目的 基于具有全国代表性的队列研究数据，探讨我国农村地区45岁以上中老年人群体力活动不足与认知障碍发生风险之间的相关性。 方法 应用中国健康与养老追踪调查2011年、2013年、2015年、2018年和2020年的纵向研究数据进行分析。体力活动根据《中国人群身体活动指南（2021）》推荐的活动量作为标准，将体力活动水平分为体力活动不足和体力活动充分。认知障碍根据4个维度即定向、计算、记忆和绘画进行测量，总分低于年龄组标准的1个标准差为认知障碍。比较不同体力活动水平人群的认知障碍发生率，采用Cox比例风险回归模型分析体力活动不足与认知障碍发生风险之间的相关性。 结果 共纳入2011年基线1 904例研究对象，其中体力活动不足者546例（28.7%），体力活动充足者1 358例（71.3%）。研究对象累计随访12 001人年，平均随访（6.3±2.8）年，随访期间共有324例出现认知障碍，总发病密度为2.70/100人年。其中，体力活动充足者发病密度为2.38/100人年，体力活动不足者发病密度为3.56/100人年（P<0.001）。多因素Cox比例风险回归分析显示：体力活动不足者较体力活动充足者认知障碍发生风险增加33%（HR=1.33，95%CI=1.05~1.69）。 结论 中国农村地区中老年人人群中，体力活动不足增加了认知障碍发生风险。建议采取充分的体力活动，减少或延缓认知功能障碍的发生发展。

Objective To investigate the association between insufficient physical activity and cognitive impairment in middle-aged and elderly people，aged 45 years or older，in rural China based on data from the nationally representative large-scale longitudinal study. Methods The data from China Health and Retirement Longitudinal Study（CHARLS） in 2011，2013，2015，2018，and 2020 were used for analysis. According to Physical Activity Guidelines for Chinese（2021），the level of physical activity was classified into insufficient physical activity and sufficient physical activity. Cognitive function was measured based on the four dimensions of orientation，computation，memory，and drawing，and cognitive impairment was defined as a total score of at least 1 standard deviation（SD） below the age standard. The incidence rate of cognitive impairment was compared between the populations with different levels of physical activity，and the Cox proportional-hazards regression model was used to analyze the association between insufficient physical activity and cognitive impairment. Results A total of 1904 subjects were included from the CHARLS national baseline survey in 2011，among whom 546（28.7%） had insufficient physical activity and 1358（71.3%） had sufficient physical activity. The subjects were followed up for 12001 person-years，with a mean follow-up time of （6.3±2.8） years，and during this period of time，324 subjects developed cognitive impairment，with a total incidence density of 2.70/100 person-years. The incidence density of cognitive impairment was 2.38/100 person-years in the subjects with sufficient physical activity and 3.56/100 person-years in those with insufficient physical activity（P<0.001）. The multivariate Cox proportional-hazards regression analysis showed that the risk of cognitive impairment in the subjects with insufficient physical activity was increased by 33% compared with that in the subjects with sufficient physical activity（hazard ratio=1.33，95% confidence interval：1.05-1.69）. Conclusion Insufficient physical activity increases the risk of cognitive impairment among middle-aged and elderly adults in rural areas of China，and it is recommended that middle-aged and elderly people take sufficient physical activity to effectively reduce or delay the development and progression of cognitive impairment.