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This study aims to explore the combined effects of blood lead levels (BLL) and physical activity (PA) on AD prevalence among middle\u2010aged and older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A total of 13,426 middle\u2010aged and older adults (57.8% over 60 years old; 49.7% males) were included. Firth's penalized logistic regression models were used for statistical analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>High blood lead level (High\u2010BLL) was associated with an 86.7% increase in AD prevalence. For PA levels, engaging in sufficiently active PA was associated with a 72% reduction in AD prevalence. In addition, the combination of sufficiently active PA with high\u2010BLL, moderate blood lead level (Moderate\u2010BLL), or low blood lead level (Low\u2010BLL) was associated with an 83.9%, 65.9%, or 76.5% reduction in AD prevalence, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Although higher BLL is associated with increased AD prevalence, engaging in PA can reduce the AD prevalence caused by BLL, with greater benefits observed from sufficiently active PA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Higher blood lead levels (BLL) are associated with an increased prevalence of Alzheimer's disease (AD), whereas engaging in physical activity (PA) is associated with a reduced prevalence. Furthermore, engaging in sufficient occupational PA and sufficient leisure\u2010time PA are both associated with a lower prevalence of AD.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Engaging in PA can reduce the AD prevalence caused by BLL, with greater benefits observed from engaging in sufficiently active PA.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The combined effects of BLL and PA levels on AD prevalence may vary among populations with different gender, marital status, socioeconomic status, or smoking status.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  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