Exercise and multidomain interventions for vascular cognitive impairment: A narrative review

Background: Vascular cognitive impairment (VCI) encompasses cognitive impairment attributable to cerebrovascular disease, including post-stroke cognitive impairment (PSCI). Exercise and multidomain interventions have been investigated in these populations; however, cognitive outcomes remain heterogeneous. Aims: To synthesize randomized controlled trials on exercise-based and exercise-inclusive multidomain interventions in VCI (including PSCI) and examine how population definition, intervention delivery, and outcome selection influence cognitive outcomes. Summary of review: A narrative review identified randomized or controlled trials reporting cognitive outcomes following exercise-only or multidomain interventions. Studies were grouped into three populations: documented cerebrovascular brain injury, vascular or metabolic risk-enriched populations without cognitively defined inclusion criteria, and cognitively defined risk states. The latter two groups were included as contextual comparators and were not assumed to meet criteria for VCI. In populations with documented cerebrovascular brain injury ( n = 20), longer-duration multidomain interventions focused on vascular risk-factor optimization and lifestyle advice improved vascular targets without consistent cognitive benefit. In contrast, structured and supervised exercise in chronic stroke and cerebral small-vessel disease more often reported domain-specific cognitive improvements, commonly in executive functioning and attention. In risk-enriched and cognitively defined populations, cognitive effects were more detectable when exercise was actively delivered and cognition was the primary outcome. Conclusions: Detectability of cognitive effects in exercise and multidomain interventions for VCI depends on population definition, outcome selection, and whether exercise is prescribed and delivered rather than simply advised.