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Addressing the elephant in the room: the need to examine the role of social determinants of health in the relationship of the 24-hour activity cycle and adult cognitive health
  1. Ryan S Falck1,2,3,
  2. Narlon Cassio Boa Sorte Silva2,3,
  3. Guilherme Moraes Balbim2,3,
  4. Linda C Li2,
  5. Cindy K Barha4,
  6. Teresa Liu-Ambrose2,3
  1. 1 School of Biomedical Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Centre for Aging SMART, Vancouver, British Columbia, Canada
  4. 4 Kinesiology, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Teresa Liu-Ambrose, Physical Therapy, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; teresa.ambrose{at}

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Daily physical activity (PA), sedentary behaviour (SB) and sleep are often collectively referred to as the 24-hour activity cycle (24HAC). These behaviours are interdependent (ie, one replaces another in the 24HAC) and interactively impact cognitive health outcomes (eg, one may amplify the effect of another) through one or more hypothesised mechanisms, including: (1) PA amplifies the relationship between sleep and cognitive health; (2) greater PA improves sleep, promoting better cognitive health; (3) limiting SB while engaging in greater PA stimulates better cognitive health and (4) greater PA ameliorates the negative consequences of SB on cognitive health.1

There is great potential for this interconnected health research area given the possible impact it has for promoting cognitive health. However, in our review of the literature, key characteristics that stratify health opportunities and outcomes are overlooked. Social determinants of health require closer consideration since they can play a critical role in health outcomes.

Using the PROGRESS-Plus framework,2 there are several social determinants of health which likely impact the 24HAC and cognitive health (figure 1). These social determinants include: place of residence, race or ethnicity, occupation, gender, religion, education, social capital, socioeconomic status, age, disability and sexual orientation. We suggest an addition to the framework—that government policies on health may be a key social determinant of the 24HAC and cognitive health relationship, as seen in figure 1. Nonetheless, these key factors have rarely (if ever) been addressed in studies …

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  • Contributors RSF wrote the first draft of the manuscript. RSF, NCBSS and GMB developed the concept for the paper. NCBSS, GMB, LL, CKB and TL-A each provided critical feedback and wrote portions of the final manuscript.

  • Funding Funding for this project was provided to TL-A by the Jack Brown and Family Alzheimer Research Foundation. RSF, NCBSSS and GMB are each funded by a Michael Smith Health Research BC Postdoctoral Fellowship Award. NCBSS and GMB are also funded by a Canadian Institutes of Health Research Postdoctoral Fellowship Award. TL-A is a Tier 1 Canada Research Chair in Healthy Aging. LL is Tier I Canada Research Chair in Patient-Oriented Knowledge Translation, and the Harold Robinson/Arthritis Society Chair in Arthritic Disease at University of British Columbia.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.