Exercise and Brain Health in Postmenopausal Women: A Review of Cognitive Benefits, Mechanisms, and Neurodegeneration Prevention

Menopause represents a major neuroendocrine transition characterized by substantial hormonal, metabolic, vascular, and inflammatory changes that may increase vulnerability to cognitive decline and neurodegenerative disease. Declining estrogen levels during the menopausal transition influence multiple neural processes, including synaptic plasticity, cerebral glucose metabolism, mitochondrial function, neuroinflammatory signaling, and cerebrovascular regulation. Women account for nearly two-thirds of individuals diagnosed with Alzheimer’s disease, and mounting evidence suggests that menopause may represent a period of heightened neurological vulnerability. Physical exercise has emerged as one of the most promising non-pharmacological strategies for preserving cognitive health and reducing neurodegeneration risk in aging women. Current evidence demonstrates that exercise interventions after menopause are associated with improvements in executive function, memory performance, attention, and global cognition. These benefits appear to result from converging biological mechanisms that include enhanced neurotrophic signaling, increased brain-derived neurotrophic factor (BDNF) expression, improved cerebrovascular function, reduced systemic inflammation, improved insulin sensitivity, enhanced metabolic regulation, and preservation of structural brain integrity. Neuroimaging studies further demonstrate exercise-associated increases in hippocampal volume, cortical thickness, functional connectivity, and cerebral blood flow. Different exercise modalities appear to produce distinct but complementary neurological benefits. Aerobic exercise is strongly associated with improved cerebrovascular function and hippocampal integrity, resistance training demonstrates favorable effects on executive function and white matter preservation, and multimodal interventions combining aerobic, resistance, balance, and cognitively engaging activities appear to produce the broadest cognitive benefits. Emerging evidence further suggests that the timing of exercise initiation relative to menopause may influence outcomes, with earlier interventions potentially conferring greater neuroprotection. This review synthesizes current evidence regarding the effects of exercise on cognitive function in postmenopausal women, with emphasis on biological mechanisms, neuroimaging findings, exercise modality, timing considerations, and implications for neurodegeneration prevention. Understanding these relationships provides a scientific rationale for positioning exercise as a foundational strategy for preserving cognitive health and reducing neurodegenerative disease burden in postmenopausal women.