Abstract Body (Do not enter title and authors here): Background: Whether there are disparities in cognitive function in individuals living in rural areas compared to urban areas is unknown. Some investigators have found that rural residents have better cognitive function, while others report the opposite. Sedentary behavior is a major risk factor for cognitive health in patients with cardiac diseases; however, little is known about the impact of sedentary behavior on cognitive function at different degrees of rurality.
Purpose: The aim of the study was to determine whether degree of rurality moderates the relationship between sedentary lifestyle and cognitive function among rural patients with coronary heart disease or heart failure.
Methods: This study includes 135 coronary heart disease or heart failure patients residing in Appalachia (aged 59 ± 12 years, 53% female). Sedentary behavior was measured by the average daily sedentary time (in minutes) using accelerometry (ActiGraph). Cognitive function was assessed using the Montreal Cognitive Assessment-Blind. Rurality was determined by Rural-Urban Commuting Area (RUCA) codes. Participants were categorized into two groups based on degree of rurality: 1) 89 participants were included in a less rural group (RUCA codes 2−3 within Appalachia and RUCA codes 4−6 for micropolitan areas < 50,000 population); and 2) 46 participants were included in a more rural group (RUCA codes 7−10 for small towns < 9,999 population). Data were analyzed using the PROCESS macro in SPSS to test the proposed moderating effect controlling for age, gender, and depressive symptoms.
Results: The time spent in sedentary behavior ranged from 3.2 to 13.3 hours per day, with an average of 7.9 ± 2.1 and a median of 7.8 hours per day. Sedentary behavior predicted cognitive function (B = −0.006, p = 0.012), but this relationship was moderated by rurality group (coefficient of rurality group*secondary behavior interaction term = 0.006, p = 0.029). Patients living in more rural areas had significantly worse cognitive function if they were sedentary for longer periods (p = 0.012), but this relationship was not observed in those living in less rural areas (p = 0.986).
Conclusions: Although being sedentary is associated with worse cognitive function, degree of rurality significantly interacts with sedentary behavior in this association. Testing the impact of promoting physical activity on cognitive function is warranted in this population, particularly for those living in highly rural areas.