in three categories:
self-report of fitness activities, cardiorespiratory assessment, or physical or physiological assessment. Researchers depending on self-report for their assessment of
fitness have generally asked their participants what type of exercise they do, the
number of years they have been doing it, and the frequency, duration, and intensity
of the exercise. From this, some investigators have calculated the METs (kilocalories
per week) or have placed the participants on some type of activity-level ordinal
scale. Self-report as a measurement suffers from invalidity and from participants'
biases. Thus, it is likely that many errors in fitness assessment were made in these
studies.
Studies that fall into the cardiorespiratory assessment category are those in
which ~ 0 , m a xor submax is directly measured, or a stress test is administered to
estimate ~ 0 ~ m aInx some
.
studies, a step test has been employed to estimate fitness.
Measuring oxygen consumption in older adults, although accepted as the best single
measure of fitness, is fraught with problems. First, most adults over the age of 60
are not able to complete a ~ 0 , m a xor stress test. Thus, the estimates are not
accurate. Second, even if they do complete the test, ~ 0 , m a xhas a substantial genetic
component. Third, ~ 0 , m a xdoes not continue to increase in parallel with increased
training and increased aerobic performance.
The third category includes those studies in which physical assessments are
measured or calculated (stature, weight, and body mass index) or in which other
physiological measures are taken, such as heart rate, systolic and diastolic blood
pressure, blood lipids, blood glucose, or pulmonary function at rest. Chodzko-Zajko
and Ringel (1987) have statistically combined these into an Index of Physiological
Status (IPS), which they found to be more predictive of cognitive function than a
single measure of ~ 0 , m a x .

Balance of Fitness-Cognition Measurement


Yet another source of error in fitness-cognition studies is that fitness and
cognition have not been measured with equal rigor. These fitness-cognition relationship studies tend to be directed either by exercise physiologists or psychologists.
When exercise physiologists are principal investigators, the measurements of fitness
tend to be rigorous, sophisticated, and comprehensive. The measurements of cognition-in terms of validity, reliability, and logic-are less well planned and administered. Conversely, in studies by psychologists, the cognitive measurements are
exquisite, and the fitness measures are sketchy and poorly planned. Consequently,
most studies of this genre are unbalanced in the treatment of the two major variables,
an imbalance that limits the usefulness of the conclusions.

402

SPIRDUSO AND ASPLUND

Age Groups
A final complicating design factor that undermines the conclusiveness of
studies on this topic is the great disparity of ages within groups labeled young and
old, as shown in Figure 4. In almost all cross-sectional studies, the age range is not
equal in the young and old groups. In some studies, the old group ranges in age
from 50 to 75 or 80, a grouping that clusters individuals of very different abilities.
Similarly, in three of these studies, the young group includes participants from 20
to 55, whereas the old groups include participants from 60 or 70 to 80. Not one of
the cross-sectional studies has equivalent age ranges and sufficiently old participants.
In general, the old participants in intervention studies are older than those in
cross-sectional studies. In Figure 5, only the exercise group ages are shown; control
groups were comparable ages, but are not shown. Many of these studies also included
groups with age ranges that were much too large.

Current Status of the Fitness-Cognition Relationship


Clearly, the complexity of the subject and the multitude of confounding factors
indicate that the state of this topic is not ready for a formal meta-analysis. The
studies that have been completed thus far are too few, too mixed in design and
variables, and too varied in terms of ages and genders studied. In order to make
some sense out of the area, and to provide some information regarding the relationship between fitness and cognition, however, studies can be categorized on some
factors and then compared in terms of whether they found or did not find a statistically
significant relationship between fitness and cognition. We deliberately did not do

Total Group
Young Group
Old Group

Figure 4 - Age ranges of participants for 19 cross-sectional studies assessing cognitive


function related to fitness. The Total Group category represents single-group studies.
The other studies described young and old groups, as designated in the legend. Studies
represented include Baylor and Spirduso (1988); Chodzko-Zajko, Schuler, Solomon,
Heinl, and Ellis (1992); Chodzko-Zajkoand Ringel (1987); Clarkson (1978); ClarksonSmith and Hartley (1989, 1990); Dustman et al. (1990); Elsayed, Ismail, and Young
(1980); Emmerson, Dustman, Shearer, and Turner (1990); Era, Jokela, and Heikkinen
(1986); Era, Parssinen, and Suominen (1991); Kroll and Clarkson (1978); Offenbach,
Chodzko-Zajko,and Ringel (1990); Powell and Pohndorf (1971); Shay and Roth (1992);
Sherwood and Selder (1979); Spirduso (1975); Spirduso and Clifford (1978); Spirduso,
MacRae, MacRae, Prewitt, and Osborne (1988).

COGNITIVE FUNCTION IN THE ELDERLY

10 20 30 40 50 60 70 80 90 100

H Exercise Group

Figure 5 -Age ranges and means of participants for 18 intervention studies assessing
the effects of exercise on cognitive function. Only the exercise group age ranges are
shown here, as the control or nonexercise group ages had similar ranges. Studies represented include Barry, Steinmetz, Page, and Rodahl (1966); Blumenthal et al. (1989);
Blumenthal and Madden (1988); Dustman et al. (1984); Elsayed, Ismail, and Young
(1980); Emery and Gatz (1990); Hassmen, Ceci, and Backman (1992); Hawkins, Kramer,
and Capaldi (1992); Hill, Storandt, and Malley (1993); Ismail and El-Nagger (1981);
Madden, Blumenthal, Allen, and Emery (1989); Molloy, Richardson, and Crilly (1988);
Panton, Graves, Pollock, Hagberg, and Chen (1990); Pierce, Madden, Siegel, and Blumenthal (1993); Rikli and Busch (1986); Rikli and Edwards (1991); Roberts (1990);
VanFraechem and VanFraechem (1977).

a meta-analysis or any type of statistical analysis of category differences that we


found because we do not wish to attribute the kind of importance that statistical
quantification can confer to the observations that we made in this very complicated
area of study.

Analysis Categories
Thirty-eight research reports were studied and were sorted according to the
following categories: type of cognition (support, function, or combinedlindex
scores), research design (cross-sectional,intervention), task acquisition status (practiced, unpracticed), and assessment of fitness (self-report, aerobic capacity measurement or estimate, or physiological assessment). The total number of statistical tests
that we used from these studies was 296; that is, in some studies several statistical
tests--either t tests, F tests, or tests of correlational significance-were made of
several variables, (e.g., simple reaction time, choice reaction time, and the Stroop
test of attention). Thus, the dependent variable of our analysis was the percentage
of significant statistical tests found for each category.

Fitness Category DifSerences


The percentage of significant statistical tests of cognitive differences between
fit and sedentary adults was different, depending upon how fitness was measured.
The differences are shown in Figure 6. The first observation that can be made is
that in all types of studies, more than one third of the tests of relationships were
significant. The relationships were greater (75%),however, in those studies in which
self-report of fitness was used and were least in those studies in which V0,max
was directly or indirectly measured. I n most cases, direct measurement of V0,max

SPIRDUSO AND ASPLUND

Percent of
Significant
Tests

Self-report

V02

Physiological

Measure of Fitness
Figure 6 - Percentages of significant statistical tests of cognitive differences between
fit and sedentary older adults in studies determining level of fitness through self-report,
V02max, and physiological measures.

Cross-sectional

Intervention

Research Design
Figure 7 - Percentages of significant statistical tests of cognitive differences between
fit and sedentary older adults for 22 cross-sectional and 17 intervention research design
studies.

occurred in intervention studies, whereas self-report occurred in cross-sectional


studies. This large difference may very well reflect the great difference in characteristics of fit and sedentary adults in these different types of studies, but it may also
reveal that VOz assessment does not measure those exercise-relatedfitness, physical,
or physiological characteristics most related to cognition.
The difference between cross-sectional and intervention designs is clearly
shown in Figure 7. These differences are enhanced because participants in exercise
groups also tend to have better health habits, to have a genetic predisposition to
optimize all aspects of their lives, and to self-select themselves into studies that

COGNITIVE FUNCTION IN THE ELDERLY

Practiced

405

Unpracticed

Figure 8 - Percentages of significant statistical tests of cognitive differences between


fit and sedentary older adults for practiced and unpracticed testing conditions.

offer tests related to health and physical prowess. The intervention studies have
tended to have severe sampling problems, poor cognitive assessment, inadequate
practice provided, and participants with low fitness levels.
Practice is a factor that complicates the issue (see Figure 8). In more than
half of the studies in which performance (practiced) rather than learning (unpracticed)
was assessed, fitness was shown to relate to some aspect of cognition.
Finally, when only those studies that were categorized as being the most
rigorous in terms of an idealized experimental design (directly testing fitness level,
using an intervention design, and providing practice) were compared to those categorized as least rigorous (self report for level of fitness, using a cross-sectional design,
and not providing practice), a huge difference was seen in the percentage of significant statistical tests of the fitness-cognition relationship (Figure 9). This result might
be interpreted to mean that when participants are categorized as "exercisers," and
no statistical disassociation from related behaviors is conducted, the exercise variable
has a much larger component of other related variables in it, such as abstinence
from smoking, abstinence from drinking, adequate sleep, high socioeconomic status,
high education level, and other optimizing factors.

Cognitive Functions and Fitness


In Figure 10, the percentages of significant statistical tests found are shown
for each cognitive function. Because some types of cognitive function were tested
by the researchers many more times and in more studies, the percentages shown at
the end of each bar cannot be interpreted without also noting the thickness of the
bar. Those functions such as psychomotor ability and attention were tested more
times (65 to 90 tests) than others. Comparing the percentages while simultaneously
considering the number of tests made suggests that cognitive supports such as speed
of processing, psychomotor control, attention, and perceptual processing are related
to physical fitness. Cognitive mechanics such as spatial manipulation and abstract
reasoning may also be related.

SPIRDUSO AND ASPLUND

Percent of 60
Significant
40
Tests

Least Rigorous

Most Rigorous

Research Design
Figure 9 -Percentages of significant statistical tests of cognitive differences between
fit and sedentary older adults for the least and most rigorous research design.

Abstract
Reasoning
Speed
Spatial

50%

Intelligence

150%

Psychomotor
Attention
Working
Memory
Perceptual

Number of Tests
5-10
37%
as-d/

Memory

65-90

Figure 10 - Percentages and numbers of significant statistical tests of cognitive differences between fit and sedentary older adults in 17 intervention and 22 cross-sectional
studies for nine components of cognition.

Conclusions
An analysis of the literature on fitness and cognition suggests that researchers'
understanding of this topic is not as clear as is desired. In the past 20 years this
issue has been addressed by many investigators, but the relationship of specific
cognitive functions to specific measures of fitness has not been high. Yet, although
these relationships have not been robust, they continuously appear. A minimum of

COGNmVE FUNCTION IN THE ELDERLY

407

one third of the statistical tests analyzed among the many research reports supported
a relationship between fitness and cognition, a fraction too high to occur bychance
alone. Correlation coefficients between fitness+ognitive measurements are not zero,
they are usually low to moderate. There have also been human studies in which the
effect of exercise on brain mechanisms has shown positive effects that support a
fitness-cognition relationship. These studies include evidence that exercise significantly changes cerebral blood flow (Hedlund, Nylin, & Regnstrdm, 1962; Kleinerman & Sokoloff, 1953; Thomas, Schroeder, Secher, & Mitchell, 1989). In animal
studies, significant exercise-related changes have been seen in increased blood flow
to the motor-sensory cerebral cortex (Gross, Marcus, & Heistad, 1980), increases
brain capillaries (Black, Isaacs, & Greenough, 1991), and effects on brain neurotransmitter function (Brown et al., 1979; Fordyce & Farrar, 1991a, 1991b; Gilliam et
al., 1984; MacRae, Spirduso, Walters, Farrar, & Wilcox, 1987).
Part of the failure to find a robust relationship may be due to serious and
plentiful errors and inadequacies in the research designs and measures employed
to test these relationships in humans. But part of the failure may also be due to the
prospect that the contribution of exercise alone is insufficient to maintain cognitive
function throughout aging. Rather, it may be that it is the constellation of good
health habits, exercise, and high socioeconomic and educational status that are
robustly related to cognition in the elderly.

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