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Effects of exercise on cognition and Alzheimer's biomarkers in a randomized controlled trial of adults with mild cognitive impairment: The EXERT study
Baker LD, Pa JA, Katula JA, Aslanyan V, Salmon DP, Jacobs DM, Chmelo EA, Hodge H, Morrison R, Matthews G, et al.. Alzheimer's & Dementia, 2025-04-24
Topic: Amyloid, tau and blood-test diagnosis
Introduction The EXERT study (Exercise in Adults with Mild Memory Problems) was a Phase 3, multicenter, randomized controlled trial that examined effects of exercise on cognition and other measures of brain health in sedentary older adults with amnestic mild cognitive impairment (MCI). Methods Participants were randomized to moderate-high intensity aerobic training (AX) or low-intensity stretching/balance/range of motion (SBR) for 18 months. Exercise was supervised for the first 12 months. Assessments were administered at baseline and every 6 months. The primary outcome was a global cognitive composite. Results A total of 296 participants were enrolled, and intervention adherence was high (supervised session attendance: AX = 81%, SBR = 87%). Intervention effects on cognition did not differ for AX and SBR (regression = -0.078, standard error [SE] = 0.074; p = 0.3). Notably, there was no 12 month cognition decline for either group, and mean 12 month hippocampal volume loss for both groups was low at 0.51%. Discussion Exercise intensity did not differentially affect cognitive trajectory. Intervention delivery was successful (high adherence) and cognition remained stable over 12 months for both MCI groups, an association that warrants further study. Highlights Exercise in Adults with Mild Memory Problems (EXERT) was a large multisite randomized controlled trial of moderate-high intensity aerobic training versus lower-intensity flexibility and balance exercise in sedentary older adults with amnestic mild cognitive impairment (MCI). A sensitive and validated measure of global cognitive function, the Alzheimer's Disease Assessment Scale-Cognition supplemented with tests of executive function (ADAS-Cog-Exec), was used to assess intervention efficacy with 12 months of supervised exercise. There was no intervention group difference on the 12-month cognitive trajectory of the ADAS-Cog-Exec. Intervention delivery was successful (high adherence), and cognition remained stable over 12 months for both exercise groups. Regular supported moderate-high or lower-intensity exercise may stall decline in adults with amnestic MCI, but further investigation is needed.
Key findings
- Results A total of 296 participants were enrolled, and intervention adherence was high (supervised session attendance: AX = 81%, SBR = 87%).
- Highlights Exercise in Adults with Mild Memory Problems (EXERT) was a large multisite randomized controlled trial of moderate-high intensity aerobic training versus lower-intensity flexibility and balance exercise in sedentary older adults with amnestic mild cognitive impairment (MCI).
Why it matters
In this trial of 296 people with mild cognitive impairment, moderate-high intensity aerobic exercise and low-intensity stretching/balance exercise did not differ in their effects on cognition. Cognition stayed stable over 12 months in both groups, but the study was not designed to show whether exercise prevents dementia.
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Study details
- Study designphase-3-trial
- Participants296
- Effect sizeBetween-group cognitive difference -0.078 (SE 0.074, p=0.3); 12-month hippocampal volume loss 0.51% in both arms
- Evidence strengthModerate
Limitations
No non-exercise control group, so the absence of decline cannot be attributed to exercise with certainty; sedentary volunteers willing to attend supervised sessions; 12-month cognitive comparison.
How this study scored 72/100
Published in a leading specialty journal, and it is a large phase 3 trial. We have no data on senior author's track record and free to read, so those were left out: it earned 68 of the 94 points we could judge it on, which is 72 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Alzheimer's & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 11 / 12 | A large phase 3 trial |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 296 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | 3 / 7 | Cited 29 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 9.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 4 / 6 | Cited 18.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 29 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 2 / 3 | University of California San Diego: institution h-index 1,852 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 10 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40271888) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 68 / 94 | Scored on 18 of 20 parts. We have no data for the rest, so they are left out: 68 of the 94 points we could judge it on is 72 out of 100. |
| Total | 72 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Baker, L. D., Pa, J. A., Katula, J. A., Aslanyan, V., Salmon, D. P., Jacobs, D. M., et al. (2025). Effects of exercise on cognition and Alzheimer's biomarkers in a randomized controlled trial of adults with mild cognitive impairment: The EXERT study. Alzheimer's & Dementia. https://doi.org/10.1002/alz.14586
Vancouver
Baker LD, Pa JA, Katula JA, Aslanyan V, Salmon DP, Jacobs DM, et al. Effects of exercise on cognition and Alzheimer's biomarkers in a randomized controlled trial of adults with mild cognitive impairment: The EXERT study. Alzheimer's & Dementia. 2025. doi:10.1002/alz.14586. PMID: 40271888.
BibTeX
@article{baker2025-40271888,
author = {Baker, L. D. and Pa, J. A. and Katula, J. A. and Aslanyan, V. and Salmon, D. P. and Jacobs, D. M. and Chmelo, E. A. and Hodge, H. and Morrison, R. and Matthews, G. and others},
title = {{Effects of exercise on cognition and Alzheimer's biomarkers in a randomized controlled trial of adults with mild cognitive impairment: The EXERT study}},
journal = {Alzheimer's \& Dementia},
year = {2025},
doi = {10.1002/alz.14586},
pmid = {40271888},
url = {https://doi.org/10.1002/alz.14586}
}
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