I biked to work for 27 years prior to my stroke, 4 miles each way 9-10 months out of the year in Minnesota. With the inability to grip the left handlebar post stroke my balance was off and I could only make about 10 blocks in total before my mental capacity for biking ran out. So now I have 42 lb. recumbent three-wheeler. Finally have a garage to store it, will try this summer to get out on it.
Cycling in Midlife Tied to Lower Risk of Dementia
Active transportation modes were associated with higher hippocampal volumes
Key Takeaways
- Active transportation modes in midlife -- notably, cycling -- were tied to a lower dementia risk over 13 years.
- Cycling was also associated with higher hippocampal volume.
- The APOE4 allele modified associations between travel modes and dementia.
Using physically active transportation modes in midlife -- particularly cycling -- was tied to lower dementia risk and greater hippocampal volume, a large U.K. Biobank study suggested.
Compared with non-active travel like driving or public transportation, travel that incorporated cycling was associated with a lower adjusted risk of all-cause dementia over 13 years (HR 0.81, 95% CI 0.73-0.91), reported Liangkai Chen, PhD, of Huazhong University of Science and Technology in Wuhan, China, and co-authors.
Risk was lower for three forms of dementia: Alzheimer's disease (HR 0.78, 95% CI 0.66-0.92), young-onset dementia (HR 0.60, 95% CI 0.38-0.95), and late-onset dementia (HR 0.83, 95% CI 0.75-0.93), the researchers wrote in JAMA Network Open.
Transportation that involved cycling -- either cycling alone, or cycling mixed with another transportation mode -- was significantly associated with a higher hippocampal volume (β=0.05, 95% CI 0.02-0.08). The APOE4 allele modified associations between travel modes and all-cause dementia (P=0.02 for interaction) and late-onset dementia (P=0.04 for interaction).
"Our findings suggest that active travel modes, particularly cycling and mixed-cycling, are associated with higher hippocampal volumes. The hippocampus is critical for memory and cognitive function, and greater volume is generally considered a sign of better brain health," Chen noted.
"This outcome could be attributed to the physical activity and aerobic exercise involved in cycling, which is known to have neuroprotective effects," Chen wrote in an email to MedPage Today. "Cycling, especially as a regular form of transport, may help increase blood flow to the brain, reduce inflammation, and stimulate neurogenesis, and requires higher cognitive engagement during travel, which could all contribute to the observed preservation of hippocampal volume."
The gene-environment interaction is a key finding, Chen observed. "Individuals without the APOE4 gene variant appeared to derive greater benefits from active travel modes in terms of dementia risk reduction. Critically, however, our data indicate that APOE4 carriers can still benefit from cycling, though these benefits are likely attenuated due to the allele's strong biological influence on neurodegeneration pathways," he pointed out.
"These results collectively suggest that promoting active travel, particularly cycling, remains a valuable public health strategy to enhance brain health across populations," he said.
Various travel modes involve different attention engagement and spatial navigation abilities. A recent study of workers in hundreds of occupations found that those who used real-time spatial and navigational processing skills the most -- notably, taxi and ambulance drivers -- had the lowest proportion of deaths due to Alzheimer's disease.
Whether the aerobic effects of indoor cycling can curb the effects of Alzheimer's disease in APOE4 carriers is being studied at the Cleveland Clinic in the CYCLE-AD trial. Early reports showed that sedentary APOE4 carriers experienced more significant declines in episodic memory and hippocampal volume than APOE4 carriers who engaged in moderate physical activity, suggesting that activities like indoor cycling may enhance the functional and structural integrity of the hippocampus in this group.
Chen and colleagues assessed data from 479,723 U.K. Biobank participants with an average baseline age of 56.5 years. More than half (54.4%) were women; all were dementia-free at baseline and able to walk. Over 85% were of European ancestry.
The researchers assessed travel modes by asking about transportation modes that participants used most often in the past 4 weeks, not including work commutes. Responses were grouped into four categories: non-active (car or public transportation), walking, mixed-walking (a combination of non-active and walking), and cycling and mixed-cycling (cycling combined with other modes).
Nearly half of the study population (49.1%) were inactive; 6.8% were classified as walking-only, 37% as mixed-walking, and 7% as cycling and mixed-cycling.
Over a median follow-up of 13.1 years, 8,845 cases of dementia and 3,956 cases of Alzheimer's disease were recorded. While participants in the mixed-walking group had a lower risk of all-cause dementia compared with those in the inactive group (HR 0.94, 95% CI 0.89-0.98), other results for walking were mixed.
"Overall, the association of walking with brain health remains inconsistent and warrants further investigation," Chen and colleagues wrote. "Our results suggest that mixed-walking models, which combine walking with other forms of travel that require higher cognitive engagement (e.g., driving), may be more beneficial in reducing dementia risk than walking alone."
The study was observational and causal relationships cannot be determined. Transportation modes were self-reported, and racial and ethnic diversity in the U.K. Biobank sample was limited, the researchers acknowledged.
Disclosures
This work was supported by grants from the Young Elite Scientists Sponsorship Program by the China Association for Science and Technology and the Young Scientists Fund of the National Natural Science Foundation of China.
Chen reported no conflicts of interest. Co-authors had no disclosures.
Primary Source
JAMA Network Open
Source Reference: Hou C, et al "Active travel mode and incident dementia and brain structure" JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2025.14316.
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