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Physical fitness and incident mild cognitive impairment: a systematic review
European Review of Aging and Physical Activity volume 22, Article number: 10 (2025)
Abstract
Higher physical fitness is associated with various health outcomes, including decreased dementia risk. Little is known as to whether physical fitness is also associated with new onset of mild cognitive impairment (MCI). Our aim was to provide an overview of longitudinal research on the associations between physical fitness and the risk of incident MCI.
AbstractSection MethodsWe conducted a systematic literature review that examined associations between different components of physical fitness such as strength or endurance with incident MCI in older adults. We searched PubMed, Scopus, and Web of Science databases for longitudinal and/ or prospective cohort studies published in English or German. Screening was performed independently by two authors, and quality of included studies was assessed using the Newcastle Ottawa Scale.
AbstractSection ResultsThe search yielded 12,298 studies, of which 19 were included in the review, with follow-up times ranging from 2 to 26 years, and sample sizes ranging from 87 to 995,243 persons. Thirteen studies that examined associations between strength, variables related to muscle quality and function with incident MCI revealed inconsistent findings, e.g., six studies showed that lower handgrip strength was associated with higher MCI risk or that higher handgrip strength was associated with decreased MCI risk, respectively; while five studies reported no associations between handgrip strength and MCI risk or only for females. One study reported associations between lower cardiovascular fitness and increased risk of MCI. Twelve studies examined associations between balance, mobility and gait-related variables, mainly focusing on gait speed, but results were inconsistent, e.g., while some reported associations between slower gait speed and increased MCI risk, others did not or only in subgroups. Five studies reported associations between higher global/ composite fitness scores and decreased risk of incident MCI. Quality of included studies was rated as good.
AbstractSection ConclusionHigher cardiovascular and overall physical fitness is associated with a decreased risk of incident MCI. There are inconsistent associations between strength, balance- or gait-related variables and MCI risk. These findings indicate the importance of overall and cardiovascular physical fitness to potentially delay new onset of MCI. More research is needed to confirm these observations, and to untangle mechanisms underlying the associations between physical fitness components and MCI risk.
Introduction
Physical fitness is critical for both physical and mental health in old age. According to the American College of Sports Medicine (ACSM), one can distinguish between health-related (i.e., cardiorespiratory endurance, body composition, muscular strength, muscular endurance, and flexibility), and skill-related physical fitness components (i.e., agility, coordination, balance, power, reaction time, and speed) [1]. However, there is no universal definition of physical fitness. Other authors have proposed five different motor abilities as main components of physical fitness in humans, i.e., cardiorespiratory fitness or endurance, muscular strength, gross motor coordination, flexibility, and speed [2], or defined physical fitness as attributes enabling a person to perform activities that require aerobic capacity, strength, flexibility, or endurance [3]. It is well established that, in general, physical fitness components decline with increasing age (e.g., [4]), and older as compared to younger adults have reduced movement coordination, speed and lower-limb muscle strength, or impaired postural stability and balance, amongst others [5]. However, it has been proposed that certain fitness components may decline faster than others [6, 7], and that the decline in physical fitness varies considerably from person to person depending, for example, on the level of engaging in physical activity; leading to the construct of “fitness gap” [8]. Decreased physical fitness levels in older adults are associated with various health outcomes, including but not limited to increased mortality (e.g., [9]), metabolic syndrome (e.g., [10]), decreased activities of daily living and higher mobility-related disability (e.g., [11]), and higher risk of falling (e.g., [12]), particularly in persons with dementia [13] or mild cognitive impairment (MCI; [14, 15]).
MCI is the intermediate stage between normal cognitive aging and dementia, and persons with MCI are at increased risk of progression to dementia. MCI is characterized by cognitive concern expressed by a person, an informant and/ or a physician; impairment in one or more cognitive domains (i.e., memory, attention/ executive function, language, and visuospatial skills); essentially normal functional activities; and absence of dementia [16,17,18]. A recent meta-analysis estimated the global prevalence of MCI to be about 16% in community-dwelling persons aged ≥ 50 years [19]. Risk factors of MCI reported in the literature include advanced age, lower education, APOEε4 genotype, diabetes, neuropsychiatric symptoms, or cardiovascular disease [20]. In addition, we and others have shown that engaging in physical activity is associated with a decreased risk of new onset of MCI [21,22,23,24,25], albeit conflicting reports also exist [26].
A growing body of research examines the associations between different components of physical fitness and cognitive impairment in old age. With regard to associations between physical fitness and cognitive function in older adults, a large study among 877 persons aged ≥ 65 years showed that higher cardiorespiratory fitness is associated with better global and domain-specific cognitive performance [27], and a systematic review of longitudinal studies published before 2011 showed that physical functioning was associated with cognitive changes over time in older adults, with associations varying depending on the measurements used to assess both physical and cognitive performance [28]. Similarly, scoping reviews concluded that handgrip strength [29], slow gait speed [30], or walking ability [31] (mainly indicated by gait speed but also other parameters such as step frequency or variability) are associated with longitudinal cognitive decline, including dementia. Rather less reviews are available that focused on categorical outcomes of cognitive status, e.g., cognitive impairment or dementia. For example, a recent scoping review noted that impaired upper limb motor function, i.e., slower speed, increased errors, and greater movement variability, is associated with cognitive impairment, but most participants of included studies were recruited from clinical settings [32]. In addition, a systematic review and meta-analysis, mainly including prospective cohort studies, showed that decreased lower limb motor function as well as reduced performance on composite motor function, balance and gait velocity are associated with an increased risk of incident dementia [33]. Furthermore, a descriptive review revealed associations between different physical functions such as gait, balance, or fine and gross motor skills, with declines in cognitive function and risk of new onset of cognitive impairment [34]. However, most reviews have been published more than 10 years ago, and to the best of our knowledge, no review in recent years has examined the associations between various components of physical fitness as predictors, and the risk of incident MCI as outcome of interest in older adults.
In this review, we sought to provide an overview of the current state of observational research, i.e., longitudinal and prospective cohort studies on the associations between physical fitness or motor performance, and the risk of new onset of MCI. We anticipate that this review may generate important information for researchers, clinical practitioners, patients, and care partners alike on the importance of maintaining fitness or engaging in fitness-enhancing activities in old age to potentially delay new onset of MCI.
Methods
Design
This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; ID: 467990), and was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) expanded checklist [35].
Search strategy
We searched PubMed database using a predefined search term that included terms related to motor performance or physical fitness and MCI. Since relying solely on database search strategies may be non-exhaustive [36], further relevant studies were identified by screening the reference lists of all selected articles. The literature search was conducted in August of 2023, updated in September of 2024 and March of 2025, at which time we also searched Scopus and Web of Science databases in addition to PubMed. For the full search terms by database, please refer to Supplementary material 1.
Inclusion and exclusion criteria
Inclusion and exclusion criteria were formulated according to PECO as follows: (1) Population: We included studies among older persons free of cognitive impairment at baseline. Studies in specific patient groups (e.g., post-stroke patients) were excluded. (2) Exposure: We included studies that assessed or considered parameters of physical fitness (e.g., strength, endurance, gait etc.) as predictors of interest (i.e., independent variables). We did not include studies that examined parameters related to body composition/ weight, albeit body composition is regarded as health-related fitness parameter by some authors. (3) Comparator: Not applicable. (4) Outcome: We included studies that assessed or considered incident/ new onset of MCI as outcome of interest (i.e., dependent variable).
With regard to study design, we included all observational studies with longitudinal design (e.g., prospective cohort study) regardless of follow-up time or period, and published in English or German. Intervention studies, case reports or study protocols, as well as (systematic) reviews were excluded.
Study selection
For the initial search, all identified studies were exported to www.rayyan.ai (AI-based reference management tool), and duplicates were removed. Screening was performed independently by two authors (MB & JKR). First, studies were included/ excluded based on their titles. Second, all included studies were transferred to Citavi®, and included/ excluded based on their abstracts. Third, the full texts of included studies were scrutinized, and any reasons for exclusion were documented by the two authors. Any disagreements at one of the screening stages were addressed via discussion until consensus was reached. For the updated search, all retrieved articles were uploaded to ASRreview (AI-based reference management tool), where title and abstract screening was conducted. The remaining articles were then imported to Zotero, where full-text screening were performed.
Assessment of study quality
Quality of included studies in terms of reporting was assessed by two authors (MB & JKR) using the Newcastle-Ottawa Scale checklist. Studies were rated on a scale of 0 to 9 points, based on three categories (selection, comparability and outcome). A higher number of points reflects a better study quality.
Data extraction
All relevant information/ data from included studies was extracted using Microsoft Excel and Word, and comprised details on study characteristics such as sample size, study participants/ population and cognitive status, follow-up duration, predictor variables (i.e., physical fitness), outcome variable (i.e., incident/ new onset of MCI), and results as well as any strengths and limitations of the studies.
Results
The search yielded 12,298 studies, of which 19 were finally included in the review (Fig. 1 provides a flowchart of study selection). 17 out of 19 studies were conducted in a population-based setting, and follow-up times ranged from 2 [37, 38] to 26 [39] years. Studies were conducted in four different continents: North-America (i.e., USA and Mexico), Europe (i.e., the Netherlands, Sweden, Germany), Australia, and Asia (i.e., China, South Korea and Singapore). Sample sizes ranged between 87 [40] and 995,243 [39] persons, with a total of 1,036,186 persons from all studies included in this review. Measures of physical fitness used in studies and for which associations with MCI were reported were: (1) strength and variables related to muscle quality and function (i.e., handgrip strength [37, 38, 41,42,43,44,45,46,47,48,49,50], skeletal muscle mass [41, 44, 46], hand dexterity [42], leg strength [51], composite strength score [52]); (2) endurance/ cardiovascular fitness (i.e., graded cycle ergometer test [39]); (3) balance (i.e., one leg stand [42, 47]), mobility (i.e., Timed Up and Go test [51], Performance Oriented Mobility Assessment (POMA) [51]) and gait-related variables (i.e., speed, function, variability [37, 40, 42, 43, 46, 49,50,51, 53,54,55]); and (4) global or composite physical fitness scores including at least two of categories 1–3 such as strength and balance or gait [42, 46, 49] or Short Physical Performance Battery (SPPB) [44, 45]. For an overview of all studies included in the review, please refer to Table 1. For a cross table providing an overview of variables examined in included studies, please refer to Supplementary material 2.
Quality of included studies
Eight studies received the highest score of 9 [39, 41, 42, 44, 47, 49, 53, 54], five studies a score of 8 [40, 48, 51, 52, 55], four a score of 7 [37, 43, 46, 50], and two studies received a score of 6 [38, 45]. Overall, the quality of included studies can thus be rated as good, with only six out of 19 studies receiving a fair quality rating. Please refer to Table 2 for an overview of quality of included studies.
Associations between strength and variables related to muscle quality and function with incident MCI
The association between handgrip strength and incident MCI was examined in twelve studies: In six studies, higher handgrip strength was statistically significantly associated with lower risk of incident MCI [42, 43, 48] or lower handgrip strength with increased risk of MCI [45, 50, 52], whereas five studies did not report significant associations between handgrip strength and incident MCI [37, 41, 44, 46, 47]. One study reported a significant association between handgrip strength and incident MCI in women but not men [38]. Similarly, skeletal muscle mass was not associated with incident MCI in three studies [41, 44, 46], and neither was leg strength [51]. One study [42] reported that hand dexterity was associated with decreased risk of incident MCI, and this association remained significant when other motor domains (i.e., hand strength, gait function, and leg strength and balance) were included in the same model. Furthermore, one study created a muscular strength score derived from tests of 11 muscle groups [52] and showed that higher muscle strength was statistically significantly associated with a decreased risk of both incident and persistent MCI. Similarly, one study [41] provided evidence of an association between a higher composite sarcopenia score (albeit only including variables related to muscle mass and function) and increased MCI risk.
Associations between endurance/cardiovascular fitness with incident MCI
Only one study [39], albeit with a large sample of nearly 1 million persons and a mean follow-up of 25.7 years examined the associations between cardiovascular fitness as assessed using a graded cycle ergometer test and incident MCI. The investigators reported that participants with low or medium as compared to high cardiovascular fitness at the age of 18 years had a statistically significantly increased risk of incident MCI, with point estimates ranging between 2.96 and 3.83 for low, and between 1.52 and 1.75 for medium fitness, and depending on the type of adjustment (i.e., different confounding variables were used in the analyses).
Associations between balance, mobility and gait-related variables with incident MCI
Two studies examined the associations between one leg stand and incident MCI, with one study reporting no association [42], and one study providing evidence of an association between passing a 15 s one leg stand test and decreased risk of incident MCI [47]. One study [51] reported associations between worse performance in the Timed Up and Go test with increased risk of incident MCI, but associations between worse POMA score and incident MCI were only present in unadjusted models. Nine studies examined associations between different gait-related variables and the outcome of incident MCI. One study [42] reported that better gait function (as indicated by time and number of steps) was associated with a decreased risk of incident MCI. Similarly, six studies showed that lower gait speed was associated with increased MCI risk [49,50,51, 53, 55] or higher gait speed was associated with decreased MCI risk [43]. In one study [46], gait speed was not related to MCI risk, and in another [37], no overall associations between baseline gait speed and progression to MCI were found, but in analyses stratified by age, slower gait speed was associated with increased risk of new onset of MCI in participants aged > 65 years but not in those aged ≤ 65 years. One study [40] examined different gait variables as predictors of interest, and found that gait variability but not speed was associated with MCI risk. Specifically, participants with high gait variability had a 12% shorter mean survival free of MCI than participants with middle or low variability. Finally, one study [54] showed that each 0.05 m/s slower gait speed was associated with a 7% increase in the risk of developing MCI.
Associations between global or composite physical fitness scores with incident MCI
One study [42] reported statistically significant associations between a higher global motor score (including hand dexterity, hand and leg strength, and gait function) with a decreased risk of incident MCI, i.e., each one standard deviation (SD) increase in global motor score at baseline was associated with about a 20% decreased risk of MCI. Further analyses revealed, however, that global motor function was only significantly associated with incident non-amnestic but not amnestic MCI. Another study [49] created a physical frailty composite score based on four components (i.e., grip strength, gait, body composition, and fatigue) and showed that a higher physical frailty score was statistically significantly associated with an increased risk of incident as well as persistent MCI. Similarly, one study [46] used a sarcopenia score including variables on skeletal muscle mass, gait speed, and handgrip strength and showed statistically significant associations between a higher sarcopenia score and an increased MCI risk. Finally, two studies [44, 45] reported that lower extremity physical functional impairment as assessed by the SPPB was associated with an increased risk of new onset of MCI.
For a graphical display of results of included studies, please refer to Figs. 2, 3, 4, 5 and 6.
Graphical display of selected results from included studies reporting odds ratios. Note: Some studies reported multiple results for a motor performance parameter depending on the degree of adjustment (please also refer to Table 1); abbreviations: LSMM = Lean skeletal muscle mass; KES = Knee extension strength; POMA = Performance Oriented Mobility Assessment
Graphical display of selected results from included study on strength, muscle quality and function reporting Hazard ratios. Note: Some studies reported multiple results for a motor performance parameter depending on the degree of adjustment (please also refer to Table 1)
Graphical display of selected results from included study on endurance/ cardiovascular fitness reporting hazard ratios. Note: Some studies reported multiple results for a motor performance parameter depending on the degree of adjustment (please also refer to Table 1); abbreviations: CV = cardiovascular fitness
Graphical display of selected results from included study on balance, mobility and gait reporting Hazard ratios. Note: Some studies reported multiple results for a motor performance parameter depending on the degree of adjustment (please also refer to Table 1); Hazard ratios and 95% confidence intervals marked with an * are not fully depicted graphically due to higher upper bound of confidence interval
Graphical display of selected results from included study on global or composite fitness reporting hazard ratios. Note: Some studies reported multiple results for a motor performance parameter depending on the degree of adjustment (please also refer to Table 1); abbreviations: SPPB = Short Physical Performance Battery
Discussion
We here provide an overview of the current state of research on different components of physical fitness or motor performance and the outcome of incident MCI. Higher cardiovascular and overall physical fitness was associated with a decreased risk of incident MCI. However, the associations between strength, balance- or gait-related variables and the risk of MCI are less clear, and there are also differences across studies related to the strength of observed associations and effect sizes.
Results on the associations between strength and incident MCI were inconsistent, e.g., six studies reported associations between lower handgrip strength with higher risk of incident MCI [45, 50, 52] or between higher handgrip strength and decreased risk of incident MCI [42, 43, 48], respectively; whereas five studies failed at establishing associations between handgrip strength and risk of new onset of MCI [37, 41, 44, 46, 47]. One study found an association between lower handgrip strength and increased risk of incident MCI in women but not men [38]. Skeletal muscle mass does not appear to be associated with MCI risk [41, 44, 46], whereas hand dexterity [42] and overall strength scores [52] were predictors of MCI risk. While cardiovascular fitness has been favorably associated with a variety of health outcomes in many research studies, we only found one longitudinal study that examined associations between cardiovascular fitness and risk of incident MCI [39]. As one may expect, the study provided evidence that lower cardiovascular fitness is associated with higher risk of incident MCI. With regard to balance and gait-related variables as potential predictors of incident MCI, results of included studies are inconsistent. Most studies focused on gait speed, and some found associations between slower gait speed and increased MCI risk [49,50,51, 53, 55], whereas others did not [46] or only in subgroups [37], i.e., persons aged > 65 years. In addition, gait function and variability were associated with the risk of incident MCI [40]. Finally, we also included studies that created global or composite physical fitness scores, and these studies all showed that higher overall fitness was associated with a decreased risk of incident MCI [42, 46, 49].
The inconsistent results regarding strength, balance, and gait-related variables and their association with risk of incident MCI can likely be attributed to several factors. First, differences in study design, such as variations in sample size and age, population characteristics including ethnic and/ or geographical background, and follow-up duration, may impact findings. Another factor that might explain inconsistent findings is that physical fitness parameters are very complex and may not directly correlate with cognitive decline in a linear fashion. Also, both physical fitness (predictor) and MCI (outcome) are known to be impacted by various mediating and confounding variables, such as medical comorbidities, lifestyle factors, or genetic predispositions, that are not accounted for in many studies. Differences in point estimates and effect sizes across studies could result from diverse analytical approaches, including but not limited to statistical methods, model adjustments, or the inclusion/ exclusion of confounders.
In addition to the 19 studies included in this review, there were some other longitudinal studies that are closely related to our research question but did not fulfill all pre-defined inclusion criteria. For example, investigators from Oregon reported that, among 204 cognitively unimpaired older adults, age-related changes in gait speed and finger-tapping speed differed significantly between participants who later developed MCI versus those who remained cognitively unimpaired [56]. An analysis based on data from 1478 cognitively unimpaired older adults participating in the Mayo Clinic Study of Aging showed that faster gait speed at baseline was associated with less pronounced decline in global and domain-specific cognitive scores after a mean follow-up of 4 years [57]. With regard to strength, Korean researchers found that a decline in handgrip strength over time was associated with higher odds of having MCI among over 6000 older adults [58]. Investigators who conducted a case-control retrospective study in the setting of the Baltimore Longitudinal Study of Aging provided evidence that a greater rate of increase in 400-m walk lap time variability differentiated individuals who progressed to MCI or Alzheimer’s disease from matched controls who remained cognitively unimpaired over a mean follow-up of 5 years [59]. Moreover, studies exist that examined the relationship between physical fitness and incident MCI in specific patients groups, e.g. in hemodialysis patients [60]. Furthermore, it is important to note that there are also longitudinal studies that did not find associations between physical fitness and cognitive impairment or decline [61].
In addition, several cross-sectional studies showed that various components of physical fitness or motor performance such as gait speed [62,63,64,65,66] and other gait-related parameters [67,68,69,70], grip strength [63, 71,72,73], sarcopenia [63, 74, 75] and frailty [76, 77], falls and fall risk [78], cardiorespiratory fitness and endurance [66, 79], balance and mobility [65, 80], as well as overall physical performance [81, 82] are associated with MCI risk or cognitive impairment, albeit some studies also reported no associations [83].
Our review is also in line with a prior review on the associations between physical fitness and the risk of incident dementia [33] which showed that decreased lower limb motor function but not handgrip strength was associated with increased risk of developing dementia. Since publication of this review, some additional studies have become available that also report associations between fitness and new onset of dementia, for example related to gait [84, 85]. Furthermore, in line with our observations, one systematic review reported associations between gait variability assessed using instrumented kinematic assessment and incident MCI [86].
Of note, relevant to our review, motoric cognitive risk is a predementia syndrome characterized by slow gait and cognitive complaints [87], that is also known to show overlap with MCI as well as frailty [88]. Persons with motoric cognitive risk have an increased risk of developing incident dementia [89,90,91].
In addition, in our review, we did not include studies on the associations between body composition or related variables (other than muscle mass which is an indicator of muscle strength) and the risk of incident MCI. While body composition is considered a part or component of physical fitness in some definitions such as from the ACSM [1], we referred to other definitions that do not include body composition as a central component of physical fitness [2, 3] when we created the search terms for this review. However, in a non-systematic literature search, we identiefied several studies on the associations between different variables related to body composition such as body mass index [92,93,94,95] or central obesity [96] and the risk of incident MCI. In general, those studies showed that a less favorable body composition (i.e., higher body mass index or higher central obesity) is associated with increased risk of incident MCI, albeit one study found inverse results [97].
This review may have implications for clinical practice. For example, physicians treating older adults at risk for cognitive impairment may want to emphasize on the importance of engaging in physical fitness-enhancing activities and may even include a brief physical fitness exam to detect limitations of their patients with regard to certain fitness components such as cardiovascular fitness or balance. Such fitness components could be improved by engaging in targeted, individualized physical exercise. Future research should focus on examining the associations between different components of physical fitness with risk of incident MCI. Most studies included in our review focused on strength and gait-related parameters as potential predictors of MCI, with most studies using handgrip strength or gait speed, and less attention has been paid to other fitness components such as cardiovascular fitness, balance, mobility, or gross-motor coordination. Thus, any conclusions on the associations between these fitness components and the risk of incident MCI may be premature, and should be considered preliminary until confirmed by future studies.
It has been proposed in the literature that physical fitness, particularly cardiorespiratory fitness, can lead to better cognition and decreased MCI risk through various mechanisms, including but not limited to an increased neural plasticity [98] and cerebral oxygenation, or improved endothelial function. To this end, a meta-analysis including 51 randomized controlled trials revealed that not only endurance training, but also resistance training, may lead to improved endothelial function [99]. Resistance training has also been linked to reduced serum homocysteine [100], and increased insulin-like growth factor 1 (IGF-1) [101, 102]. While an elevated level of homocysteine is associated with impaired cognition [103] and Alzheimer’s disease [104], IGF-1 is known to have a favorable effect on neuronal growth and cognitive performance [105]. Physical activity may also play an important role in the association between physical fitness and incident MCI. For example, one study included in our review [54] showed that physical activity fragmentation (described by the investigators as the degree to which an individual alternates physical activity bouts and periods of rest) may interact with gait in predicting MCI risk, i.e., each 0.05 m/s slower gait speed at low but not high activity fragmentation was associated with MCI risk. The researchers postulate that slow gait speed coupled with low degree of activity fragmentation may be indicative of underlying causes linked to the central nervous system such as poor balance, gross-motor coordination or motor planning, which may ultimately be related to impaired cognition [54].
To the best of our knowledge, our review is novel in that it examined the associations between various components of physical fitness or motor performance with the risk of incident MCI in older adults based on longitudinal, observational studies. However, as in any review, one limitation pertains to the search term which may not have been suitable to detect all pertinent publications. However, we created the search term by considering search terms used in previous literature reviews on similar topics. Furthermore, the initial search was conducted in only one scientific database, i.e., PubMed and may therefore have missed pertinent studies that are not listed in PubMed, albeit we also screened reference lists of included research. However, when we updated the literature search, we also searched in Scopus and Web of Science databases. In our review, we included studies that examined whether physical fitness or motor performance (as predictor variables) is associated with the risk of incident MCI (as outcome of interest), hypothesizing that physical fitness may have an impact on future MCI risk. However, reverse causality is also possible, and cannot be ruled out based on observational studies like those included in our review. This means that it is also possible that persons who develop MCI are more likely to have lower fitness levels in pre-MCI stages, potentially due to lower engagement in physical activity and exercise. Indeed, longitudinal studies have shown that having MCI is associated with greater decline in physical fitness as compared to being cognitively unimpaired [106]. In addition, while we focused on different components of physical fitness or motor performance as predictor variables, we did not consider all variables that may be considered to be part of physical fitness. For example, we did not include studies on the associations between body composition and the risk of MCI in our review, e.g., [92,93,94]. Finally, we used the Newcastle-Ottawa Scale to rate the quality of included studies in terms of reporting, but did not evaluate risk of bias.
Conclusions
Higher cardiovascular and overall physical fitness appears to be associated with a lower risk of incident MCI in older adults, whereas associations between strength and balance- or gait-related variables with MCI risk are inconsistent. Importantly, no study reported that higher fitness is associated with increased MCI risk. Therefore, in line with a large body of prior research, our review suggests that older adults should aim at maintaining or increasing their physical fitness or motor performance in order to potentially delay new onset of MCI. More research is needed to confirm these observations, particularly focusing on cardiovascular fitness, balance, mobility, or gross-motor coordination as predictor variables, and also explore underlying mechanisms.
Data availability
All manuscripts included in the systematic review are published and available from PubMed.
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This study was funded by Baden-Württemberg Landesgraduiertenförderung (LGF) program (MB), Karlsruhe Institute of Technology and Barrow Neurological Foundation.
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MB and JKR designed the study, developed the search strategy, conducted the search, selected studies and rated risk of bias individually, and created the results tables according to the PRISMA statement. MB created the figures for graphical display. The manuscript was drafted by MB and JKR, and was substantially revised by YEG, KB and AW. All authors read and approved the final manuscript.
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Bergmann, M., Geda, Y., Boes, K. et al. Physical fitness and incident mild cognitive impairment: a systematic review. Eur Rev Aging Phys Act 22, 10 (2025). https://doi.org/10.1186/s11556-025-00376-9
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DOI: https://doi.org/10.1186/s11556-025-00376-9