Mediation role of estimated pulse wave velocity in the association between physical activity and cognitive function

This study aimed to clarify the mediating role of arterial stiffness, measured as estimated pulse wave velocity (ePWV), in the relationship between physical activity levels and cognitive function in older adults. Data from the National Health and Nutrition Examination Survey from 2011 to 2014 were analyzed. ePWV was calculated using age and mean blood pressure. Survey-weighted logistic regression and subgroup analyses were conducted to explore the associations between physical activity and cognitive function. Additionally, receiver operating characteristic curve analysis assessed the predictive value of ePWV for cognitive impairment. Mediation analysis was used to determine whether ePWV mediates the relationship between physical activity and cognitive function. A total of 1802 participants aged 60 years or older were included in the study. Higher physical activity levels were significantly associated with better cognitive function after adjusting for confounders (OR: 1.517, 95% CI: 1.010-2.280, P = .046). Subgroup analyses confirmed a consistent positive association across most covariates. Receiver operating characteristic curve analysis showed that ePWV had moderate predictive value for cognitive impairment (area under the curve: 0.678, 95% CI: 0.647-0.709). Mediation analysis revealed that ePWV partially mediated the relationship between physical activity and cognitive impairment, with a total effect of 0.031, a mediated effect of 0.006, and a proportion mediated of 19.35%. Higher physical activity levels are associated with better cognitive function in older adults. Estimated pulse wave velocity plays a mediating role in this association, suggesting that arterial stiffness may be an important pathway through which physical activity benefits cognitive health.