Get Help Quick Close

Resources

banner-image-2
Get Help Quick Close

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

Overview

These evidence-based physical activity guidelines were developed specifically for older Australians aged 60 and over with mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Adapted from the Canadian Physical Activity Guidelines for Older Adults using the ADAPTE guideline adaptation framework and assessed using the AGREE II instrument, the guidelines incorporate findings from a comprehensive literature review of 41 studies, including 24 randomised controlled trials. They address the benefits of physical activity across cognitive, physical, mental health, quality of life and biomarker outcomes in this population, and provide four formal recommendations covering aerobic activity, progressive resistance training, balance, and individually tailored exercise. The guidelines also include practical advice on barriers and enablers to participation in physical activity and identify priorities for future research. The document was funded by the Dementia Collaborative Research Centres (DCRCs) as a Commonwealth Government of Australia initiative, and includes both a technical guidelines document and a lay version developed for consumers.

Download this resource (~1,645KB) Give us feedback

Developed by the Academic Unit for Psychiatry of Old Age (AUPOA), University of Melbourne, funded by the Dementia Collaborative Research Centres (DCRCs) as part of an initiative of the Commonwealth Government of Australia

Individual authors

Lautenschlager NL, Cox K, Hill KD, Pond D, Ellis KA, Dow B, Hosking D, Chong T, You E, Curran E, Cyarto E, Southam J, Anstey KJ

Key insights

These guidelines synthesise evidence from 41 studies — including 24 randomised controlled trials — on the benefits of physical activity for older Australians aged 60 and over with mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Adapted from the Canadian Physical Activity Guidelines using the ADAPTE and AGREE II frameworks, they provide four practical recommendations to support brain health, physical function, mental health and quality of life in this population, while acknowledging significant evidence gaps that future research must address.

<p>Evidence from randomised controlled trials confirms that older adults with MCI or SCD can safely participate in physical activity and exercise, with adverse events &mdash; predominantly minor musculoskeletal injuries &mdash; 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.</p>

<p>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.</p>

<p>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.</p>

<p>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.</p>

<p>Evidence indicates that physical activity programs designed to accommodate cognitive impairment &mdash; through individual tailoring, supervision, graded intensity, simplified instruction with multimodal memory aids, social interaction and targeted education &mdash; 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.</p>

<p>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 &mdash; who represent approximately one third of Australia&#39;s older population &mdash; 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.</p>

Did this resource draw on transformative evidence?

<p>Yes &mdash; 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.</p>
<p>Yes &mdash; 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.</p>
<p>Yes &mdash; 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 &mdash; themselves based on a systematic review &mdash; 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.</p>

How can this resource help me as a...?

Toggle audience types below to explore.

Older adults aged 60 and over with MCI or SCD are the primary intended audience of these guidelines. A lay version of the guidelines was also produced to increase accessibility. The document provides clear, practical information about safe and beneficial types, frequencies and intensities of physical activity, including specific guidance on falls risk and how to seek advice from a healthcare provider.

Carers and family members of older adults with MCI or SCD are explicitly identified as key supports for initiating and maintaining physical activity participation. The guidelines highlight that the attitudes and encouragement of carers significantly influence engagement in physical activity, and provide information carers can use to understand the importance of PA and actively support participation.

Health professionals — including GPs, physiotherapists, occupational therapists and accredited exercise physiologists — are a primary audience. The guidelines provide evidence-based recommendations for prescribing tailored PA programs for patients with MCI or SCD, including practical guidance on supervision, safety monitoring, accommodating cognitive impairment, and enablers and barriers to adherence.

Government and policy bodies at Commonwealth and State level are explicitly identified as a target audience. The guidelines address broad public health priorities related to dementia prevention and health promotion for an ageing population, and are intended to inform investment and policy decisions regarding physical activity programs for older Australians.

The guidelines identify significant evidence gaps and make detailed recommendations for future research priorities, including study design, outcome measures, targeted populations and the need for pragmatic real-world trials. They represent a valuable foundation and reference point for researchers designing studies in this area.

Leaders of health and community services supporting older adults are an implicit audience. The guidelines inform service design decisions regarding PA programming, workforce capability requirements, and implementation considerations for older adults with MCI or SCD in community and clinical settings.

Feedback

Let us know if you found this resource useful.

Categories

Resource type

Practice Guideline

Literature Review

Target audiences

Carers

Practitioners

Policymakers

Researchers

Service Leaders

Consumers

Translational research priority theme

Community-based models of care

Dedicated supports for carers, families and supporters

Workforce capability

Promoting prevention, early intervention and help-seeking

Embedding evidence-informed continuous improvement

Supporting system navigation, partnerships and collaborative care

Delivering compassionate care, support and treatment

Working with diverse consumers, families and communities

Enabling reflective and supportive ways of working

Delivering holistic and collaborative assessment and care planning

Population cohort

Older Adults

Adults

Culturally & Linguistically Diverse Communities

People living with disability

Collaborative Centre core function

Lived Experience Participation

Service delivery

You might like

Related resources

Resource

Online Exercise Coaching for Cognitive & Mental Health

Can tailored online exercise coaching reduce dementia risk in older adults living with cognitive and mental health concerns? Explore the EXCEL study's promising findings and what they mean for practice and service delivery.

Published 13th May 2026

Resource

Physical Activity Model for Cognitive Health

What helps people with cognitive concerns and depression or anxiety get active? This evidence-informed model identifies five key mechanisms to guide precise, targeted physical activity intervention design for dementia risk reduction.

Published 13th May 2026

See all resources