Exercise Training for Cerebrovascular and Cognitive Health in Adults at Risk of Cognitive Decline: A Scoping Review of Healthcare Translation and Evidence Gaps

Background/Objectives: Dementia and cognitive decline place increasing demands on healthcare systems, rehabilitation services, long-term care, and community-based prevention. Structured exercise training is a promising strategy for adults at risk of cognitive decline, but it remains unclear how intervention studies integrate cerebrovascular and cognitive outcomes in ways that can inform clinical translation, rehabilitation planning, and exercise prescription. Methods: This scoping review followed PRISMA-ScR guidance. PubMed/MEDLINE and Scopus were searched for peer-reviewed English-language studies published from 2010 to 2026, supplemented by reference list checking and citation chasing. Eligible studies were human intervention studies involving structured exercise training and at least one cerebrovascular, vascular, brain-related, or cognitive outcome. Studies were mapped by exercise modality, population risk profile, grouped outcome domain, and outcome-integration category. Results: Fifty-four studies were included. A central finding was the vascular cognitive integration gap: only 7 studies assessed both cerebrovascular and cognitive outcomes within the same intervention design, whereas 38 studies reported cognitive outcomes only and 9 reported cerebrovascular or vascular outcomes only. Aerobic training formed the most developed evidence cluster for direct cerebrovascular outcomes, whereas other modalities were more often represented in cognition-focused studies but less frequently included direct cerebrovascular measures. Conclusions: Current evidence is limited by a major vascular cognitive integration gap. Because most exercise intervention studies separate cerebrovascular and cognitive outcomes, the field cannot yet determine whether exercise-induced cerebrovascular adaptations correspond to cognitive improvements in the same participants. Future trials should combine cerebrovascular assessment, domain-specific cognitive testing, dose reporting, adherence monitoring, safety reporting, feasibility evaluation, and mechanistic biomarkers to support more precise exercise prescription for dementia risk mitigation and cognitive health promotion.