Degree of rurality moderates the association of sedentary time with cognitive function in rural patients with cardiac diseases and depressive symptoms

Chin Yen Lin; Jia Rong Wu; Geunyeong Cha; Jung Hee Kang; Martha J. Biddle; Misook L. Chung; Ashmita Thapa; Mary Kay Rayens; Linda Gibson-Young; Debra K. Moser

doi:10.1111/jrh.70092

Degree of rurality moderates the association of sedentary time with cognitive function in rural patients with cardiac diseases and depressive symptoms

Chin Yen Lin
, Jia Rong Wu
, Geunyeong Cha
, Jung Hee Kang
, Martha J. Biddle
, Misook L. Chung
, Ashmita Thapa
, Mary Kay Rayens
, Linda Gibson-Young
, Debra K. Moser

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

BACKGROUND: Prolonged sedentary time has been linked to impaired cognitive outcomes. However, the impact of sedentary time on cognitive function at different degrees of rurality is not yet well understood in patients with cardiac diseases and depressive symptoms. PURPOSE: To determine whether degree of rurality moderates the relationship between sedentary time and cognitive function. METHODS: This study includes 135 coronary heart disease or heart failure patients, primarily residing in rural Kentucky, including Appalachian areas, United States. Sedentary time 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. Patients were categorized into two groups by rurality: (1) 89 patients in a less rural group (RUCA codes 4-6); and (2) 46 patients in a more rural group (RUCA codes 7-10). Data were collected May 2021-September 2022 and analyzed using the Hayes PROCESS macro in SPSS. RESULTS: Sedentary time predicted cognitive function (B = -0.006, p = 0.019), and this relationship was moderated by rurality (interaction term = 0.006, p = 0.022). Patients living in more rural areas had significantly worse cognitive function when sedentary for longer periods (p = 0.019); specifically, every 100-min increase in sedentary time was associated with a 0.6-point decrease in cognitive function score. However, this relationship was not observed in those living in less rural areas (p = 0.658). CONCLUSIONS: Testing the impact of interventions aimed at reducing sedentary time on cognitive function is warranted in this population, particularly for those living in highly rural areas.

Original language	English
Pages (from-to)	e70092
Journal	Journal of Rural Health
Volume	41
Issue number	4
DOIs	https://doi.org/10.1111/jrh.70092
State	Published - Sep 1 2025

Bibliographical note

Publisher Copyright:
© 2025 National Rural Health Association.

Funding

This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Award (AD-2019C3-17982, D.K. Moser, PI). The statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of the PCORI, its Board of Governors, or Methodology Committee. This work was also supported by the National Institute of Nursing Research of the National Institutes of Health (NIH) under Award Number R01NR020478 (J.R. Wu, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This work was supported through a Patient‐Centered Outcomes Research Institute (PCORI) Award (AD‐2019C3‐17982, D.K. Moser, PI). The statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of the PCORI, its Board of Governors, or Methodology Committee. This work was also supported by the National Institute of Nursing Research of the National Institutes of Health (NIH) under Award Number R01NR020478 (J.R. Wu, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funders	Funder number
National Institute of Health National Institute of Nursing Research
Patient-Centered Outcomes Research Institute	AD‐2019C3‐17982
National Institutes of Health (NIH)	R01NR020478

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

coronary heart disease
heart failure
moderator
rural population
sedentary behavior
sedentary time

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

Access to Document

10.1111/jrh.70092

Cite this

@article{502a5daa9ddc496596fe90c044489b17,

title = "Degree of rurality moderates the association of sedentary time with cognitive function in rural patients with cardiac diseases and depressive symptoms",

abstract = "BACKGROUND: Prolonged sedentary time has been linked to impaired cognitive outcomes. However, the impact of sedentary time on cognitive function at different degrees of rurality is not yet well understood in patients with cardiac diseases and depressive symptoms. PURPOSE: To determine whether degree of rurality moderates the relationship between sedentary time and cognitive function. METHODS: This study includes 135 coronary heart disease or heart failure patients, primarily residing in rural Kentucky, including Appalachian areas, United States. Sedentary time 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. Patients were categorized into two groups by rurality: (1) 89 patients in a less rural group (RUCA codes 4-6); and (2) 46 patients in a more rural group (RUCA codes 7-10). Data were collected May 2021-September 2022 and analyzed using the Hayes PROCESS macro in SPSS. RESULTS: Sedentary time predicted cognitive function (B = -0.006, p = 0.019), and this relationship was moderated by rurality (interaction term = 0.006, p = 0.022). Patients living in more rural areas had significantly worse cognitive function when sedentary for longer periods (p = 0.019); specifically, every 100-min increase in sedentary time was associated with a 0.6-point decrease in cognitive function score. However, this relationship was not observed in those living in less rural areas (p = 0.658). CONCLUSIONS: Testing the impact of interventions aimed at reducing sedentary time on cognitive function is warranted in this population, particularly for those living in highly rural areas.",

keywords = "coronary heart disease, heart failure, moderator, rural population, sedentary behavior, sedentary time",

author = "Lin, \{Chin Yen\} and Wu, \{Jia Rong\} and Geunyeong Cha and Kang, \{Jung Hee\} and Biddle, \{Martha J.\} and Chung, \{Misook L.\} and Ashmita Thapa and Rayens, \{Mary Kay\} and Linda Gibson-Young and Moser, \{Debra K.\}",

note = "Publisher Copyright: {\textcopyright} 2025 National Rural Health Association.",

year = "2025",

month = sep,

day = "1",

doi = "10.1111/jrh.70092",

language = "English",

volume = "41",

pages = "e70092",

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T1 - Degree of rurality moderates the association of sedentary time with cognitive function in rural patients with cardiac diseases and depressive symptoms

AU - Lin, Chin Yen

AU - Wu, Jia Rong

AU - Cha, Geunyeong

AU - Kang, Jung Hee

AU - Biddle, Martha J.

AU - Chung, Misook L.

AU - Thapa, Ashmita

AU - Rayens, Mary Kay

AU - Gibson-Young, Linda

AU - Moser, Debra K.

PY - 2025/9/1

Y1 - 2025/9/1

N2 - BACKGROUND: Prolonged sedentary time has been linked to impaired cognitive outcomes. However, the impact of sedentary time on cognitive function at different degrees of rurality is not yet well understood in patients with cardiac diseases and depressive symptoms. PURPOSE: To determine whether degree of rurality moderates the relationship between sedentary time and cognitive function. METHODS: This study includes 135 coronary heart disease or heart failure patients, primarily residing in rural Kentucky, including Appalachian areas, United States. Sedentary time 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. Patients were categorized into two groups by rurality: (1) 89 patients in a less rural group (RUCA codes 4-6); and (2) 46 patients in a more rural group (RUCA codes 7-10). Data were collected May 2021-September 2022 and analyzed using the Hayes PROCESS macro in SPSS. RESULTS: Sedentary time predicted cognitive function (B = -0.006, p = 0.019), and this relationship was moderated by rurality (interaction term = 0.006, p = 0.022). Patients living in more rural areas had significantly worse cognitive function when sedentary for longer periods (p = 0.019); specifically, every 100-min increase in sedentary time was associated with a 0.6-point decrease in cognitive function score. However, this relationship was not observed in those living in less rural areas (p = 0.658). CONCLUSIONS: Testing the impact of interventions aimed at reducing sedentary time on cognitive function is warranted in this population, particularly for those living in highly rural areas.

AB - BACKGROUND: Prolonged sedentary time has been linked to impaired cognitive outcomes. However, the impact of sedentary time on cognitive function at different degrees of rurality is not yet well understood in patients with cardiac diseases and depressive symptoms. PURPOSE: To determine whether degree of rurality moderates the relationship between sedentary time and cognitive function. METHODS: This study includes 135 coronary heart disease or heart failure patients, primarily residing in rural Kentucky, including Appalachian areas, United States. Sedentary time 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. Patients were categorized into two groups by rurality: (1) 89 patients in a less rural group (RUCA codes 4-6); and (2) 46 patients in a more rural group (RUCA codes 7-10). Data were collected May 2021-September 2022 and analyzed using the Hayes PROCESS macro in SPSS. RESULTS: Sedentary time predicted cognitive function (B = -0.006, p = 0.019), and this relationship was moderated by rurality (interaction term = 0.006, p = 0.022). Patients living in more rural areas had significantly worse cognitive function when sedentary for longer periods (p = 0.019); specifically, every 100-min increase in sedentary time was associated with a 0.6-point decrease in cognitive function score. However, this relationship was not observed in those living in less rural areas (p = 0.658). CONCLUSIONS: Testing the impact of interventions aimed at reducing sedentary time on cognitive function is warranted in this population, particularly for those living in highly rural areas.

KW - coronary heart disease

KW - heart failure

KW - moderator

KW - rural population

KW - sedentary behavior

KW - sedentary time

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U2 - 10.1111/jrh.70092

DO - 10.1111/jrh.70092

M3 - Article

C2 - 41177933

AN - SCOPUS:105020770724

SN - 0890-765X

VL - 41

SP - e70092

JO - Journal of Rural Health

JF - Journal of Rural Health

IS - 4

ER -

Degree of rurality moderates the association of sedentary time with cognitive function in rural patients with cardiac diseases and depressive symptoms

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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Cite this