This longitudinal study examined the long-term effects of physical activity persistence on functional independence and cognitive health among older adults in Korea. Using nine waves (2006–2022) of nationally representative data from the Korean Longitudinal Study of Ageing (KLoSA), 5,310 individuals aged 65 years and older who participated in at least two survey waves were analyzed. Physical activity persistence was defined as maintaining regular exercise across consecutive waves. Functional decline was measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), and cognitive impairment was defined as a Korean Mini-Mental State Examination (K-MMSE) score ≤23. Weighted descriptive analyses, fixed-effects (FE) models, generalized estimating equations (GEE), and inverse probability weighting (IPW) were applied to account for within-person variation and attrition bias over the 16-year period.
The findings indicated that consistent participation in physical activity significantly reduced both functional and cognitive decline. Older adults who maintained regular exercise exhibited lower odds of ADL decline (OR=0.71, 95% CI=0.65–0.77), IADL decline (OR=0.74, 95% CI=0.68–0.81), and cognitive impairment (OR=0.78, 95% CI=0.72–0.85) than those who did not. These associations remained robust across all models and after IPW adjustment, confirming the durability of the results. Continuity in physical activity—not temporary engagement—emerged as a key determinant of successful aging, preserving both physical and cognitive health. Policies and community programs should therefore emphasize long-term adherence to exercise, especially among vulnerable populations, to enhance healthy longevity and reduce functional dependence and dementia risk.