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 January 2010 to 4 May 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. Cognitive outcomes were assessed more frequently than cerebrovascular outcomes: 38 studies reported cognitive outcomes only, 9 reported cerebrovascular or vascular outcomes only, and 7 assessed both domains within the same intervention design. 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 shows a major vascular-cognitive integration gap. Most exercise intervention studies do not determine whether cerebrovascular adaptations correspond with cognitive outcomes 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.