Physical activity showed an L-shaped association with cognitive impairment among Chinese adults with hearing loss, and participants following an unstable rise-then-fall activity pattern had lower cognitive function than those with a slight decline pattern.
Key Findings
Results
Physical activity demonstrated an L-shaped dose-response relationship with cognitive impairment among adults with self-reported hearing loss.
The L-shaped relationship suggests that initial increases in physical activity are associated with meaningful reductions in cognitive impairment risk, but benefits plateau at higher activity levels.
Physical activity was assessed biennially using the International Physical Activity Questionnaire and expressed as metabolic equivalent minutes per week.
The sample included 2055 adults aged ≥ 45 years with hearing difficulties and normal cognition at baseline from the China Health and Retirement Longitudinal Study (2011-2020).
Results
Three distinct long-term physical activity trajectories were identified among adults with self-reported hearing loss.
The three trajectories were: slight decline (70.61% of participants), sharp drop (15.28% of participants), and rise-then-fall (14.11% of participants).
Trajectories were identified using group-based trajectory modeling with physical activity data collected biennially over the 9-year study period (2011-2020).
The slight decline trajectory was the most common, comprising nearly three-quarters of the sample.
Results
Participants following a rise-then-fall physical activity trajectory had significantly lower global cognition and mental status scores compared to those in the slight-decline group.
The rise-then-fall group had lower global cognition scores (β = -0.621, 95% CI -1.022 to -0.219) compared to the slight-decline group.
The rise-then-fall group also had lower mental status scores (β = -0.449, 95% CI -0.648 to -0.249) compared to the slight-decline group.
Cognitive function in 2020 was measured by validated tests of episodic memory and mental status with a range of 0-21.
Associations were examined using multiple linear regression.
Results
The rise-then-fall physical activity trajectory was more prevalent among specific demographic and behavioral subgroups.
This trajectory was more common among men, younger rural residents, frequent drinkers, non-nappers, and those with depressive symptoms.
These characteristics suggest that the rise-then-fall pattern may reflect difficulty sustaining behavioral changes in certain social and psychological contexts.
No specific prevalence percentages within subgroups were reported in the abstract.
Results
No significant difference in cognitive outcomes was found between the sharp-drop trajectory group and the slight-decline reference group.
Only the rise-then-fall group, not the sharp-drop group, showed statistically significant associations with lower cognitive function compared to the slight-decline group.
This suggests that the pattern of physical activity change—particularly an unstable increase followed by decline—may be more relevant to cognitive outcomes than a steady decline alone.
The sharp-drop group comprised 15.28% of participants.
Methods
The study population consisted of middle-aged and older Chinese adults with self-reported hearing difficulties who had normal cognition at baseline.
The study drew from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2020, a 9-year longitudinal period.
The sample included 2055 adults aged ≥ 45 years.
Inclusion required self-reported hearing difficulties and normal cognition at baseline in 2011.
Physical activity was assessed biennially across multiple waves of data collection.
What This Means
This research suggests that among middle-aged and older Chinese adults who have difficulty hearing, the pattern of physical activity over time matters for brain health. Using nearly a decade of data from a large national study, researchers found that physical activity has an 'L-shaped' relationship with cognitive impairment risk—meaning that some activity is much better than none, but extremely high amounts don't provide proportionally greater benefit. They also identified three distinct patterns of how people's activity levels changed over 9 years: most people showed a gradual slight decline, some had a sharp drop, and a smaller group initially increased their activity before eventually falling back down.
The most notable finding was that people whose physical activity rose and then fell—an unstable pattern—ended up with measurably lower scores on tests of memory and mental function compared to those who simply declined gradually. This unstable pattern was more common among men, younger rural residents, people who drank frequently, those who didn't nap, and those with depressive symptoms, suggesting that social and psychological factors may make it harder for some people to maintain consistent activity habits. Interestingly, even those who had a sharp drop in activity did not show significantly worse cognitive outcomes than the gradual decline group, pointing to the particular harm associated with inconsistent engagement.
This research suggests that for people with hearing loss—a group already at elevated risk for cognitive decline—sustaining a consistent level of physical activity over the long term may be more important than achieving short-term peaks in activity. The findings highlight the need for programs that help people with hearing difficulties build and maintain regular physical activity habits, rather than focusing only on increasing activity intensity or volume in the short run.
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Li X, Tang Y, Qiu R, Zhang C, Zhao Y, Feng H, et al.. (2026). Physical Activity and Cognitive Function Among Chinese Adults Aged 45 Years and Older with Self-Reported Hearing Loss: A 9-Year Longitudinal Study.. Brain and behavior. https://doi.org/10.1002/brb3.71646