Physical activity and exercise for the prevention and management of mild cognitive impairment and dementia: a collaborative international guideline
Authors: Veronese Nicola , Soysal Pinar , Demurtas Jacopo , Solmi Marco , Bruyère Olivier , Christodoulou Nikos , Ramalho Rodrigo , Fusar-Poli Paolo , Lappas Andreas S. , Pinto Daniel , Frederiksen Kristian Steen , Corbi Grazia Maria , Karpenko Olga , Georges Jean , Durães João , Schlögl Mathias , Yilmaz Ozlem , Sieber Cornel , Shenkin Susan D. , Smith Lee , Reginster Jean-Yves , Maggi Stefania , Limongi Federica , Ars Joan , Barbagallo Mario , Cherubini Antonio , Quinn Terry ,   on behalf of Alzheimer Europe, Georges Jean ,   European College of Neuropsychopharmacology, Fusar-Poli Paolo , Solmi Marco ,   European Geriatric Medicine Society (Lead Society), Ramirez Javier Alonso , Alves Mariana , Bahat Gülistan , Bauer Jurgen , Bautman Ivan , Buzaco Rui , Herrero Álvaro Casas , Cesari Matteo , Chen Yaohua , Cherubini Antonio , Corbi Grazia Maria , Jentoft Alfonso Cruz , De Cock Anne-Marie , Demurtas Jacopo , Dogu Burcu Balam , Freiberger Ellen , Haaksma Miriam L. , Kotsani Marina , Lamb Sarah , Lamloum Mounir , Liuu Evelyne , Melis Rene , Bazan Laura Monica Perez , Polidori Maria Cristina , Ricart Joan Ars , Rincon Almudena Medina , Rolland Yves , Romero-Ortuno Roman , Sacco Guillaume , Schlögl Mathias , Schoene Daniel , Shapiro Debbie , Shenkin Susan , Sieber Cornel , Smith Lee , Soysal Pinar , Tannou Thomas , Veronese Nicola , Yilmaz Ozlem ,   European Interdisciplinary Council on Ageing, Brugiavini Agar , Limongi Federica , Maggi Stefania ,   European Society of Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, Bruyère Olivier , Pinto Daniel , Reginster Jean-Yves ,   International Association of Gerontology and Geriatrics-European Region, Barbagallo Mario ,   Scottish Brain Health ARC,   World Psychiatry Association-Preventive Psychiatry Section, Christodoulou Nikos , Karpenko Olga , Lappas Andreas S. , Ramalho Rodrigo ,   endorsed by the European Academy of Neurology, Duraes Joao , Schmidt Reinhold , Frederiksen Kristian Steen 
Published: September 2023

Abstract
Background
Physical activity and exercise have been suggested as effective interventions for the prevention and management of mild cognitive impairment (MCI) and dementia, but there are no international guidelines.

Objectives
To create a set of evidence- and expert consensus-based prevention and management recommendations regarding physical activity (any bodily movement produced by skeletal muscles that results in energy expenditure) and exercise (a subset of physical activity that is planned, structured, repetitive), applicable to a range of individuals from healthy older adults to those with MCI/dementia.

Methods
Guideline content was developed with input from several scientific and lay representatives’ societies. A systematic search across multidisciplinary databases was carried out until October 2021. Recommendations for prevention and management were developed according to the GRADE and complemented by consensus statements from the expert panels.

Recommendations
Physical activity may be considered for the primary prevention of dementia. In people with MCI there is continued uncertainty about the role of physical activity in slowing the conversion to dementia. Mind–body interventions have the greatest supporting evidence. In people with moderate dementia, exercise may be used for maintaining disability and cognition. All these recommendations were based on a very low/low certainty of evidence.

Conclusions
Although the scientific evidence on the beneficial role of physical activity and exercise in preserving cognitive functions in subjects with normal cognition, MCI or dementia is inconclusive, this panel, composed of scientific societies and other stakeholders, recommends their implementation based on their beneficial effects on almost all facets of health.