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REVIEW ARTICLE

Effectiveness of physical exercise on cognitive and functional capacity in elderly patients with Alzheimer’s disease: A systematic review of randomized controlled trials

Enkeleda Gjini1 ,  Jasemin Todri2* ,  Orges Lena2
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1 Department of Nursing, Faculty of Medicine, Catholic University of Our Lady of Good Counsel, Tirana, Albania
2 Innovation in Manual and Physical Therapies Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Podology and Ocupational Therapy, UCAM San Antonio Catholic University, Murcia, Spain
Advanced Neurology, 025420099 https://doi.org/10.36922/AN025420099
Received: 19 October 2025 | Revised: 15 November 2025 | Accepted: 28 November 2025 | Published online: 9 December 2025
(This article belongs to the Special Issue Mechanisms and Interventions for Emotional and Cognitive Disorders)
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Alzheimer’s disease (AD) is a neurodegenerative condition characterized by progressive cognitive decline and a loss of functional independence. Physical exercise has emerged as a potential non-pharmacological intervention capable of improving or maintaining both cognitive and functional capacities in individuals with AD. This study synthesizes evidence from randomized controlled trials (RCTs) published between 2011 and 2024 evaluating the effects of physical exercise on cognitive and functional outcomes in elderly patients diagnosed with AD. A systematic search was conducted across PubMed, Web of Science, Cochrane Library, PsycINFO, and Physiotherapy Evidence Database databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The inclusion criteria were RCTs with participants (i) aged 65 years or older, (ii) clinically diagnosed with mild-to-moderate AD, (iii) who received structured physical exercise interventions compared with usual care or non-exercise controls, and (iv) assessed for cognitive and/or functional outcomes. The risk of bias was evaluated using the Cochrane Collaboration’s risk-of-bias tool, and the quality of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation approach. Seven RCTs met the inclusion criteria (n = 550 participants, mean age = 75 years). Exercise interventions included aerobic, resistance, or multicomponent training lasting 12–52 weeks. Five studies demonstrated stabilization or modest improvement in cognitive scores, and six reported significant functional benefits in gait, balance, or activities of daily living. No serious adverse events were reported. Overall, moderate-intensity aerobic or multicomponent exercise performed at least 3 times weekly for 16 weeks or longer appears to maintain or modestly enhance cognitive performance, while consistently improving functional capacity in elderly individuals with mild-to-moderate AD. These findings support exercise as a safe, evidence-based adjunct to pharmacological treatment in AD management.

Keywords
Alzheimer’s disease; Physical exercise
Cognitive function
Functional capacity
Elderly
Rehabilitation
Funding
The study publication fee was supported by Delta Pharma Albania (grant no.: 57).
Conflict of interest
The authors declare that they have no competing interests.
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing
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