Physical Activity and Memory Function among Older Adults in Lebanon: Differences by Sex and Rural-Urban Living

Main Article Content

Sondos Taher Monique Chaaya Martine El Bejjani Salim Adib Khalil El Asmar


Introduction: The increase in the population of 60 years and above has led to an increase in dementia. Middle East and North Africa region (MENA) has one of the highest prevalence of dementia. One of the factors revealing promising results in reducing the burden of dementia, yet not researched in MENA and in other parts of the world, is physical activity.

Objective: We aimed to assess the association between subjective and objective physical activity, and memory recall of older adults with no dementia in Lebanon. We also investigated the moderating effect of sex and place of residence on this association.

Methods: This is a secondary data analysis of a cross-sectional study conducted in 2013 on a community of 502 older adults 65 years of age and above, selected randomly from two areas, Lebanon’s capital, Beirut, and Mount Lebanon. After excluding those who had dementia diagnoses and who did not have data on physical activity, the eligible sample was 459 persons. Physical activity was assessed by three indicators: physical activity perception, walking half a kilometer, and 2-minute step test (2MST). Memory recall, defined as episodic memory, was measured using a 10-word list-learning test with two outcomes: immediate and delayed. Regression models were performed adjusting for cluster effect. Additionally, associations between main exposures and memory recall were stratified by sex and rural/urban residence at the univariate and multivariate levels.

Results: The findings of this study revealed that the three measures of physical activity were significantly associated with higher memory function, at a significance level of 0.05. The data demonstrated that sex and place of residence did not modify the association between physical activity measures and immediate and delayed memory recall.

Conclusion: Physical activity of older adults should be promoted for a variety of health reasons including improvement of memory recall. Further research is needed to determine the long-term impact on the relationship between physical activity and episodic memory.

Keywords: older, adults, episodic memory, memory recall, physical activity, 2MST

Article Details

How to Cite
TAHER, Sondos et al. Physical Activity and Memory Function among Older Adults in Lebanon: Differences by Sex and Rural-Urban Living. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 19 june 2024. doi:
Research Articles


1. The 10/66 Dementia Research Group. Published 2008. Accessed.
2. Haidari B. Dementia treatment options in the Middle East.,increase%20in%20an%20ageing%20population. Published 2020. Accessed.
3. Ye M, Wang L, Xiong J, Zheng G. The effect of mind-body exercise on memory in older adults: a systematic review and meta-analysis. Aging Clin Exp Res. 2020.
4. MayoClinic. Triglycerides: Why do they matter? Published 2020. Accessed.
5. WHO. Dementia.,is%20between%205%2D8%25. Published 2020. Accessed.
6. King AC, Rejeski WJ, Buchner DM. Physical activity interventions targeting older adults. A critical review and recommendations. Am J Prev Med. 1998;15(4):316-333.
7. Camina E, Güell F. The Neuroanatomical, Neurophysiological and Psychological Basis of Memory: Current Models and Their Origins. Frontiers in Pharmacology. 2017;8(438).
8. Sales M, Levinger P, Polman R. Relationships between self perceptions and physical activity behaviour, fear of falling, and physical function among older adults. European Review of Aging and Physical Activity. 2017;14(1):17.
9. Anstey KJ, Ee N, Eramudugolla R, Jagger C, Peters R. A Systematic Review of Meta-Analyses that Evaluate Risk Factors for Dementia to Evaluate the Quantity, Quality, and Global Representativeness of Evidence. J Alzheimers Dis. 2019;70(s1):S165-s186.
10. Kahan D. Adult physical inactivity prevalence in the Muslim world: Analysis of 38 countries. Prev Med Rep. 2015;2:71-75.
11. Al-Tannir M, Kobrosly S, Itani T, El-Rajab M, Tannir S. Prevalence of physical activity among Lebanese adults: a cross-sectional study. J Phys Act Health. 2009;6(3):315-320.
12. Beam CR, Kaneshiro C, Jang JY, Reynolds CA, Pedersen NL, Gatz M. Differences Between Women and Men in Incidence Rates of Dementia and Alzheimer's Disease. J Alzheimers Dis. 2018;64(4):1077-1083.
13. Brouwers N, Sleegers K, Van Broeckhoven C. Molecular genetics of Alzheimer's disease: an update. Ann Med. 2008;40(8):562-583.
14. Farrer LA, Cupples LA, Haines JL, et al. Effects of age, sex, and ethnicity on the association between apolipoprotein E genotype and Alzheimer disease. A meta-analysis. APOE and Alzheimer Disease Meta Analysis Consortium. Jama. 1997;278(16):1349-1356.
15. Beydoun MA, Boueiz A, Abougergi MS, et al. Sex differences in the association of the apolipoprotein E epsilon 4 allele with incidence of dementia, cognitive impairment, and decline. Neurobiol Aging. 2012;33(4):720-731.e724.
16. Russ TC, Batty GD, Hearnshaw GF, Fenton C, Starr JM. Geographical variation in dementia: systematic review with meta-analysis. Int J Epidemiol. 2012;41(4):1012-1032.
17. Helgadóttir B, Owen N, W. Dunstan D, Ekblom Ö, Hallgren M, Forsell Y. Changes in physical activity and sedentary behavior associated with an exercise intervention in depressed adults. Psychology of Sport and Exercise. 2017;30:10-18.
18. Pratt M, Sallis, J. F., Cain, K. L., Conway, T. L., Palacios-Lopez, A., Zezza, A., Spoon, C., Geremia, C. M., Gaddis, I., Amankwah, A., Friedman, J., & Kilic, T. . Physical activity and sedentary time in a rural adult population in Malawi compared with an age-matched US urban population. BMJ open sport & exercise medicine. 2020.
19. Hariharan A. The correlates of physical activity in rural and urban older adults, Iowa State University; 2010.
20. Phung KTT, Chaaya M, Prince M, et al. Dementia prevalence, care arrangement, and access to care in Lebanon: A pilot study. Alzheimers Dement. 2017;13(12):1317-1326.
21. Tatsumi IF, Watanabe M. Verbal Memory. In: Binder MD, Hirokawa N, Windhorst U, eds. Encyclopedia of Neuroscience. Berlin, Heidelberg: Springer Berlin Heidelberg; 2009:4176-4178.
22. Różańska-Kirschke A, Kocur P, Wilk M, Dylewicz P. The Fullerton Fitness Test as an index of fitness in the elderly. Medical Rehabilitation. 2006.
23. Alosco ML, Spitznagel MB, Raz N, et al. The 2-minute step test is independently associated with cognitive function in older adults with heart failure. Aging Clin Exp Res. 2012;24(5):468-474.
24. Prince M, Ferri CP, Acosta D, et al. The protocols for the 10/66 dementia research group population-based research programme. BMC Public Health. 2007;7:165.
25. Richards M, Hardy R, Wadsworth ME. Does active leisure protect cognition? Evidence from a national birth cohort. Soc Sci Med. 2003;56(4):785-792.
26. Poehlman ET. Influence of endurance training on energy intake, norepinephrine kinetics, and metabolic rate in older individuals. Poehlman E, Gardner A, Goran M. Metabolism 1992;41 (September):941-8. Metabolism. 2005;54(9):1267.
27. Antunes HK, T. DMM. Effects of a physical fitness program on memory and blood viscosity in sedentary elderly men. Braz J Med Biol Res. 2015;48(9).
28. Coyle EF. Physical activity as a metabolic stressor. Am J Clin Nutr. 2000;72(2 Suppl):512s-520s.
29. Hattori N, Yabe I, Hirata K, et al. Brain regions associated with cognitive impairment in patients with Parkinson disease: quantitative analysis of cerebral blood flow using 123I iodoamphetamine SPECT. Clin Nucl Med. 2013;38(5):315-320.
30. Dostálová R, Stillman C, Erickson KI, Slepička P, Mudrák J. The Relationship between Physical Activity, Self-Perceived Health, and Cognitive Function in Older Adults. Brain Sci. 2021;11(4).
31. Lohne-Seiler H, Hansen BH, Kolle E, Anderssen SA. Accelerometer-determined physical activity and self-reported health in a population of older adults (65–85 years): a cross-sectional study. BMC Public Health. 2014;14(1):284.
32. Colley RC, Butler G, Garriguet D, Prince SA, Roberts KC. Comparison of self-reported and accelerometer-measured physical activity in Canadian adults. Health Rep. 2018;29(12):3-15.
33. Cust AE, Smith BJ, Chau J, et al. Validity and repeatability of the EPIC physical activity questionnaire: a validation study using accelerometers as an objective measure. International Journal of Behavioral Nutrition and Physical Activity. 2008;5(1):33.
34. Mahrs Träff A, Cedersund E, Nord C. Perceptions of physical activity among elderly residents and professionals in assisted living facilities. European Review of Aging and Physical Activity. 2017;14(1):2.
35. Welmer AK, Mörck A, Dahlin-Ivanoff S. Physical activity in people age 80 years and older as a means of counteracting disability, balanced in relation to frailty. J Aging Phys Act. 2012;20(3):317-331.
36. Baceviciene M, Jankauskiene R, Emeljanovas A. Self-perception of physical activity and fitness is related to lower psychosomatic health symptoms in adolescents with unhealthy lifestyles. BMC Public Health. 2019;19(1):980.
37. Tuakli-Wosornu YA, Rowan M, Gittelsohn J. Perceptions of physical activity, activity preferences and health among a group of adult women in urban Ghana: a pilot study. Ghana Med J. 2014;48(1):3-13.
38. Sibai AM, Hwalla N. WHO STEPS chronic diseases risk factor surveillance: American University of Beirut. file:///C:/Users/user/Downloads/WHO_Databook_Lebanon_2010_final%20(1).pdf. Published 2010. Accessed.
39. Sibai AM, Tohme R, Mahfoud Z, Chaaya M. Non-communicable Diseases and Behavioral Risk Factor Survey. 2009.
40. Chaabane S, Chaabna K, Doraiswamy S, Mamtani R, Cheema S. Barriers and Facilitators Associated with Physical Activity in the Middle East and North Africa Region: A Systematic Overview. Int J Environ Res Public Health. 2021;18(4).
41. WHO. Regional workshop on developing plans of action for promotion of physical activity and prevention and control of obesity. 2010.
42. van Uffelen JGZ, Khan A, Burton NW. Gender differences in physical activity motivators and context preferences: a population-based study in people in their sixties. BMC Public Health. 2017;17(1):624.
43. Sibai AM, Costanian C, Tohme R, Assaad S, Hwalla N. Physical activity in adults with and without diabetes: from the 'high-risk' approach to the 'population-based' approach of prevention. BMC Public Health. 2013;13:1002.
44. DAIH. Lebanon: NGO Report on MIPPAA Progress 2002–2007. Accessed2022.
45. CDC. What Is Dementia? Published 2019. Accessed.
46. Chemali Z, Chahine LM, Sibai AM. Older adult care in Lebanon: towards stronger and sustainable reforms. East Mediterr Health J. 2008;14(6):1466-1476.
47. Barha CK, Davis JC, Falck RS, Nagamatsu LS, Liu-Ambrose T. Sex differences in exercise efficacy to improve cognition: A systematic review and meta-analysis of randomized controlled trials in older humans. Front Neuroendocrinol. 2017;46:71-85.
48. Lundervold AJ, Wollschläger D, Wehling E. Age and sex related changes in episodic memory function in middle aged and older adults. Scand J Psychol. 2014;55(3):225-232.
49. Sunderaraman P, Blumen HM, DeMatteo D, Apa ZL, Cosentino S. Task demand influences relationships among sex, clustering strategy, and recall: 16-word versus 9-word list learning tests. Cogn Behav Neurol. 2013;26(2):78-84.
50. Pauls F, Petermann F, Lepach AC. Gender differences in episodic memory and visual working memory including the effects of age. Memory. 2013;21(7):857-874.
51. Taylor D. Physical activity is medicine for older adults. Postgraduate Medical Journal. 2014;90(1059):26-32.
52. Fahs I, Khalife Z, Malaeb D, Iskandarani M, Salameh P. The Prevalence and Awareness of Cardiovascular Diseases Risk Factors among the Lebanese Population: A Prospective Study Comparing Urban to Rural Populations. Cardiol Res Pract. 2017;2017:3530902.
53. Guerchet M, Prince M, Albanese E, Prina M. Numbers of people with dementia around the world. Alzheimer's Disease International2017.
54. UCSF. Memory. Published 2021. Accessed.
55. Guedes M, Lopes J, Andrade A, Guedes T, Ribeiro J, Cortez L. Validation of the two minute step test for diagnosis of the functional capacity of hypertensive elderly persons. SciEo Brazil. 2015.