OBJECTIVE:While risky driving behaviors and unhealthy lifestyle behaviors both have deleterious consequences, they are rarely targeted jointly. The present study examines the associations between risky driving behaviors, health-related behaviors, and cardiometabolic risk factors among adults over time. METHODS:Longitudinal examination of 17,846 adults who attended a preventive medicine clinic (Dallas, TX) at least twice (1988-2024). The primary independent variables were risky driving behaviors: not wearing a seat belt, driving after drinking alcohol, angry driving, and speeding, as well as an overall score (0-4). The dependent variables were current smoking, alcohol intake, cardiorespiratory fitness levels, and cardiometabolic risk factors. The relationships were examined using a hybrid model, which accounted for both between- and within-person variations. RESULTS:The average age of participants at baseline was 46.4 years (SD = 8.7), three-quarters (75.2%) were men, and 84.6% were college-educated. Examining variation between participants, a 1-point higher risky driving behavior total score was associated with 2.89 (95%CI 2.52, 3.33) times higher odds for current smoking, 1.61 (95%CI 1.53, 1.70) times higher odds for greater alcohol intake, and 10.0% lower odds for higher fitness (OR = 0.90; 95%CI 0.85, 0.94). Additionally, a higher total risky driving behaviors score was related to elevated cardiometabolic risk factors, such as elevated waist circumference (OR = 1.73; 95%CI 1.51, 1.97) and glucose (OR = 1.20; 95%CI 1.11, 1.30). In a within-person examination, a 1-point increase in the total risky driving behaviors score was associated with increased alcohol intake (OR = 1.09; 95%CI 1.07, 1.11), and elevated glucose (OR = 1.07; 95%CI 1.02, 1.12). When examining risky driving behaviors, not wearing a seatbelt and driving after drinking were related to three dependent variables in the within-person analyses. For example, an increase in driving after drinking was associated with increased smoking (OR = 1.26; 95%CI 1.05, 1.52), increased alcohol intake (OR = 1.51; 95%CI 1.43, 1.59), and increased glucose (OR = 1.28; 95%CI 1.15, 1.42). CONCLUSIONS:Findings indicate that risky driving behaviors may accompany broader risk-taking tendencies across domains. Future research is warranted to determine whether targeting underlying psychological constructs can lead to improvements in both domains.

PURPOSE:Examine the relationship between physical activity (PA) characteristics and depressive symptoms among community-dwelling adults. METHODS:The study consisted of 38,946 participants (n = 26,378 men, n = 12,568 women) who completed a 10-item depression screening assessment, the Center for Epidemiologic Studies Depression Scale (CES-D), and reported PA within the prior 3 months as part of a preventive exam. Intensity of PA reported in metabolic equivalent of task (METs) was assigned based on activity using the Compendium of Physical Activities. Weekly PA volume (MET·min per wk) was calculated as the product of product of intensity (METs) and weekly duration (min per wk) summed across reported activities. Leading type (participants' predominant activity) was classified as aerobic, strength, mixed-endurance (e.g., circuit/interval training, basketball, racket sports, etc.), and flexibility. Diversity of activity was calculated based on Shannon's diversity index using binary logarithms on the proportions of time spent in each reported activity. Depressive symptoms were determined by a CES-D score ≥10. Adjusted odds ratios and 95% confidence intervals were estimated using logistic regression to assess the association between PA characteristics and depression symptoms by sex, adjusted for age, current smoking, alcohol intake, body mass index, glucose, cholesterol, and systolic blood pressure. RESULTS:The mean age ± SD for women and men was 48.3 ± 10.8 and 49 ± 10.1 years, respectively. CES-D score ≥10 was present in 15.4% of women and 9.1% of men. Risk of depressive symptoms was inversely related to all PA characteristics individually and to average intensity and diversity of activity when all PA variables were modeled together. CONCLUSIONS:While all measured PA characteristics were associated with reduced odds of depressive symptoms, the most significant associations were observed for PA intensity and diversity. As such, engaging in a variety of activities, some of which are high-intensity, may be associated with lower odds of depressive symptoms.

OBJECTIVE To examine the association between glucagon-like peptide-1 receptor agonist (GLP-1RA) use and alcohol intake in a large cohort of outpatient adults who currently drink. PATIENTS AND METHODS We conducted a retrospective analysis of 11,258 participants seen at the Cooper Clinic (Dallas, Texas) from January 2, 2008, to July 22, 2024, comparing changes in self-reported weekly alcohol intake between adults who were initiated on a GLP-1RA (n =256) versus a control group (n =11,002) that did not receive a GLP-1RA. A linear mixed-effects model was used to estimate changes in alcohol intake, adjusting for time between visits, age, sex, glucose level, and weight. RESULTS The GLP-1RA treatment group had a greater reduction in weekly alcohol intake than the control group (−1.0 drinks/week; 95% CI −1.6 to −0.4; P =.002), which became non-significant after adjusting for weight change (P =.10). CONCLUSIONS GLP-1RA treatment was associated with a reduction in alcohol intake. This effect was attenuated when controlling for weight loss. The findings suggest a reduction in alcohol use with GLP-1RAs that was related to a reduction in weight.

Background Higher cardiorespiratory fitness (CRF) is associated with a lower risk for chronic disease and death, but its relation to healthy aging more broadly remains understudied. Objectives The aim of this study was to examine the associations between midlife CRF and later life health span (years without major chronic disease), disease burden, and lifespan among adults who remained apparently healthy through 65 years of age. Methods This cohort study included 24,576 participants (25% women) from the CCLS (Cooper Center Longitudinal Study) (1971-2017) linked to Medicare administrative claims (1999-2019). CRF was estimated using a maximal treadmill test at a preventive medicine clinic visit before age 65 years. Eleven major chronic conditions were identified from the Medicare Chronic Conditions Data Warehouse and used to define disease as: 1) any of the 11 conditions (composite); 2) any condition within a clinical group (cardiovascular, cardiovascular-kidney-metabolic, cancer); or 3) an individual condition. Multivariable illness-death models estimated the likelihood of transitioning between health, disease, and death by CRF level (low, moderate, or high). Model parameters were used to calculate adjusted Aalen-Johansen probabilities and expected times in each state of health, disease, and death; these were then used to calculate expected health span, number of diseases, disease-years, and lifespan by CRF. Results When disease was defined as any of 11 major chronic conditions, high-fit men had a 2% (95% CI: 1%-2%) longer health span, 9% (95% CI: 1%-17%) fewer diseases, and a 3% (95% CI: 2%-4%) longer lifespan compared with low-fit men, with similar patterns among women. When disease was clinically grouped, higher fit men and women generally had a later onset of cardiovascular, cardiovascular-kidney-metabolic, and cancer outcomes and developed fewer conditions within each group. On average, the onset of each of the 11 chronic conditions occurred at least 1.5 years later among high-fit men and women compared with low-fit individuals. Results were consistent across clinical subgroups defined by clinic visit year (before or after 1990), age (younger or older than 45 years), smoking status (current smoking, nonsmoking, or missing smoking), and weight status according to body mass index (healthy weight and overweight or obese). Conclusions Higher midlife CRF was associated with longer health span, lower multimorbidity, and longer lifespan among men and women.

Background Cardiorespiratory fitness (CRF) and coronary artery calcium (CAC) are established cardiovascular risk markers reflecting physiological reserve and subclinical atherosclerosis, respectively. Their independent and joint associations with dementia remain unclear. Objectives We examined mid-to-late midlife CRF and CAC in relation to later-life dementia within a large U.S. cohort. Methods Participants in the Cooper Center Longitudinal Study (1998-2018) were linked to Medicare claims (1999-2019). CRF was estimated via maximal treadmill testing (categorized as age- and sex-specific low, moderate, or high); CAC was categorized as <100 vs ≥100 Agatston units. Incident all-cause dementia was identified via Medicare surveillance. Parametric illness-death models estimated HRs for dementia, accounting for competing mortality and adjusting for demographic, behavioral, and cardiometabolic risk factors, with mutual adjustment for CRF and CAC. Results Among 10,933 participants free of cardiovascular disease and dementia at baseline (mean age 57.2 years; 30.2% women), 868 dementia cases occurred over a median follow-up of 5.8 years. After multivariable adjustment, high CRF (vs low) was associated with a lower dementia risk (HR: 0.69; 95% CI: 0.53-0.90), whereas CAC ≥100 (vs <100) was associated with a higher risk (HR: 1.24; 95% CI: 1.07-1.44). Continuous analyses demonstrated a linear inverse association for CRF and a graded positive association for CAC. No interaction between CRF and CAC was observed. Conclusions Lower CRF and higher CAC are independently associated with incident dementia. These findings support complementary, nonoverlapping roles of functional fitness and cumulative vascular injury in dementia pathogenesis, highlighting the importance of lifelong cardiovascular health.

BACKGROUND:High-volume physical activity (PA) is associated with a higher prevalence of subclinical coronary artery disease (CAD). However, the clinical significance of subclinical CAD among high-volume exercisers remains incompletely understood, and the dose-response relationship between high-volume PA and clinical CAD events remains uncertain. METHODS:Individual participant data from the Cooper Center Longitudinal Study (1987-2018) were linked to Medicare claims files. PA volume was determined by self-report and categorized as <500, 500 to 1499, 1500 to 2999, and ≥3000 metabolic equivalent of task (MET)-minutes per week. Subclinical CAD (coronary artery calcium [CAC]) was measured by cardiac computed tomography. All other risk factors were measured in the standard fashion. Composite CAD events (acute myocardial infarction and revascularization) and all-cause mortality were determined from Medicare claims files. A multivariable-adjusted proportional hazards illness-death model with random shared frailty was used to estimate the association between PA volume, CAC, and both clinical CAD and death. Heterogeneity in the association between CAC and clinical CAD across levels of PA was determined with multiplicative interaction terms. RESULTS:We included 26 724 participants (54 years of age; 28% women). Mean exercise volume was 1130 MET-minutes per week, with 1997 (7.5%) reporting ≥3000 MET-minutes per week. After a mean follow-up of 20.5 years, we observed 811 acute myocardial infarction events, 1636 composite CAD events, and 2857 deaths without CAD. Compared with individuals exercising <500 MET-minutes per week, the lowest risk for acute myocardial infarction occurred among individuals with intermediate PA volumes (500-1499 MET-minutes per week: hazard ratio [HR], 0.77 [95% CI, 0.65-0.91]; 1500-2499 MET-minutes per week: HR, 0.78 [95% CI, 0.63-0.95]). There was no association between high-volume PA (>3000 MET-minutes per week) and risk for acute myocardial infarction (HR, 0.95 [95% CI, 0.72-1.25]). In contrast, the lowest risk for death was observed among the high-volume PA group (HR, 0.71 [95% CI, 0.60-0.83]). CAC (on log scale) was associated with a higher risk for composite CAD across all PA categories, including among the high-volume PA subgroup (HR, 1.29 [95% CI, 1.16-1.44]; P<0.001; Pinteraction= 0.969). CONCLUSIONS:Compared with low-volume PA, high-volume PA was associated with a lower risk for all-cause mortality but a similar risk for clinical CAD. CAC was associated with an increased risk for clinical CAD regardless of the volume of PA.

Despite the established evidence that physical activity, sedentary behavior, and sleep affect cognitive function individually, less is known about the combined effects of these movement behaviors. The study aimed to identify movement patterns of physical activity, sitting time, and sleep and to examine the association of movement patterns with cognitive function. This cross-sectional study included 1,240 participants aged ≥ 55 years participating in the Cooper Center Longitudinal Study who visited the Cooper Clinic, Dallas (2016–2019) for preventive health care. Four movement behaviors were self-reported, including leisure-time aerobic activity, muscle-strengthening activity, sitting time, sleep, and other characteristics. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA). Four categorical indicators were created for each movement behavior and used to identify latent classes. Information criterion, scaled relative entropy and model interpretability were used to determine the optimal number of classes. Participants were assigned to the predicted classes based on their highest posterior probabilities. Multinomial regressions examined the association between movement patterns and each covariate. Linear and logistic regression models examined the association of movement patterns and cognitive function. A sensitivity analysis accounted for misclassification errors. Participants were predominantly White (95

BACKGROUND:This study aimed to examine the longitudinal association between muscle strength, incident dementia, and dementia-related mortality among community-dwelling adults. METHODS:This prospective cohort study included 7755 participants (20-90 y) participating in the Cooper Center Longitudinal Study (1980-1990) and enrolled in Medicare between 1999 and 2019. Upper and lower body strength was measured with 1-repetition isotonic maximum bench and leg press. Relative muscle strength was computed relative to body weight and categorized into tertiles based on previously established age and sex normative data. Earliest indication of dementia and dementia-related mortality were determined with Medicare Administrative Claims Data and the National Death Index. The associations of muscle strength with incident dementia and dementia-related mortality were determined using an illness-death model with random frailty. RESULTS:Participants were predominantly White (97%) and male (86%), with an average age of 44 years at baseline. The mean duration between baseline muscle strength assessment and Medicare surveillance was 23 years. The incidence of all-cause dementia was 18.2 per 1000 person-years. Individuals in the medium tertile of lower body strength had reduced hazard of all-cause dementia (hazard ratio = 0.84; 95% CI, 0.72-0.98) relative to the low tertile, controlling for cardiovascular risk factors. Yet, the association was marginally significant (hazard ratio = 0.86; 95% CI, 0.73-1.0) when further controlled for cardiorespiratory fitness. There were no associations between body strength and dementia-related mortality. CONCLUSIONS:No associations of upper and lower body muscle strength with the risk of dementia and related mortality were observed after adjusting for cardiovascular risk factors and cardiorespiratory fitness.

Background Cross‐sectional studies suggesting that SARS‐CoV‐2 infection and long COVID are associated with reduced cardiorespiratory fitness (CRF) lack preinfection CRF measures. The objective of this study was to determine the association of SARS‐CoV‐2 infection and long COVID with change in CRF. Methods Cooper Center Longitudinal Study is a cohort study based at the Cooper Clinic, a preventive medicine clinic in Dallas, Texas; we included adults ages 20 to 74 years old with CRF assessed at least twice between 2017 and 2023. COVID status was defined as “prepandemic” (2 CRF measures pre‐2020), “uninfected” (no self‐reported COVID), “recovered” (self‐reported COVID with symptoms ≤3 months), or “long COVID” (self‐reported COVID with symptoms >3 months). CRF was estimated in metabolic equivalents via a maximal modified Balke treadmill protocol. Results We included 4005 participants (mean age: 51.8 years, 26.8% women), of whom, 1666 (41.6%) reported COVID and 80 (4.8% of infected) reported long COVID along with 1826 uninfected and 513 pre‐pandemic controls. At baseline, those who later developed long COVID had lower CRF (10.0 metabolic equivalents, 11.1 recovered, 10.7 uninfected, 11.3 prepandemic; P<0.001). All groups exhibited minor decreases in CRF (~0.2 metabolic equivalents; P<0.001 for each). CRF decreased slightly more among the infected (−0.1 metabolic equivalents greater decrease [95% CI, −0.1 to 0.0]; P=0.02) but not by long COVID status (P=0.10). Conclusions Pre‐COVID fitness, on average, is lower among people who developed long COVID. COVID does not greatly accelerate age‐related declines in CRF, even among some with long COVID, although few included participants had severely disabling long COVID. Future longitudinal research will clarify if differences in CRF by infection status emerge over longer follow‐up.

BackgroundIdentifying lifestyle factors that independently or jointly lower dementia risk is a public health priority given the limited treatment options available to patients. In this cohort study, we examined the associations between Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diet adherence and cardiorespiratory fitness (CRF) with later-life dementia, and assessed whether the associations between dietary pattern and dementia are modified by CRF.MethodsData are from 9,095 adults seeking preventive care at the Cooper Clinic (1987-1999) who completed a 3-day dietary record and a maximal exercise test. Alzheimer's disease and related disorders or senile dementia (i.e., all-cause dementia) was identified from Medicare administrative claims (1999-2019). Illness-death models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between Mediterranean or DASH diet adherence (primary exposure), CRF (secondary exposure), and all-cause dementia, adjusted for demographic and clinical factors. An interaction term was included between diet score and CRF to assess effect modification by CRF.ResultsThe mean age at baseline was 50.6 (standard deviation [SD]: 8.4) years, and a majority of the study sample were men (77.5%) and White (96.4%). 1449 cases of all-cause dementia were identified over a mean follow-up of 9.2 (SD: 5.8) years. Neither Mediterranean nor DASH diet adherence was associated with dementia risk in fully adjusted models (HR per SD of Mediterranean diet score: 1.00, 95% CI: 0.94, 1.05; HR per SD of DASH diet score: 1.02, 95% CI: 0.96, 1.08). However, participants with higher CRF had a decreased hazard of dementia (HR, per metabolic equivalent of task [MET] increase, Mediterranean model: 0.95, 95% CI: 0.92, 0.98; HR, per MET increase, DASH model: 0.96, 95% CI: 0.92, 0.97). No effect modification by CRF was observed in the association between diet and dementia.ConclusionsIn this sample of apparently healthy middle-aged adults seeking preventive care, higher CRF at midlife was associated with a lower risk of all-cause dementia, though adherence to a Mediterranean or DASH diet was not, and CRF did not modify the diet-dementia association. CRF should be emphasized in multimodal interventions for dementia prevention and investigated among diverse samples.

Importance:Prior cross-sectional studies have suggested that very high levels of physical activity (PA) are associated with a higher prevalence of coronary artery calcium (CAC). However, less is known regarding the association between high-volume PA and progression of CAC over time. Objective:To explore the association between PA (measured at baseline and during follow-up) and the progression of CAC over time. Design, Setting, and Participants:This cohort study included data from 8771 apparently healthy men and women 40 years and older who had multiple preventive medicine visits at the Cooper Clinic (Dallas, Texas), with a mean (SD) follow-up time of 7.8 (4.7) years between the first and last clinic visit. Participants with reported PA and CAC measurements at each visit during 1998 to 2019 were included in the study. Data were analyzed from March 2023 to February 2024. Exposures:PA reported at baseline and follow-up, examined continuously per 500 metabolic equivalent of task minutes per week (MET-min/wk) and categorically: less than 1500, 1500 to 2999, 3000 or more MET-min/wk. Main Outcomes and Measures:Negative binomial regression was used to estimate the rate of mean CAC progression between visits, with potential modification by PA volume, calculated as the mean of PA at baseline and follow-up. In addition, proportional hazards regression was used to estimate hazard ratios for baseline PA as a predictor of CAC progression to 100 or more Agatston units (AU). Results:Among 8771 participants, the mean (SD) age at baseline was 50.2 (7.3) years for men and 51.1 (7.3) years for women. The rate of mean CAC progression per year from baseline was 28.5% in men and 32.1% in women, independent of mean PA during the same time period. That is, the difference in the rate of CAC progression per year was 0.0% per 500 MET-min/wk for men and women (men: 95% CI, -0.1% to 0.1%; women: 95% CI, -0.4% to 0.5%). Moreover, baseline PA was not associated with CAC progression to a clinically meaningful threshold of 100 AU or more over the follow-up period. The hazard ratio for a baseline PA value of 3000 or more MET-min/wk vs less than 1500 MET-min/wk to cross this threshold was 0.84 (95% CI, 0.66 to 1.08) in men and 1.16 (95% CI, 0.57 to 2.35) in women. Conclusions and Relevance:This study found that PA volume was not associated with progression of CAC in a large cohort of healthy men and women who were initially free of overt cardiovascular disease.

ObjectiveTo determine the associations between muscle-strengthening activity (MSA) and cognitive function among middle-aged and older adults.MethodsThis cross-sectional study included 2973 participants aged ≥55 in the Cooper Center Longitudinal Study. Participants self-reported leisure-time physical activity. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). The associations of reported MSA frequency (0-1 vs. ≥2 sessions/week) and volume (zero, low: ≤250, medium: 250-420, high: >420 MET minutes/week) with mild cognitive impairment (MCI, defined as MoCA<26) and MoCA total score were examined using logistic and linear regression.ResultsIndividuals who participated in ≥2 MSA sessions/week had a significantly higher MoCA total score. Participants with medium MSA volume were significantly associated with lower odds of being classified as MCI and associated with a higher MoCA total score than those with zero volume.ConclusionsEngaging in MSA is associated with cognitive health among middle-aged and older adults independent of aerobic exercise.

BACKGROUND:Asthma appears to be associated with a variety of psychiatric illnesses including depression and alcohol use disorder. The current study examined the relationship between asthma, heavy alcohol intake and suggested alcohol dependence controlling for depressive symptom severity. METHODS:Data from 37,625 adult patients at the Cooper Clinic who enrolled in the Cooper Center Longitudinal Study, completed a medical history questionnaire including information on asthma, depressive symptoms and alcohol use were used. The association between lifetime asthma and heavy alcohol intake, while accounting for depressive symptoms (10-item Center for Epidemiological Studies-Depression (CESD)), and demographic variables was examined employing logistic regression with heavy alcohol intake (yes/no) as the outcome. Logistic regression was similarly utilized to examine the association between asthma and suggested alcohol dependence (CAGE scores ≥2: yes/no) among current drinkers (n = 29,235). RESULTS:Multivariable analysis revealed no significant association between asthma and heavy alcohol consumption with or without controlling for CES-D scores. Asthma was, however, associated with higher odds for suggested alcohol dependence (OR 1.18, 95 % CI 1.07, 1.31), which was attenuated but still significant when controlling for CES-D scores. CONCLUSION:Asthma was associated with higher risk for suggested alcohol dependence while current heaving drinking risk was not increased. The suggested drinking findings were slightly less strong when controlling for CES-D scores. The differences between current heavy drinking and CAGE findings might be due to differences in perception of problematic drinking by people with asthma or the timeframe of the assessments (current for drinking, lifetime for CAGE).