THE ARISING · Longevity & Healthspan
Low Activity Plus Weak Grip Linked to Higher Cognitive Impairment Risk
Adults who stayed both physically inactive and physically weak over several years were more likely to develop cognitive impairment later, according to a large study of older adults in the United States, China and South Korea.
This is an observational study in people, published in 2026 in the International Journal of Behavioral Nutrition and Physical Activity. Researchers analysed data from 11,381 adults aged 50 and older. All were free of cognitive impairment and daily-living disability at the start. Observational work can show that two things go together. It cannot show that one causes the other.
The data came from three national aging studies: the Health and Retirement Study in the US, the China Health and Retirement Longitudinal Study, and the Korean Longitudinal Study of Aging. The team tracked each person's physical activity and grip strength together across three survey waves. Grip strength is a common, simple measure of muscle strength. The researchers then grouped people by how both measures changed over time.
After those three waves, the team followed participants for 6 to 10 years to see who developed cognitive impairment. In total, 4,068 people did. To reduce the chance that early illness was driving the results, the researchers excluded anyone with cognitive impairment during the tracking period, or with daily-living disability at the first wave.
The comparison was between two groups. One had persistently high activity and high strength. The other had persistently low activity and low strength. The low-low group had a higher risk of cognitive impairment in every cohort. The hazard ratio was 1.41 in the US data (95% confidence interval 1.20 to 1.66). It was 1.26 in China (1.03 to 1.53) and 1.22 in South Korea (1.02 to 1.46). A hazard ratio compares how quickly new cases appear in one group versus another. So these figures translate to roughly 22% to 41% higher risk.
The authors say the pattern was directionally similar when they used other statistical approaches. These included a method that accounts for people dying of other causes first. However, they note that some secondary estimates differed across models and subgroups.
The team also tested machine learning models to see whether the activity and strength pattern could help predict who would develop cognitive impairment. The combined trajectory ranked as an important feature in those models. But the authors describe this work as exploratory. Prediction accuracy was only moderate, and it was lower on held-out validation data than on the data used to build the models.
For you
What does this mean for personal health? The study looked at activity and strength together, and the risk showed up when both stayed low. It did not test whether starting strength training or becoming more active changes brain outcomes. It also cannot rule out that other factors explain the link. The authors conclude only that the findings support further investigation of these combined patterns as possible markers of cognitive risk in aging populations.
According to the journal page, the work was funded by the National Natural Science Foundation of China and the China Postdoctoral Foundation. The authors declared no competing interests, and the funders had no role in the study.
What to watch next
Studies that test whether raising activity and muscle strength together actually lowers later cognitive risk, and whether the prediction models hold up in new groups of people.
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