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Alzheimer’s still does not have a cure or treatment, but there is one overarching message that both research and doctors support: Physical fitness may be able to change the trajectory of the disease. A new study adds evidence to that view, suggesting that women with high physical fitness are 88 percent less likely to develop dementia than those who are just moderately fit.

That’s not all—even when the women at a high level of fitness did develop dementia, they did so at an average of 11 years later. That’s the difference between developing dementia at age 90 rather than age 79.

Researchers ranked middle-aged women with an exercise test that measured cardiovascular fitness. One hundred and ninety one women with an average age of 50 hopped on an exercise bike and pedaled until they tired, according to researchers. Forty of those women qualified as highly fit, pedaling 120 watts or higher. Ninety-two qualified as moderate, and 59 were considered low physical fitness at 80 watts or less.

The researchers then followed the women for 44 years, testing them for dementia a total of six times. Over that time, 44 developed dementia—five percent of the highly fit women, compared to 25 percent of the moderately fit and 32 percent of the women with low fitness. Of those who had to stop that initial biking test entirely due to chest pain or high blood pressure, 45 percent went on to develop dementia.

“These findings are exciting because it’s possible that improving people’s cardiovascular fitness in middle age could delay or even prevent them from developing dementia,” said study author Helena Hörder, PhD, of the University of Gothenburg in Gothenburg, Sweden.

However, this was an observational study, rather than experimental, said Hörder. “This study does not show cause and effect between cardiovascular fitness and dementia, it only shows an association. More research is needed to see if improved fitness could have a positive effect on the risk of dementia and also to look at when during a lifetime a high fitness level is most important.”

The group of participants was also fairly small and all the women were from Sweden, which limits how this might translate to a broader population.

Still, it’s an encouraging finding that adds to a large body of research suggesting how fit someone is in middle age might affect dementia risk decades later.

This study was published in the journal Neurology.