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Background: Ghana’s ageing population is experiencing a rising burden of cognitive decline, yet limited evidence exists on the role of physical activity in cognitive health among older adults in sub-Saharan Africa. This study examined the association between physical activity and cognitive function in older Ghanaian adults and explored whether functional ability mediates this relationship.
Methods: We analysed data from 2,587 adults aged 60 years or older in the Ghana arm of the World Health Organization’s Study on Global Ageing and Adult Health (WHO-SAGE) Wave 1, conducted between 2007 and 2009. Physical activity was assessed using the Global Physical Activity Questionnaire and categorised as active (≥600 MET-min/week) or inactive. Cognitive function was measured using a composite z-score from tests of memory, verbal fluency, and working memory. Inverse probability weighting (IPW) adjusted for sociodemographic, clinical, and behavioural confounders. Mediation analysis assessed the indirect effect of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) on the outcome.
Results: Physically active participants had significantly better cognitive scores than inactive peers (adjusted β = 0.45; 95% CI: 0.18, 0.67; p < 0.001). ADLs mediated 46% (ACME = 0.19; 95% CI: 0.13, 0.28), and IADLs mediated 35% (ACME = 0.15; 95% CI: 0.09, 0.21) of the total effect of physical activity on cognition.
Conclusion: Physical activity is positively associated with cognitive function in older Ghanaian adults, partly through improved functional ability. Promoting physical activity may offer a culturally relevant strategy for reducing cognitive decline and maintaining independence in ageing populations.
Keywords: Cognitive function, Ghana, Inverse Probability Weighting (IPW), Older Adult, Physical Activity