Physical Activity and Cognitive Function in Older Adults: A Narrative Review

Background Physical activity and structured exercise have been investigated as modifiable factors supporting cognitive health in older adults. However, reported effects vary according to exercise modality, cognitive domain, baseline cognitive status, and training characteristics. Aim This narrative review aimed to synthesize evidence on the relationship between physical activity and cognitive function in older adults, with emphasis on exercise modality, exercise dose, cognitive decline, and dementia risk. Materials and Methods PubMed and Google Scholar were searched for English-language publications available through July 2026. Systematic reviews, meta-analyses, randomized controlled trials, observational studies, and relevant reviews were considered. Evidence was synthesized thematically according to exercise modality, cognitive outcomes, exercise dose, baseline cognitive status, and long-term cognitive trajectories. Results Aerobic, resistance, and mind-body exercise were associated with favorable cognitive outcomes, although effects varied across cognitive domains and populations. Resistance training improved global cognition in cognitively healthy (standardized mean difference 0.54) and cognitively impaired older adults (standardized mean difference 0.60). Dose-response evidence suggested nonlinear relationships, but did not establish a universally optimal exercise prescription. Longitudinal evidence indicated a modest association between greater physical activity and more favorable cognitive trajectories. Conclusions Physical activity and structured exercise are associated with favorable cognitive outcomes in older adults, but no single modality or dose can currently be considered universally optimal. Evidence does not establish that physical activity alone prevents cognitive decline or dementia. Further long-term research is needed to clarify comparative effects, dose-response relationships, and sustained cognitive outcomes.