Takeaway
Advising patients that regular physical activity can improve not just physical, but also cognitive health, may motivate patients to start exercising.
Lifelong Learning in Clinical Excellence | August 7, 2025 | 2 min read
By Susan Lehmann, MD, Johns Hopkins Medicine
A 76-year-old patient recently told me he was “too old to exercise.” He’s a retired lawyer who never liked exercise; while his wife goes to the gym regularly, she hasn’t been able to persuade him to join her.
Motivating patients of any age to initiate and maintain regular exercise can be challenging for healthcare professionals, and this is especially true for older adults. In fact, according to data from National Institute of Health in the U.S., only about 30% of people between the ages of 45 to 64 exercise regularly, and among people aged 65 to 74 the percentage is only 15% and drops to 5% for people over age 85.
My patient’s comment particularly struck me because he voiced a common feeling among some older adults: that at some point, it might be too late in life to exercise. Certainly, we know that one is never too old to benefit from exercise in terms of improving strength, mobility, stamina, sleep and overall well-being. But what about cognitive health?
While exercise at mid-life is correlated with decreased future risk for dementia, there’s considerable evidence that exercise has cognitive benefits for older adults, even for those who already have some cognitive impairment. A systematic review from 2018 looked at 98 randomized controlled trials that examined the relationship between exercise and cognition in adults over the age of 60 and that included at least one neuropsychological outcome measure. They included studies with healthy older adults as well as those with cognitive impairment. Strikingly, they found that exercise improved cognitive performance in older adults, both with and without cognitive impairment. Benefits of exercise were seen in processing speed and attention, executive function, and global cognition.
In talking with older patients about the value of exercise it can be helpful to emphasize the benefits of exercise on cognitive brain health. As we age, we all want to maintain the ability to focus, concentrate, plan, organize as well as to learn and remember. The good news is that you are never too old to start and never too old to benefit from exercise.
Three pieces of advice to share with patients:
1. Make it doable.
Don’t start out with lofty goals in terms of time or type of exercise. Begin with 10 minutes a day. Walking is accessible to all of us and is great for brain and cardiovascular health.
2. Make it social.
Engage a friend to exercise with you. You’re more likely to do the exercise with a partner, and it will be more enjoyable, too.
3. Make it a habit.
Consistency is key. Find a time of day when it will work for you, either morning or afternoon is best. It can take one to two months for a new behavior to become a habit that feel an essential part of your daily and weekly routine.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.