Physical activity and exercise in dementia: clinical relevance and emerging insights

Dementia continues to pose a growing challenge worldwide, particularly in aging populations where effective disease-modifying treatments remain limited. In this context, attention has increasingly shifted toward non-pharmacological approaches, including physical activity and structured exercise. Evidence accumulated over the past decade suggests that regular exercise may offer modest but meaningful benefits across several domains. These include improvements in cognitive function-especially executive function and attention-as well as gains in mobility, daily functioning, and psychological well-being. While the extent of cognitive improvement varies across studies, a consistent pattern emerges indicating greater benefit when interventions are initiated earlier in the disease course. Beyond clinical outcomes, several biological mechanisms have been proposed, including enhanced cerebral perfusion, upregulation of neurotrophic factors such as brain-derived neurotrophic factor, and attenuation of neuroinflammatory processes. At the same time, challenges remain. Differences in exercise protocols, issues related to adherence, and variability in patient populations make it difficult to define an optimal approach. Despite these limitations, physical activity represents a practical, low-cost strategy that can be integrated into routine care. Further research is needed to refine intervention design and understand long-term effects.