Alzheimer's Disease & Dementia
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Exercise Interventions to Improve Cognitive Performance in Older Adults – Potential Psychological Mediators to Explain Variation in Findings

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Published Online: May 15th 2012 European Neurological Review, 2012;7(2):107-112 DOI:
Authors: Jennifer Stock, Angela Clifford, Eef Hogervorst
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Evidence suggests that exercise interventions can improve cognitive performance in older adults and prevent dementia. However, there are inconsistent results across studies. Exercise interventions vary greatly in terms of their environment and specific features. As a consequence, the different types of social interaction, mental engagement and feedback alter the psychological impact of the exercise. In this article, mediating relationships are discussed in terms of the impact that psychological factors related to exercise can have on cognitive performance. The probable psychological mediators discussed here include self-efficacy, attitudes and self-perceptions of ageing, perceived control manifesting in a self-fulfilling prophecy, causal attributions of memory problems and mood. The mechanisms of these mediating relationships are unclear and further research is needed to investigate them. In addition, the magnitude of the effect of psychological mediators and their relative contribution compared with physiological mechanisms in this context should be further investigated.


Cognitive performance, exercise intervention, older adults, attitudes to ageing, self-perceptions, self-efficacy, perceived control, exercise environment, memory problems


Dementia is characterised by severe cognitive deficiencies that impact on functional activities of daily life.1 With an ageing population, the risk of dementia increases,2 which is a main cause of disability in later life, more so than some cancers, stroke and cardiovascular disease.3 Dementia is a worldwide problem. In the UK in 2010, there were estimated to be over 820,000 elderly afflicted with late-onset dementia.4 This is expected to rise to one million by 2025 and to exceed 1.7 million by 2051.5 The economic costs of dementia in the UK are estimated to be £23 billion per year (approximately twice as much as cancer).4

No cure for dementia is currently available; prevention is key to reducing risk. The nature–nurture debate can be used to illustrate the factors that explain individuals’ risk of developing dementia. Dementia risk cannot be entirely explained by genetics: the apolipoprotein E (APOE)-4 allele has been recognised as a risk factor for Alzheimer disease and also for a younger age of onset;6,7 however, not all individuals who have this allele develop dementia and not all individuals who develop dementia have this allele.8 Therefore, environmental factors are implicated for theircontribution to dementia risk. These include demographic factors9 such as education, occupation and socioeconomic status, as well as lifestyle factors including diet,10 smoking,11 social engagement12 andphysical activity.13

Modifiable risk factors for dementia overlap with those for cardiovascular disease.14 The evidence showing that exercise improves cardiovascular health is well documented.15 Due to the overlap in risk factors, the scope for physical exercise to improve cognitive performance – with the aim of delaying the onset of dementia – has been widely investigated. A recent review reported that many studies demonstrate that physical exercise can help to maintain cognitive abilities into old age, but not all treatment studies found positive effects.13 It was further reported that exercise may be more effective if carried out in midlife at the latest to prevent dementia in later life. However, once individuals have developed dementia, some cognitive improvement can still be seen through physical exercise. Some investigated direct physiological mechanisms for improvingcognitive performance through exercise include: encouraging neurogenesis and neurotrophins,16–18 a reduction in blood lipids,19 lowering of blood pressure19 and improved vascular output and cerebral perfusion.20 The effects of these direct mechanisms are unclear; both acute and longer-term effects of exercise on cognitive improvement have been reported, but there are wide variations in results across studies, with many not finding any effects.13

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Article Information:

The authors have no conflicts of interest to declare.


Eef Hogervorst, School of Sport, Exercise and Health Sciences, Applied Cognitive Research, Brockington Building, Loughborough University, LE11 3TU, UK. E:




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