Skip to main content Accessibility help
Hostname: page-component-cd4964975-xtmlv Total loading time: 0 Render date: 2023-03-31T23:46:25.035Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Chapter 16 - The Influence of Physical Exercise on Cognitive Aging

Published online by Cambridge University Press:  30 November 2019

Kenneth M. Heilman
University of Florida
Stephen E. Nadeau
University of Florida
Get access


Declines in cognitive functioning are a normal and widespread consequence of normal aging. Lacking promising drug interventions for reducing cognitive deficits, the field of cognitive aging has turned to nonpharmacologic treatments that could prevent or delay cognitive decline, or even improve performance in those at risk for decline. Physical activity is one of the most promising behavioral approaches for influencing cognitive and brain health. In this chapter, we first describe the ways of studying the relationship between physical activity, cardiorespiratory fitness, and cognitive functioning. We then summarize the existing evidence for how physical activity and cardiorespiratory fitness influence both cognition and the brain in the context of aging. By the end of the chapter, readers should be able to describe (1) typical patterns of associations between physical activity, cardiorespiratory fitness, and cognitive and brain health in older adults; (2) the evidence that increasing physical activity improves cognitive functioning in older adults; and (3) whether physical activity influences cognitive functions and brain health in older adults with mild to more severe cognitive deficits, such as found in people with mild cognitive impairment or dementia.

Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Caspersen, CJ, Powell, KE, Christenson, GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–31.Google ScholarPubMed
Adams, SA, Matthews, CE, Ebbeling, CB, Moore, CG, Cunningham, JE, Fulton, J, et al. The effect of social desirability and social approval on self-reports of physical activity. Am J Epidemiol. 2005;161(4):389–98.CrossRefGoogle ScholarPubMed
Prince, SA, Adamo, KB, Hamel, ME, Hardt, J, Connor Gorber, S, Tremblay, M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5(56):56.CrossRefGoogle ScholarPubMed
Committee PAGA. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: US Department of Health and Human Services; 2018.
Pate, RR, Pratt, M, Blair, SN, Haskell, WL, Macera, CA, Bouchard, C, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402–7.CrossRefGoogle ScholarPubMed
Spirduso, W. Physical fitness, aging, and psychomotor speed: a review. J Gerontol. 1980;35(6):850–65.CrossRefGoogle ScholarPubMed
Spirduso, W. Exercise and the aging brain. Res Q Exerc Sport. 1982;54(2):208–18.Google Scholar
Folstein, M, Folstein, S, McHugh, P. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefGoogle ScholarPubMed
Middleton, LE, Barnes, DE, Lui, LY, Yaffe, K. Physical activity over the life course and its association with cognitive performance and impairment in old age. J Am Geriatr Soc. 2010;58(7):1322–6.CrossRefGoogle ScholarPubMed
Oberlin, L, Verstynen, T, Burzynska, A, Voss, M, Prakash, R, Chaddock-Heyman, L, et al. White matter microstructure mediates the relationship between cardiorespiratory fitness and spatial working memory in older adults. NeuroImage. 2016;131:91101.CrossRefGoogle ScholarPubMed
Freudenberger, P, Petrovic, K, Sen, A, Toglhofer, A, Fixa, A, Hofer, E, et al. Fitness and cognition in the elderly: the Australian Stroke Prevention Study. Neurology. 2016;86(5):418–24.CrossRefGoogle Scholar
Dupuy, O, Gauthier, CJ, Fraser, SA, Desjardins-Crepeau, L, Desjardins, M, Mekary, S, et al. Higher levels of cardiovascular fitness are associated with better executive function and prefrontal oxygenation in younger and older women. Front Hum Neurosci. 2015;9:66.CrossRefGoogle ScholarPubMed
Hayes, SM, Hayes, JP, Cadden, M, Verfaellie, M. A review of cardiorespiratory fitness-related neuroplasticity in the aging brain. Front Aging Neurosci. 2013;5:31.CrossRefGoogle ScholarPubMed
Weuve, J, Kang, JH, Manson, JE, Breteler, MM, Ware, JH, Grodstein, F. Physical activity, including walking, and cognitive function in older women. JAMA. 2004;292(12):1454–61.CrossRefGoogle ScholarPubMed
Hillman, CH, Motl, RW, Pontifex, MB, Posthuma, D, Stubbe, JH, Boomsma, DI, et al. Physical activity and cognitive function in a cross-section of younger and older community-dwelling individuals. Health Psychol. 2006;25(6):678–87.CrossRefGoogle Scholar
Ainsworth, BE, Haskell, WL, Leon, AS, Jacobs, DR Jr., Montoye, HJ, Sallis, JF, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993;25(1):7180.CrossRefGoogle ScholarPubMed
Shephard, R, Vuillemin, A. Limits to the measurements of habitual physical activity by questionnaires. Br J Sports Med. 2003;37(3):197206.CrossRefGoogle ScholarPubMed
Innerd, P, Catt, M, Collerton, J, Davies, K, Trenell, M, Kirkwood, T, et al. A comparison of subjective and objective measures of physical activity from the Newcastle 85+ study. Age and Ageing. 2015;44(4):691–4.CrossRefGoogle ScholarPubMed
DeFina, L, Willis, B, Radford, N, Gao, A, Leonard, D, Haskell, W, et al. The association between midlife cardiorespiratory fitness levels and later-life dementia: a cohort study. Ann Intern Med. 2013;158(3):162–8.CrossRefGoogle ScholarPubMed
Laurin, D, Verreault, R, Lindsay, J, MacPherson, K, Rockwood, K. Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol. 2001;58(3):498504.CrossRefGoogle ScholarPubMed
Etgen, T, Sander, D, Huntgeburth, U, Poppert, H, Forstl, H, Bickel, H. Physical activity and incident cognitive impairment in elderly persons: the INVADE study. Arch Intern Med. 2010;170(2):186–93.CrossRefGoogle ScholarPubMed
Sofi, F, Valecchi, D, Bacci, D, Abbate, R, Gensini, GF, Casini, A, et al. Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J Intern Med. 2011;269(1):107–17.CrossRefGoogle ScholarPubMed
Hamer, M, Lavoie, KL, Bacon, SL. Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing. Br J Sports Med. 2014;48(3):239–43.CrossRefGoogle ScholarPubMed
Blondell, S, Hammersley-Mather, R, Veerman, J. Does physical activity prevent cognitive decline and dementia? A systematic review and meta-analysis of longitudinal studies. BMC Public Health. 2014;14(1).CrossRefGoogle ScholarPubMed
Grande, G, Vanacore, N, Maggiore, L, Cucumo, V, Ghiretti, R, Galimberti, D, et al. Physical activity reduces the risk of dementia in mild cognitive impairment subjects: a cohort study. J Alzheimers Dis. 2014;39(4):833–9.CrossRefGoogle ScholarPubMed
Bherer, L, Erickson, KI, Liu-Ambrose, T. A review of the effects of physical activity and exercise on cognitive and brain functions in older adults. J Aging Res. 2013;2013:657508.Google ScholarPubMed
Hamer, M, Chida, Y. Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med. 2009;39(1):311.CrossRefGoogle ScholarPubMed
Stephen, R, Hongisto, K, Solomon, A, Lonnroos, E. Physical activity and Alzheimer’s disease: a systematic review. J Gerontol A Biol Sci Med Sci. 2017;72(6):733–9.Google ScholarPubMed
Dustman, R, Ruhling, R, Russell, E, Shearer, D, Bonekat, H, Shigeoka, J, et al. Aerobic exercise training and improved neuropsychological function of older adults. Neurobiol Aging. 1984;5:3542.CrossRefGoogle Scholar
Colcombe, S, Kramer, AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125–30.CrossRefGoogle ScholarPubMed
Heyn, P, Abreu, BC, Ottenbacher, KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil. 2004;85(10):1694–704.Google ScholarPubMed
Groot, C, Hooghiemstra, A, Raijmakers, P, van Berckel, B, Scheltens, P, Scherder, E, et al. The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing Res Rev. 2016;25:1323.CrossRefGoogle ScholarPubMed
Lautenschlager, N, Cox, K, Flicker, L, Foster, J, van Bockxmeer, F, Xiao, J, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA. 2008;300(9):1027–37.CrossRefGoogle ScholarPubMed
Stewart, AL, Mills, KM, King, AC, Haskell, WL, Gillis, D, Ritter, PL. CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc. 2001;33(7):1126–41.Google ScholarPubMed
Rosen, WG, Mohs, RC, Davis, KL. A new rating scale for Alzheimer’s disease. Am J Psychiatry. 1984;141(11):1356–64.Google ScholarPubMed
Morris, J, Vidoni, E, Johnson, D, Van Sciver, A, Mahnken, J, Honea, R, et al. Aerobic exercise for Alzheimer’s disease: a randomized controlled pilot trial. PLoS ONE. 2017;12(2).CrossRefGoogle ScholarPubMed
Angevaren, M, Aufdemkampe, G, Verhaar, HJ, Aleman, A, Vanhees, L. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev. 2008;3(3).CrossRefGoogle Scholar
Barnes, DE, Santos-Modesitt, W, Poelke, G, Kramer, AF, Castro, C, Middleton, LE, et al. The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. JAMA Intern Med. 2013;173(9):797804.CrossRefGoogle ScholarPubMed
Sink, KM, Espeland, MA, Castro, CM, Church, T, Cohen, R, Dodson, JA, et al. Effect of a 24-month physical activity intervention vs health education on cognitive outcomes in sedentary older adults: the LIFE randomized trial. JAMA. 2015;314(8):781–90.CrossRefGoogle ScholarPubMed
Young, J, Angevaren, M, Rusted, J, Tabet, N. Aerobic exercise to improve cognitive function in older adults without known cognitive impairment. Cochrane Database Syst Rev. 2015 Apr 22;(4):CD005381.CrossRef
Stillman, C, Cohen, J, Lehman, M, Erickson, K. Mediators of physical activity on neurocognitive function: a review at multiple levels of analysis. Frontiers in Human Neuroscience. 2016 Dec 8;10:626.CrossRefGoogle ScholarPubMed
Hamilton, G, Rhodes, J. Exercise regulation of cognitive function and neuroplasticity in the healthy and diseased brain. Prog Mol Biol Transl Sci. 2015;135:381406.CrossRefGoogle ScholarPubMed
Cotman, C, Berchtold, N, Christie, L. Exercise builds brain health: key roles of growth factor cascades and inflammation. Trends Neurosci. 2007;30(9):464–72.CrossRefGoogle Scholar
Raz, N, Lindenberger, U, Rodrigue, K, Kennedy, K, Head, D, Williamson, A, et al. Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cereb Cortex. 2005;15(11):1676–89.CrossRefGoogle ScholarPubMed
Erickson, KI, Leckie, R, Weinstein, A. Physical activity, fitness, and gray matter volume. Neurobiol Aging. 2014;35(Suppl 2):S20S28.CrossRefGoogle ScholarPubMed
Colcombe, S, Erickson, KI, Raz, N, Webb, AG, Cohen, NJ, McAuley, E, et al. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Scie. 2003;58(2):M176M180.CrossRefGoogle ScholarPubMed
Erickson, KI, Prakash, R, Voss, M, Chaddock-Heyman, L, Hu, L, Morris, K, et al. Aerobic fitness is associated with hippocampal volume in elderly humans. Hippocampus. 2009;19(10):1030–9.CrossRefGoogle ScholarPubMed
Sen, A, Gider, P, Cavalieri, M, Freudenberge, P, Farzi, A, Schallert, M, et al. Association of cardiorespiratory fitness and morphological brain changes in the elderly: results of the Australian Stroke Prevention Study. Neurodegener Dis. 2012;10:135–7.CrossRefGoogle Scholar
Burzynska, A, Chaddock-Heyman, L, Voss, M, Wong, C, Gothe, N, Olson, E, et al. Physical activity and cardiorespiratory fitness are beneficial for white matter in low-fit older adults. PLoS ONE. 2014;9(9).CrossRefGoogle ScholarPubMed
Tian, Q, Simonsick, E, Erickson, KI, Aizenstein, H, Glynn, N, Boudreau, R, et al. Cardiorespiratory fitness and brain diffusion tensor imaging in adults over 80 years of age. Brain Research. 2014;1588:6372.CrossRefGoogle ScholarPubMed
Schwarb, H, Johnson, C, Daugherty, A, Hillman, CH, Kramer, AF, Cohen, NJ, et al. Aerobic fitness, hippocampal viscoelasticity, and relational memory performance. NeuroImage. 2017;153:179–88.CrossRefGoogle ScholarPubMed
Fletcher, M, Low, K, Boyd, R, Zimmerman, B, Gordon, B, Tan, C, et al. Comparing aging and fitness effects on brain anatomy. Front Hum Neurosci. 2016;10.CrossRefGoogle ScholarPubMed
Teixeira, C, Rezende, T, Weiler, M, Nogueira, M, Campos, B, Pegoraro, L, et al. Relation between aerobic fitness and brain structures in amnestic mild cognitive impairment elderly. Age (Dordr). 2016 Jun;38(3):51.CrossRefGoogle ScholarPubMed
Perea, R, Vidoni, E, Morris, J, Graves, R, Burns, J, Honea, R. Cardiorespiratory fitness and white matter integrity in Alzheimer’s disease. Brain Imaging Behav. 2016;10(3):660–8.CrossRefGoogle ScholarPubMed
Voss, M, Prakash, R, Erickson, K, Basak, C, Chaddock, L, Kim, J, et al. Plasticity of brain networks in a randomized intervention trial of exercise training in older adults. Front Aging Neurosci. 2010; 2.Google Scholar
Voss, M, Weng, T, Burzynska, A, Wong, C, Cooke, G, Clark, R, et al. Fitness, but not physical activity, is related to functional integrity of brain networks associated with aging. NeuroImage. 2016;131:113–25.CrossRefGoogle Scholar
Albinet, C, Mandrick, K, Bernard, P, Perrey, S, Blain, H. Improved cerebral oxygenation response and executive performance as a function of cardiorespiratory fitness in older women: a fNIRS study. Front Aging Neurosci. 2014;6.CrossRefGoogle ScholarPubMed
Wong, C, Chaddock-Heyman, L, Voss, M, Burzynska, A, Basak, C, Erickson, KI, et al. Brain activation during dual-task processing is associated with cardiorespiratory fitness and performance in older adults. Front Aging Neurosci. 2015 Aug 12;7:154.CrossRefGoogle ScholarPubMed
Erickson, KI, Raji, C, Lopez, O, Becker, J, Rosano, C, Newman, A, et al. Physical activity predicts gray matter volume in late adulthood: the Cardiovascular Health Study. Neurology. 2010;75(16):1415–22.CrossRefGoogle ScholarPubMed
Gow, A, Bastin, M, Maniega, S, Valdes Hernandez, M, Morris, Z, Murray, C, et al. Neuroprotective lifestyles and the aging brain: activity, atrophy, and white matter integrity. Neurology. 2012;79(17):1802–8.CrossRefGoogle ScholarPubMed
Best, J, Rosano, C, Aizenstein, H, Tian, Q, Boudreau, R, Ayonayon, H, et al. Long-term changes in time spent walking and subsequent cognitive and structural brain changes in older adults. Neurobiol Aging. 2017;57:153–61.CrossRefGoogle ScholarPubMed
Erickson, KI, Voss, MW, Prakash, RS, Basak, C, Szabo, A, Chaddock, L, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A. 2011;108(7):3017–22.CrossRefGoogle ScholarPubMed
Niemann, C, Godde, B, Voelcker-Rehage, C. Not only cardiovascular, but also coordinative exercise increases hippocampal volume in older adults. Front Aging Neurosci. 2014;6.CrossRefGoogle ScholarPubMed
Ten Brinke, L, Bolandzadeh, N, Nagamatsu, L, Hsu, C, Davis, J, Miran-Khan, K, et al. Aerobic exercise increases hippocampal volume in older women with probably mild cognitive impairment: a 6-month randomised controlled trial. Br J Sports Med. 2014;49(4):248–54.Google Scholar
Colcombe, S, Erickson, KI, Scalf, P, Kim, J, Prakash, R, McAuley, E, et al. Aerobic exercise training increases brain volume in aging humans. J Gerontol A Biol Sci Med Sci. 2006;61(11):1166–70.CrossRefGoogle ScholarPubMed
Firth, J, Stubbs, B, Vancampfort, D, Schuch, F, Lagopoulos, J, Rosenbaum, S, et al. Effect of aerobic exercise on hippocampal volume in humans: a systematic review and meta-analysis. NeuroImage. 2018;166:230–8.CrossRefGoogle ScholarPubMed
Smith, J, Nielson, K, Antuono, P, Lyons, J, Hanson, R, Butts, A, et al. Semantic memory functional MRI and cognitive function after exercise intervention in mild cognitive impairment. J Alzheimer’s Dis. 2013;37(1):197215.CrossRefGoogle ScholarPubMed
Suzuki, T, Shimada, H, Makizako, H, Doi, T, Yoshida, D, Ito, K, et al. A randomized controlled trial of multicomponent exercise in older adults with mild cognitive impairment. PLoS ONE. 2013;8(4):e61483.CrossRefGoogle ScholarPubMed
Burdette, J, Laurienti, P, Espeland, M, Morgan, A, Telesford, Q, Vechlekar, C, et al. Using network science to evaluate exercise-associated brain changes in older adults. Front Aging Neurosci. 2010;2.Google ScholarPubMed
Biswal, B, Kylen, J, Hyde, J. Simultaneous assessment of flow and BOLD signals in resting-state functional connectivity maps. NMR in Biomedicine. 1997;10(4–5):165–70.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
Reiter, K, Nielson, K, Smith, T, Weiss, L, Alfini, A, Smith, J. Improved cardiorespiratory fitness is associated with increased cortical thickness in mild cognitive impairment. J Int Neuropsychol Soc. 2015;21(10):757–67.CrossRefGoogle ScholarPubMed
Devenney, K, Sanders, M, Lawlor, B, Olde Rikkert, M, Schneider, S, Group, NS. The effects of an extensive exercise programme on the progression of mild cognitive impairment (MCI): study protocol for a randomised controlled trial. BMC Geriatrics. 2017;17(1).Google ScholarPubMed
Leeuwis, A, Hooghiemstra, A, Amier, R, Ferro, D, Franken, L, Nijveldt, R, et al. Design of the ECersion-VCI study: the effect of aerobic exercise on cerebral perfusion in patients with vascular cognitive impairment. ALzheimer’s & Dementia. 2017;3(2):157–65.Google ScholarPubMed
Cotman, C, Berchtold, N. Exercise: a behavioral intervention to enhance brain health and plasticity. Trends Neurosci. 2002;25(6):295301.CrossRefGoogle Scholar
Erickson, KI, Miller, D, Roecklein, K. The aging hippocampus: interactions between exercise, depression, and BDNF. Neuroscientist. 2012;18(1):8297.CrossRefGoogle ScholarPubMed
Leckie, R, Weinstein, A, Hodzic, J, Erickson, KI. Potential moderators of physical activity on brain health. J Aging Res. 2012;2012:948981.CrossRefGoogle ScholarPubMed
Rosendorff, C, Beeri, M, Silverman, J. Cardiovascular risk factors for Alzheimer’s disease. Am J Geriatr Cardiol. 2007;16(3):143–9.CrossRefGoogle ScholarPubMed
O’Donovan, C, Lithander, F, Raftery, T, Gormley, J, Mahmud, A, Hussey, J. Inverse relationship between physical activity and arterial stiffness in adults with hypertension. J Phys Act Health. 2014;11:272–7.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats