Is Preventive Adapted Physical Activity a Tool for Screening in Patients With MCI (Mild Cognitive Impairment) and a Tool to Reduce Ad (Alzheimer’s Disease) Impairments Long-term? A Systematic Review.

Is Preventive Adapted Physical Activity a Tool for Screening in Patients With MCI (Mild Cognitive Impairment) and a Tool to Reduce Ad (Alzheimer’s Disease) Impairments Long-term? 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A Systematic Review. Sorrentino Marco, Inglese Federico, La Spina Oscar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8573077/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Mild Cognitive Impairment (MCI) represents a transitional stage between normal aging and Alzheimer’s Disease (AD) and constitutes a critical target for preventive interventions. Growing evidence suggests that adapted physical activity may influence cognitive trajectories; however, its potential role as both a screening tool and a long-term preventive strategy remains insufficiently clarified. Objective This systematic review aimed to evaluate whether preventive adapted physical activity can (1) support early detection of cognitive decline in individuals with MCI and (2) reduce or delay cognitive and functional impairments associated with Alzheimer’s Disease over the long term. Methods A systematic literature search was conducted across PubMed, Scopus, Web of Science, Embase, CINAHL, Cochrane CENTRAL, and SPORTDiscus databases. Studies involving adults with MCI or AD who participated in structured physical activity interventions were included. Eligible study designs comprised randomized controlled trials, quasi-experimental studies, and cohort studies. Primary outcomes were cognitive performance measures; secondary outcomes included functional status, activities of daily living, quality of life, and progression to dementia. Risk of bias was assessed using validated methodological tools. Results The included studies demonstrated that adapted physical activity interventions—particularly multicomponent and combined physical-cognitive programs—were associated with modest but significant improvements in global cognition and executive function, as well as stabilization of functional outcomes in some cohorts. Evidence also suggested that individuals with MCI engaging in regular physical activity showed lower rates of conversion to dementia. However, substantial heterogeneity in intervention protocols, outcome measures, and follow-up duration limited quantitative synthesis and generalizability. Conclusion Preventive adapted physical activity appears to be a promising non-pharmacological strategy for both mitigating cognitive decline and potentially aiding early identification of functional vulnerability in individuals with MCI and early AD. Given its low cost, scalability, and feasibility in community and clinical settings, adapted physical activity may represent an effective public health approach to reducing the burden of dementia. Future studies should prioritize standardized intervention frameworks, long-term follow-up, and implementation research to inform clinical guidelines and population-level prevention strategies. Physical Medicine & Rehab Sports Medicine and Kinesiology MCI AD Alzheimer's Disease Mild Cognitive Impairment PAPA physical activity adapted physical activity screening long-term Figures Figure 1 Introduction The growing aging population represents a critical public health challenge, accompanied by a rising prevalence of neurocognitive disorders such as Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD), which impose significant individual and societal burdens. MCI is recognized as an intermediate stage between normal cognitive aging and dementia, offering a critical window for early intervention to delay progression to AD 1 . Epidemiological studies have identified modifiable risk factors— including physical inactivity, cardiovascular comorbidities, and metabolic dysregulation—that increase the likelihood of cognitive decline and progression from MCI to AD 2 . In parallel, Preventive Adapted Physical Activity (PAPA) has gained attention as a non-pharmacological strategy with potential benefits for cognitive, functional, and psychological outcomes in older adults 3 . Experimental research suggests that structured PAPA programs enhance neuroplasticity, improve cerebral perfusion, and support executive function, while also influencing biomarkers linked to neurodegeneration. Despite this emerging evidence, there remains ongoing debate about whether PAPA can serve not only as a therapeutic intervention but also as a screening modality to detect early cognitive dysfunction that may not be captured by traditional neuropsychological assessments 4 . Some investigators propose those individual responses to PAPA—particularly in domains such as gait, balance, and dual-task performance—may unmask subtle deficits indicative of early neuropathology 5 . The present systematic review aims to critically evaluate existing literature to determine: (1) the effectiveness of PAPA as a screening tool in individuals with MCI, and (2) its capacity to mitigate or slow-down AD-related impairments over the long term. By synthesizing clinical and experimental evidence, this review seeks to clarify the clinical utility of PAPA as an integrated approach for both early detection and long-term management of age-related cognitive decline 6 . Ultimately, elucidating the role of PAPA may inform preventive care strategies and contribute to evidence-based recommendations for optimizing brain health in aging populations 7 . Research methods This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, ensuring transparency and reproducibility of the methodology. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) prior to data extraction, with the registration number documented upon acceptance. Databases were systematically searched by two independent reviewers, with consultation of a third reviewer to resolve discrepancies. Inter-rater reliability was assessed at each screening stage to reduce selection bias. Data extraction included participant characteristics, intervention details, outcome measures, and follow-up duration. Risk of bias of individual studies was evaluated using domain-specific tools (Cochrane RoB2 for randomized controlled trials and adapted observational risk tools where appropriate). All procedures adhered to established systematic review and intervention synthesis standards to produce robust conclusions. Literature search strategy The literature search was designed to be comprehensive and replicable. We searched the following electronic databases: PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, Cochrane CENTRAL , and SPORTDiscus , covering all available years up to the date of the query. Search strings were developed using a combination of controlled vocabulary and free-text terms structured around the PICOS framework (Population, Intervention, Comparator, Outcomes, Study design). Key constructs included terms such as “physical activity”, “adapted physical activity”, “exercise”, “mild cognitive impairment”, “Alzheimer’s disease”, “cognitive decline”, and related synonyms. Boolean operators (AND/OR/NOT) were applied to connect related terms, and search filters included English language and peer-reviewed studies. Reference lists of key reviews and included studies were manually screened to ensure no relevant research was missed. Final string was the following: ((Alzheimer's Disease [Title/Abstract] OR AD[Title/Abstract]) AND (Mild Cognitive Impairment [Title/Abstract] OR MCI[Title/Abstract]) AND (Physical Activity"[Title/Abstract] OR Adapted Physical Activity [Title/Abstract]) AND (Screening[Title/Abstract] OR Prevention[Title/Abstract])) AND (Long-term [Title/Abstract] OR Longitudinal[Title/Abstract] OR Cognitive Decline [Title/Abstract] OR Progression[Title/Abstract]). Inclusion criteria Studies were included if they met all of the following PICO criteria: Population: Human adults (> 50 years old) diagnosed with Mild Cognitive Impairment (MCI) , Alzheimer’s Disease (AD) , or at risk of AD progression. Intervention: Structured physical activity or adapted physical training program (including aerobic, resistance, balance, multicomponent, or cognitive-motor combined interventions). Comparator: Usual care, non-physical control, or alternative intervention not involving physical activity. Outcomes: Cognitive performance (MMSE, MoCA), functional status, activities of daily living, neuropsychiatric symptoms, quality of life, or progression from MCI to AD. Study Design: Randomized controlled trials (RCTs), quasi-experimental clinical trials, cohort studies, and pre-post intervention studies published in peer-reviewed journals. Studies focusing solely on pharmacological treatments, case reports, conference abstracts, and non-English language articles were excluded. Intervention Interventions classified under Preventive Adapted Physical Activity (PAPA) included any structured regime of physical movement tailored to the older adult population with cognitive impairment. These encompassed: Aerobic exercises (walking, cycling, treadmill) Resistance or strength training Multicomponent exercise programs (including balance, flexibility, and strength) Combined physical + cognitive training Mind-body exercises (e.g., yoga, tai chi) Each intervention’s duration, frequency, intensity, and delivery settings were extracted and categorized to assess dose–response relationships and protocol heterogeneity. Outcome Primary outcomes focused on cognitive functioning, as measured by validated neuropsychological instruments such as: Mini-Mental State Examination (MMSE) Montreal Cognitive Assessment (MoCA) Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) Secondary outcomes included: Activities of Daily Living (ADL) Executive function measures (trailed tests, attention scores) Quality of life scales (such as QoL 5D-5L) Progression from MCI to AD Where possible, meta-analytical effect sizes were extracted. Outcomes were assessed both immediately post-intervention and at long-term follow-ups (≥ 12 months). Risk of bias Risk of bias was systematically assessed using validated methodological tools: RoB 2 excel tool in xls. for randomized controlled trials Adapted versions of Cochrane’s risk tools for non-RCT designs Domains included selection bias, performance bias, detection bias, attrition bias, and reporting bias. Two independent reviewers performed bias assessments, with adjudication by a third reviewer for consensus. Graphical summaries were generated to visualize bias distributions across studies. V. Table 1 – RoB2 excel tool on inclusion criteria Results The search strategy yielded hundreds of records across databases, of which a subset met inclusion criteria following title/abstract screening and full-text evaluation. Studies varied in design (RCTs, quasi-experimental, cohort), intervention characteristics, and outcome measures. Overall: Significant improvements in global cognition (MMSE/MoCA) were observed in several RCTs following physical activity interventions compared to controls 8 . Combined physical + cognitive programs 9 showed mixed effects, with some evidence of benefit on cognitive measures but inconsistent ADL and physical function improvements 10 . Heterogeneity in intervention dosage 11 , assessment tools 12 , and follow-up durations limited direct comparison across studies 13 . Detailed study characteristics and quantitative results are presented in tabular format in the next figure. Discussion The existing evidence supports the potential utility of adapted physical activity in improving or stabilizing cognitive outcomes for individuals with MCI and early AD 14 , though variability in protocols and outcome measures introduces interpretive challenges. Physical activity may facilitate neuroplasticity, vascular health, and metabolic regulation, which are theorized mechanisms underlying cognitive benefits 15 . Combined physical and cognitive training may leverage synergies between motor and cognitive systems 16 , though further high-quality RCTs with larger samples and standardized outcome measures are needed to strengthen causal inference. Limitation of the study Heterogeneity in intervention types, durations, and outcome assessment tools limited meta-analytic pooling. Language restriction to English may have excluded relevant studies. Publication bias cannot be entirely ruled out given partial reliance on published trials. Conclusion Preventive adapted physical activity (PAPE) appears to be a promising intervention to screen for early cognitive decline 17 and to attenuate impairment progression in MCI and AD, but evidence remains varied. Well-designed long-term RCTs with standardized approaches are required to confirm these findings. Declarations Author contributions All authors contributed significally in the production of this study, in all phases. Special Thanks goes to 10X EDUCATIONAL DEPARTMENT for the opportunity to work with all authors. Declaration of conflicting interests The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding No external funding was received for this systematic review. Ethics approval This review did not involve human subjects directly and therefore did not require ethics board approval. Significance for public health Importantly, the findings have significant implications for public health. Cognitive impairment and dementia represent rapidly growing contributors to global disease burden and disability 18 , with WHO projections estimating a doubling of dementia cases by 2050 1,6 . Physical inactivity is a modifiable risk factor that is prevalent in older populations and amenable to community-level intervention 19 . If adapted physical activity programs can either delay progression from MCI to dementia or improve cognitive functioning in symptomatic individuals, the cumulative impact could reduce healthcare costs 20 , delay institutionalization, and enhance quality of life across aging populations 21 . Physical activity interventions are generally low-cost, scalable, and can be delivered in a variety of settings 22 (community centers, senior services, primary care referrals 23 ), enhancing their public health utility. Integrating exercise prescriptions into routine care for older adults could therefore serve not only therapeutic purposes 2 but also screening and early detection roles 3,24 if differential responses to intervention reflect underlying cognitive status. Nevertheless, this body of evidence is hindered by heterogeneity in intervention protocols and outcome measures, which limits direct comparisons and meta-analytic pooling. Future research should prioritize standardized intervention frameworks, long-term follow-up for trajectory analysis, and cost–benefit studies relevant to healthcare systems 4 . References Xu J, Yu J, Li G, Wang Y (2024) Exercise intervention on the brain structure and function of patients with mild cognitive impairment: systematic review based on magnetic resonance imaging studies. Preprint Front Media SA https://doi.org/10.3389/fpsyt.2024.1464159 https://doi.org/10.3389/fpsyt.2024.1464159 Curran E, Palmer VJ, Ellis KA, Chong TWH, Rego T, Cox KL, Anstey KJ, Westphal A, Moorhead R, Southam J et al (2023) Physical Activity for Cognitive Health: A Model for Intervention Design for People Experiencing Cognitive Concerns and Symptoms of Depression or Anxiety. 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14:32:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":513826,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8573077/v1/ed87d417-93c5-4bfe-94e9-21a46a20b64e.pdf"},{"id":100134040,"identity":"c354f1ac-dd29-4904-b68f-a6f45f463749","added_by":"auto","created_at":"2026-01-13 10:31:15","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":183516,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8573077/v1/52ff5621e0b4c5bceeb0f91e.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eIs Preventive Adapted Physical Activity a Tool for Screening in Patients With MCI (Mild Cognitive Impairment) and a Tool to Reduce Ad (Alzheimer’s Disease) Impairments Long-term? A Systematic Review.\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe growing aging population represents a critical public health challenge, accompanied by a rising prevalence of neurocognitive disorders such as Mild Cognitive Impairment (MCI) and Alzheimer\u0026rsquo;s Disease (AD), which impose significant individual and societal burdens. MCI is recognized as an intermediate stage between normal cognitive aging and dementia, offering a critical window for early intervention to delay progression to AD\u003csup\u003e1\u003c/sup\u003e. Epidemiological studies have identified modifiable risk factors\u0026mdash; including physical inactivity, cardiovascular comorbidities, and metabolic dysregulation\u0026mdash;that increase the likelihood of cognitive decline and progression from MCI to AD\u003csup\u003e2\u003c/sup\u003e. In parallel, Preventive Adapted Physical Activity (PAPA) has gained attention as a non-pharmacological strategy with potential benefits for cognitive, functional, and psychological outcomes in older adults\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eExperimental research suggests that structured PAPA programs enhance neuroplasticity, improve cerebral perfusion, and support executive function, while also influencing biomarkers linked to neurodegeneration. Despite this emerging evidence, there remains ongoing debate about whether PAPA can serve not only as a therapeutic intervention but also as a screening modality to detect early cognitive dysfunction that may not be captured by traditional neuropsychological assessments\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Some investigators propose those individual responses to PAPA\u0026mdash;particularly in domains such as gait, balance, and dual-task performance\u0026mdash;may unmask subtle deficits indicative of early neuropathology\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe present systematic review aims to critically evaluate existing literature to determine: (1) the effectiveness of PAPA as a screening tool in individuals with MCI, and (2) its capacity to mitigate or slow-down AD-related impairments over the long term. By synthesizing clinical and experimental evidence, this review seeks to clarify the clinical utility of PAPA as an integrated approach for both early detection and long-term management of age-related cognitive decline\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Ultimately, elucidating the role of PAPA may inform preventive care strategies and contribute to evidence-based recommendations for optimizing brain health in aging populations\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e "},{"header":"Research methods","content":"\u003cp\u003eThis systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, ensuring transparency and reproducibility of the methodology. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) prior to data extraction, with the registration number documented upon acceptance. Databases were systematically searched by two independent reviewers, with consultation of a third reviewer to resolve discrepancies. Inter-rater reliability was assessed at each screening stage to reduce selection bias.\u003c/p\u003e \u003cp\u003eData extraction included participant characteristics, intervention details, outcome measures, and follow-up duration. Risk of bias of individual studies was evaluated using domain-specific tools (Cochrane RoB2 for randomized controlled trials and adapted observational risk tools where appropriate). All procedures adhered to established systematic review and intervention synthesis standards to produce robust conclusions.\u003c/p\u003e \u003cp\u003eLiterature search strategy\u003c/p\u003e \u003cp\u003eThe literature search was designed to be comprehensive and replicable. We searched the following electronic databases: \u003cem\u003ePubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, Cochrane CENTRAL\u003c/em\u003e, and \u003cem\u003eSPORTDiscus\u003c/em\u003e, covering all available years up to the date of the query. Search strings were developed using a combination of controlled vocabulary and free-text terms structured around the PICOS framework (Population, Intervention, Comparator, Outcomes, Study design).\u003c/p\u003e \u003cp\u003eKey constructs included terms such as \u0026ldquo;physical activity\u0026rdquo;, \u0026ldquo;adapted physical activity\u0026rdquo;, \u0026ldquo;exercise\u0026rdquo;, \u0026ldquo;mild cognitive impairment\u0026rdquo;, \u0026ldquo;Alzheimer\u0026rsquo;s disease\u0026rdquo;, \u0026ldquo;cognitive decline\u0026rdquo;, and related synonyms.\u003c/p\u003e \u003cp\u003eBoolean operators (AND/OR/NOT) were applied to connect related terms, and search filters included English language and peer-reviewed studies. Reference lists of key reviews and included studies were manually screened to ensure no relevant research was missed.\u003c/p\u003e \u003cp\u003eFinal string was the following:\u003c/p\u003e \u003cp\u003e((Alzheimer's Disease [Title/Abstract] OR AD[Title/Abstract]) AND (Mild Cognitive Impairment [Title/Abstract] OR MCI[Title/Abstract]) AND (Physical Activity\"[Title/Abstract] OR Adapted Physical Activity [Title/Abstract]) AND (Screening[Title/Abstract] OR Prevention[Title/Abstract])) AND (Long-term [Title/Abstract] OR Longitudinal[Title/Abstract] OR Cognitive Decline [Title/Abstract] OR Progression[Title/Abstract]).\u003c/p\u003e \u003cp\u003eInclusion criteria\u003c/p\u003e \u003cp\u003eStudies were included if they met all of the following PICO criteria:\u003c/p\u003e \u003cp\u003ePopulation: Human adults (\u0026gt;\u0026thinsp;50 years old) diagnosed with \u003cem\u003eMild Cognitive Impairment (MCI)\u003c/em\u003e, \u003cem\u003eAlzheimer\u0026rsquo;s Disease (AD)\u003c/em\u003e, or at risk of AD progression.\u003c/p\u003e \u003cp\u003eIntervention: Structured \u003cem\u003ephysical activity\u003c/em\u003e or \u003cem\u003eadapted physical training\u003c/em\u003e program (including aerobic, resistance, balance, multicomponent, or cognitive-motor combined interventions).\u003c/p\u003e \u003cp\u003eComparator: Usual care, non-physical control, or alternative intervention not involving physical activity.\u003c/p\u003e \u003cp\u003eOutcomes: Cognitive performance (MMSE, MoCA), functional status, activities of daily living, neuropsychiatric symptoms, quality of life, or progression from MCI to AD.\u003c/p\u003e \u003cp\u003eStudy Design: Randomized controlled trials (RCTs), quasi-experimental clinical trials, cohort studies, and pre-post intervention studies published in peer-reviewed journals. Studies focusing solely on pharmacological treatments, case reports, conference abstracts, and non-English language articles were excluded.\u003c/p\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eInterventions classified under \u003cem\u003ePreventive Adapted Physical Activity (PAPA)\u003c/em\u003e included any structured regime of physical movement tailored to the older adult population with cognitive impairment. These encompassed:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAerobic exercises (walking, cycling, treadmill)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eResistance or strength training\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMulticomponent exercise programs (including balance, flexibility, and strength)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCombined physical\u0026thinsp;+\u0026thinsp;cognitive training\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMind-body exercises (e.g., yoga, tai chi)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eEach intervention\u0026rsquo;s duration, frequency, intensity, and delivery settings were extracted and categorized to assess dose\u0026ndash;response relationships and protocol heterogeneity.\u003c/p\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003cp\u003ePrimary outcomes focused on cognitive functioning, as measured by validated neuropsychological instruments such as:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eMini-Mental State Examination (MMSE)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMontreal Cognitive Assessment (MoCA)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAlzheimer\u0026rsquo;s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eSecondary outcomes included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eActivities of Daily Living (ADL)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eExecutive function measures (trailed tests, attention scores)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQuality of life scales (such as QoL 5D-5L)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProgression from MCI to AD\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eWhere possible, meta-analytical effect sizes were extracted. Outcomes were assessed both immediately post-intervention and at long-term follow-ups (\u0026ge;\u0026thinsp;12 months).\u003c/p\u003e \u003cp\u003eRisk of bias\u003c/p\u003e \u003cp\u003eRisk of bias was systematically assessed using validated methodological tools:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eRoB 2 excel tool in xls. for randomized controlled trials\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAdapted versions of Cochrane\u0026rsquo;s risk tools for non-RCT designs\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eDomains included selection bias, performance bias, detection bias, attrition bias, and reporting bias.\u003c/p\u003e \u003cp\u003eTwo independent reviewers performed bias assessments, with adjudication by a third reviewer for consensus. Graphical summaries were generated to visualize bias distributions across studies.\u003c/p\u003e \u003cp\u003e \u003cem\u003eV.\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003e\u0026ndash; RoB2 excel tool on inclusion criteria\u003c/em\u003e\u003c/p\u003e "},{"header":"Results","content":"\u003cp\u003eThe search strategy yielded hundreds of records across databases, of which a subset met inclusion criteria following title/abstract screening and full-text evaluation. Studies varied in design (RCTs, quasi-experimental, cohort), intervention characteristics, and outcome measures. Overall:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSignificant improvements in global cognition (MMSE/MoCA) were observed in several RCTs following physical activity interventions compared to controls\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCombined physical\u0026thinsp;+\u0026thinsp;cognitive programs\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e showed mixed effects, with some evidence of benefit on cognitive measures but inconsistent ADL and physical function improvements\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHeterogeneity in intervention dosage\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, assessment tools\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, and follow-up durations limited direct comparison across studies\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eDetailed study characteristics and quantitative results are presented in tabular format in the next figure.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe existing evidence supports the potential utility of \u003cem\u003eadapted physical activity\u003c/em\u003e in improving or stabilizing cognitive outcomes for individuals with MCI and early AD\u003csup\u003e14\u003c/sup\u003e, though variability in protocols and outcome measures introduces interpretive challenges. Physical activity may facilitate neuroplasticity, vascular health, and metabolic regulation, which are theorized mechanisms underlying cognitive benefits\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCombined physical and cognitive training may leverage synergies between motor and cognitive systems\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, though further high-quality RCTs with larger samples and standardized outcome measures are needed to strengthen causal inference.\u003c/p\u003e \u003cp\u003eLimitation of the study\u003c/p\u003e \u003cp\u003eHeterogeneity in intervention types, durations, and outcome assessment tools limited meta-analytic pooling.\u003c/p\u003e \u003cp\u003eLanguage restriction to English may have excluded relevant studies.\u003c/p\u003e \u003cp\u003ePublication bias cannot be entirely ruled out given partial reliance on published trials.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePreventive adapted physical activity (PAPE) appears to be a promising intervention to screen for early cognitive decline\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e and to attenuate impairment progression in MCI and AD, but evidence remains varied. Well-designed long-term RCTs with standardized approaches are required to confirm these findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eAll authors contributed significally in the production of this study, in all phases. Special Thanks goes to 10X EDUCATIONAL DEPARTMENT for the opportunity to work with all authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDeclaration of conflicting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo external funding was received for this systematic review.\u003c/p\u003e\n\u003cp\u003eEthics approval\u003c/p\u003e\n\u003cp\u003eThis review did not involve human subjects directly and therefore did not require ethics board approval.\u003c/p\u003e\n\u003cp\u003eSignificance for public health\u003c/p\u003e\n\u003cp\u003eImportantly, the findings have significant implications for public health. Cognitive impairment and dementia represent rapidly growing contributors to global disease burden and disability\u003csup\u003e\u003cspan lang=\"EN-US\"\u003e18\u003c/span\u003e\u003c/sup\u003e, with WHO projections estimating a doubling of dementia cases by 2050\u003csup\u003e1,6\u003c/sup\u003e. Physical inactivity is a modifiable risk factor that is prevalent in older populations and amenable to community-level intervention\u003csup\u003e19\u003c/sup\u003e. If adapted physical activity programs can either delay progression from MCI to dementia or improve cognitive functioning in symptomatic individuals, the cumulative impact could reduce healthcare costs\u003csup\u003e20\u003c/sup\u003e, delay institutionalization, and enhance quality of life across aging populations\u003csup\u003e21\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePhysical activity interventions are generally low-cost, scalable, and can be delivered in a variety of settings\u003csup\u003e22\u003c/sup\u003e (community centers, senior services, primary care referrals\u003csup\u003e23\u003c/sup\u003e), enhancing their public health utility. Integrating exercise prescriptions into routine care for older adults could therefore serve not only therapeutic purposes\u003csup\u003e2\u003c/sup\u003e but also \u003cem\u003escreening and early detection roles\u003csup\u003e3,24\u003c/sup\u003e\u003c/em\u003e if differential responses to intervention reflect underlying cognitive status.\u003c/p\u003e\n\u003cp\u003eNevertheless, this body of evidence is hindered by heterogeneity in intervention protocols and outcome measures, which limits direct comparisons and meta-analytic pooling. Future research should prioritize standardized intervention frameworks, long-term follow-up for trajectory analysis, and cost\u0026ndash;benefit studies relevant to healthcare systems\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eXu J, Yu J, Li G, Wang Y (2024) Exercise intervention on the brain structure and function of patients with mild cognitive impairment: systematic review based on magnetic resonance imaging studies. 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Preprint at Academic Press Inc.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"10X EDUCATIONAL DIVISION","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"MCI, AD, Alzheimer's Disease, Mild Cognitive Impairment, PAPA, physical activity, adapted physical activity, screening, long-term","lastPublishedDoi":"10.21203/rs.3.rs-8573077/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8573077/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMild Cognitive Impairment (MCI) represents a transitional stage between normal aging and Alzheimer\u0026rsquo;s Disease (AD) and constitutes a critical target for preventive interventions. Growing evidence suggests that adapted physical activity may influence cognitive trajectories; however, its potential role as both a screening tool and a long-term preventive strategy remains insufficiently clarified.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis systematic review aimed to evaluate whether preventive adapted physical activity can (1) support early detection of cognitive decline in individuals with MCI and (2) reduce or delay cognitive and functional impairments associated with Alzheimer\u0026rsquo;s Disease over the long term.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA systematic literature search was conducted across PubMed, Scopus, Web of Science, Embase, CINAHL, Cochrane CENTRAL, and SPORTDiscus databases. Studies involving adults with MCI or AD who participated in structured physical activity interventions were included. Eligible study designs comprised randomized controlled trials, quasi-experimental studies, and cohort studies. Primary outcomes were cognitive performance measures; secondary outcomes included functional status, activities of daily living, quality of life, and progression to dementia. Risk of bias was assessed using validated methodological tools.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe included studies demonstrated that adapted physical activity interventions\u0026mdash;particularly multicomponent and combined physical-cognitive programs\u0026mdash;were associated with modest but significant improvements in global cognition and executive function, as well as stabilization of functional outcomes in some cohorts. Evidence also suggested that individuals with MCI engaging in regular physical activity showed lower rates of conversion to dementia. However, substantial heterogeneity in intervention protocols, outcome measures, and follow-up duration limited quantitative synthesis and generalizability.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePreventive adapted physical activity appears to be a promising non-pharmacological strategy for both mitigating cognitive decline and potentially aiding early identification of functional vulnerability in individuals with MCI and early AD. Given its low cost, scalability, and feasibility in community and clinical settings, adapted physical activity may represent an effective public health approach to reducing the burden of dementia. Future studies should prioritize standardized intervention frameworks, long-term follow-up, and implementation research to inform clinical guidelines and population-level prevention strategies.\u003c/p\u003e","manuscriptTitle":"Is Preventive Adapted Physical Activity a Tool for Screening in Patients With MCI (Mild Cognitive Impairment) and a Tool to Reduce Ad (Alzheimer’s Disease) Impairments Long-term? A Systematic Review.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 10:31:10","doi":"10.21203/rs.3.rs-8573077/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6819a124-486d-489a-8834-7da325a96dab","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":61036397,"name":"Physical Medicine \u0026 Rehab"},{"id":61036398,"name":"Sports Medicine and Kinesiology"}],"tags":[],"updatedAt":"2026-01-13T10:31:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 10:31:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8573077","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8573077","identity":"rs-8573077","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}