Physical Activity Guidelines for Older Australians with Mild Cognitive Impairment or Subjective Cognitive Decline

Evidence from randomised controlled trials confirms that older adults with MCI or SCD can safely participate in physical activity and exercise, with adverse events — predominantly minor musculoskeletal injuries — occurring infrequently and serious adverse events being extremely rare. The benefits of participation clearly outweigh the risks, and adherence levels across reviewed interventions were generally high with low dropout rates. This positions physical activity as a viable, low-risk health intervention for this population.

Eleven of thirteen Level 1 and 2 randomised controlled trials demonstrated that aerobic physical activity improved global cognitive function in older adults with MCI or SCD, with the most effective interventions delivered at or around 150 minutes per week of moderate-to-vigorous intensity. Aerobic activity was the most strongly evidenced activity type for cognitive benefit. Studies also showed improvements in aerobic fitness, metabolic health parameters and physical function, providing a consistent foundation for extrapolating general older adult population guidelines to people with MCI or SCD.

Multiple Level 1 and 2 quality randomised controlled trials found that progressive resistance training (PRT) undertaken on at least two days per week improved both cognitive outcomes and physical health and function in older adults with MCI or SCD. While the evidence base is smaller than for aerobic activity, it is consistent with findings for healthy older adults. MRI studies showed resistance training produced positive changes in brain structure, including reversal of white matter hyperintensities, suggesting a neurological mechanism for cognitive benefit.

Older adults with MCI or SCD have significantly higher falls risk and poorer balance than cognitively healthy peers, making balance-focused physical activity a priority recommendation. While no studies specifically examined balance-only interventions in this population, indirect evidence from five randomised controlled trials using multimodal interventions that included balance components showed both cognitive and physical health benefits. Balance recommendations are extrapolated from robust general older adult evidence and supported by the specific vulnerabilities of this cohort.

Evidence indicates that physical activity programs designed to accommodate cognitive impairment — through individual tailoring, supervision, graded intensity, simplified instruction with multimodal memory aids, social interaction and targeted education — improve both engagement and sustained adherence for older adults with MCI or SCD. People with MCI or SCD may have greater difficulty initiating and maintaining behaviour change independently, and the attitudes and encouragement of carers and health professionals were found to significantly influence participation. Consultation with a GP, physiotherapist or accredited exercise physiologist before commencing a program is recommended.

Despite growing evidence, there are insufficient studies specifically examining balance-only interventions for older adults with MCI or SCD, and dose-response relationships across activity types remain poorly understood. Research involving older people from culturally and linguistically diverse (CALD) backgrounds — who represent approximately one third of Australia's older population — or from socially disadvantaged groups, is largely absent from the evidence base. Future research must address these gaps through rigorous, large-scale and methodologically consistent trials that include diverse populations and real-world settings.

Yes — Seven consumer representatives with lived experience of cognitive health concerns participated as members of the independent advisory panel, reviewing and providing feedback on the lay version of the guidelines. Their involvement ensured the guidelines were relevant and accessible to the older adults they are designed to support. It should be noted that consumer review was limited to the lay consumer version rather than the full technical guideline document.

Yes — The multidisciplinary project team included clinicians with extensive practical expertise across psychiatry of old age, physiotherapy, exercise physiology, general practice, occupational therapy and psycho-social aspects of ageing. The independent advisory panel further included a geriatrician, occupational therapist and policy makers. Clinical judgement informed decisions about which recommendations to adapt from the Canadian Guidelines, how to modify them for the MCI or SCD population, and how to address practical considerations such as supervision, safety monitoring and tailoring approaches.

Yes — The guidelines are grounded in a comprehensive literature review that screened 668 studies and identified 41 as relevant, including 24 randomised controlled trials, 8 qualitative studies and 8 observational studies. The guideline development process followed internationally recognised frameworks (ADAPTE and AGREE II), and the Canadian Physical Activity Guidelines — themselves based on a systematic review — were used as the primary source for adaptation. Evidence was categorised by quality level, activity type and health outcome domain, providing a transparent and rigorous evidence foundation.