Alzheimer’s disease and related dementias are among the world’s foremost health and economic challenges, impacting over 55 million people worldwide and costing more than 1.3 trillion U.S. dollars in 2019 alone. With no imminent cure, there is an urgent need for interventions that reduce dementia risk in healthy older adults. 

Physical exercise is one of the greatest modifiable risk factors for dementia. Yet, exercise prescriptions for brain health in older adults are lacking. Unfortunately, the consequences of this are twofold. First, people may undervalue the clinical utility of exercise for dementia prevention, and second, it poses a barrier to the recommendation of exercise for healthy aging in primary care settings. Our graphical review, published in Exercise, Sport, and Movement, attempts to remedy this by providing evidence-based exercise prescription principles for dementia prevention as a starting point to help guide clinical practice and research. 

Building on current scientific evidence, we reviewed the state of knowledge concerning brain-level changes that occur with aging. We included details on why memory is impacted in healthy aging and how these changes progress toward dementia. To help readers understand how exercise promotes the brain’s health, we described pertinent physiological mechanisms through which exercise impacts the brain to support memory. Ultimately, we synthesized this fundamental knowledge into practical exercise prescription principles to help individuals and practitioners formulate evidence-informed exercise programs to support brain health. 

A notable strength was our use of the FITT framework — which details the frequency, intensity, time and type of exercise — thus providing the necessary components for formulating effective exercise prescriptions. We highlighted the similarities and differences in the suggested exercises for brain health versus those recommended by ACSM for cardiorespiratory, musculoskeletal and neuromotor fitness. Respecting the reality that one size does not fit all, we offer a flexible formula for creating exercise prescriptions that can be adapted to fit everyone’s unique needs. 

That said, the evidence suggests that certain types and intensities of exercise should be incorporated into every exercise prescription for brain health. Specifically, exercise “type” should include aerobic (walking, cycling, swimming, etc.), resistance (free weights, resistance bands, yoga, Tai Chi, etc.) or a blend of both types of exercise. Exercise “intensity” should include moderate to vigorous activities relative to the individual’s baseline cardiorespiratory fitness capabilities. In contrast, exercise “frequency” and “time” (duration) permit more freedom. Instead of setting a rigid threshold, the emphasis is on some physical activity is better than no physical activity (i.e., being sedentary), with the understanding that brain health is best supported by consistent engagement in regular exercise. 

As a starting point, we encourage practitioners to download the final figure of our graphical review, Figure 4, to initiate conversations about exercise with their clients. Practitioners are also encouraged to use behavioral change techniques like brief action planning and SMART goal setting to help their clients create and commit to an exercise plan that is feasible for them. For practitioners with limited experience with exercise prescription, a referral to an ACSM Certified Clinical Exercise Physiologist^® can ensure each patient receives the appropriate guidance. 

With the growing aging population and the rising prevalence of dementia, it has never been more important to optimize exercise programming for better brain health. We hope these principles for prescribing exercise for brain health will help stave off cognitive decline one step at a time. 

Jennifer Heisz, Ph.D., is an associate professor in kinesiology at McMaster University, director of the NeuroFit lab, and author of Move the Body, Heal the Mind. She is the interim editor-in-chief for ACSM’s premier open-access journal, Exercise, Sport, and Movement. Her research examines how physical activity promotes brain function, mental health and cognition in young adults, older adults and individuals with Alzheimer’s disease. 

Emma Waddington, M.Sc., is a McMaster University alumna and member of the NeuroFit lab. Her work examines the impact of orienteering training on cognitive function and has been featured in The New York Times, NBC and others. 

Viewpoints presented in ACSM Bulletin commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic must disclose such relationships at the time they accept an invitation to write for the ACSM Bulletin. 

Ozempic™, Wegovy™, Mounjaro™, and now, Zepbound™ - everywhere you turn, you hear about these new medications that have changed the weight loss world and are making a major impact on chronic diseases. The reality is that while 2023 has been flooded with media and excitement, it will likely continue - these effective medications promote, on average, 15-20+ percent weight loss.  

Now that these new medications are here, can we forget about diet and exercise when it comes to weight loss? 

If you asked me 20 years ago if I would be talking to you about using medications as a strategy for weight loss – I would have said, “No.”  

However, after working with thousands of people seeking to lose weight in both research and real-world settings, I now understand the complexity of obesity as a disease. Sometimes the path to weight loss using the traditional “eat less and exercise more” method is not enough, and additional support with medical management (like taking a medication) is needed.  

I get how confusing this can be, especially with all the media attention these new medications are getting and all the mixed messages out there. To simplify, let’s breakdown some common misconceptions that I hear a lot. Spoiler alert: being physically active is still important! 

#1 – Ozempic™ is the Magic Bullet for Weight Loss 

Ozempic™ is approved for the treatment of type 2 diabetes, not weight loss. The two popular medications that are FDA (Food and Drug Administration) approved for weight loss are semaglutide (Wegovy™) and tirzepatide (Zepbound™). These medications were originally approved for type 2 diabetes and later approved for weight loss, which explains why there are different trade names.

So, are Wegovy™ and Zepbound™ the magic bullets for weight loss?  

Rule No. 1 – if someone tells you they have “the perfect” weight loss method or program, do not engage! Whether you are seeking dietary or physical activity support, only work with professionals who spend time determining what is best FOR you, not just overlaying their method ON you. Seek out support from registered dietitians and certified exercise professionals with experience in weight management and behavior change strategies.  

#3 You Can Use a Medication to Quickly Lose Weight and Skip Diet and Exercise  

I hear this constantly in my work, and sadly it is promoted a lot by influencers and celebrities. It sounds like the perfect solution, especially if you have previously struggled to lose weight with diet and exercise alone. Unfortunately, talking about using the medications in this manner is not recommended for several reasons:  

First, all these medications were tested and approved for use alongside a lifestyle program that includes healthy eating and physical activity. Using a medication without modifying diet and moving more is against what is recommended!  

Secondly, once a person comes off the medication, those hunger signals will come back, and this can be followed by weight regain.  

Third, any time you lose weight, you don’t just lose fat mass, but also lean mass. This is typical, but there is concern that higher levels of lean mass loss might be occurring with these newer weight loss medications.  

A big question is whether the lean mass that is lost is actually your muscle mass.  

Most people don’t realize this, but the terms “lean mass” and “muscle mass” are not the same. Muscle mass is only one aspect of your body’s lean mass. Researchers are currently studying the effect these medications have on lean mass loss that includes not only muscle but also bone, water, organs, and other body tissues.  

Why does this matter to you? Some people taking these medications report feeling weaker and taking care of your muscular health may help.  

This is where exercise may play an important role. 

Will resistance training completely preserve lean mass or muscle mass loss? The verdict is still out, and the answer is likely no. But we do know that resistance training is still beneficial for you during weight loss, and of course can improve feelings of weakness, and your overall strength and physical function.  

Some people taking these medications also report feeling fatigued or tired even though they have lost weight.  

Overtime, participating in a regular exercise program can improve feelings of fatigue. Moderate-intensity physical activity, as simple as brisk walking, can be a great place to start to increase stamina.  

Have I convinced you yet that these medications are not quick fix for weight loss?!?!  

Bottom line – a foundation in healthy eating patterns and a physical activity plan are critically important to support your weight loss journey to have you feeling your very best! They may help you keep the weight off and provide health benefits beyond what happens on the scale.  


Dr. Renee J. Rogers, Ph.D., FACSM, is a senior scientist at the University of Kansas Medical Center and also works as an independent healthy lifestyle consultant and strategist. She chairs ACSM’s Strategic Health Initiative on Behavioral Strategies and Summit Program Committees. Dr. Rogers is an expert in bio-behavioral intervention design with a focus on relevant engagement approaches that blends her 20+ years of experience working in exercise physiology, behavior change, and weight management.