Dementia is one of the most significant health and aged care issues facing Australia, and it is now the leading cause of death in the country (Dementia Australia, 2026). In 2026, an estimated 446,500 Australians are living with dementia, a number projected to rise by 82% to around 812,500 by 2054 (Dementia Australia, 2026). The impact reaches well beyond the person diagnosed: an estimated 1.7 million Australians are involved in caring for someone living with dementia (Dementia Australia, 2026).

This Dementia Action Week, I want to look at why exercise matters for people living with dementia, and why the way we deliver it can shape their long-term health and independence.

What is dementia?

Dementia is an umbrella term for a group of progressive brain conditions that cause decline in memory, thinking, language, behaviour and the physical ability to carry out everyday tasks. There are many types, the most common being Alzheimer’s disease, vascular dementia, Lewy body disease and frontotemporal dementia.

A common misconception is that dementia is a normal part of ageing. Age does increase risk, but many other risk factors can be changed. The 2024 Lancet Commission estimated that up to 45% of dementia cases could be prevented or delayed by addressing 14 modifiable risk factors, including physical inactivity, high blood pressure, obesity, high LDL cholesterol, hearing loss and smoking (Livingston et al., 2024).

There is no cure for dementia, but many people live active, fulfilling lives for years after diagnosis. Australian clinical guidelines recommend that people living with dementia be encouraged to exercise, and it is well recognised as a non-drug therapy for preserving physical function and independence (Forbes et al., 2015; Guideline Adaptation Committee, 2016).

How dementia affects movement

The effects of dementia on the body can be just as complex as its effects on memory, mood and thinking. Every person’s experience is different, but exercise can help with many of the physical challenges that come with dementia, including:

• Balance and mobility, to reduce the risk of falls
• Strength for everyday tasks such as climbing stairs, getting on and off public transport, and personal care
• Coordination and motor skills for multitasking, such as crossing the room while carrying a cup of tea or doing jobs around the home

The evidence is strongest for exercise helping people keep doing their everyday activities. A Cochrane review found that exercise programs may improve the ability of people with dementia to perform activities of daily living, while the effects on cognition are less clear (Forbes et al., 2015). For many people and their families, being able to shower, dress and get out into the community independently is the outcome that matters most.

What type of exercise, and how much?

There is no consensus on the ideal frequency, duration or intensity of exercise for people living with dementia. The practical goal is to help people move towards Australia’s Physical Activity and Exercise Guidelines, which for adults aged 65 and over recommend at least 30 minutes of moderate-intensity activity on most, preferably all, days, along with activities that build fitness, strength, balance and flexibility (Department of Health, Disability and Ageing, 2021). In practice, this means helping people spend more time each week on:

1. Aerobic exercise that raises your heart and breathing rate, such as brisk walking, cycling, swimming, stair climbing or boxing
2. Balance, mobility and coordination work, such as gait and balance exercises, dancing, tai chi or yoga
3. Muscle strengthening against your own bodyweight or an external load, such as squats, step-ups, pushing and pulling

Every bit of movement counts and adds up across the week. Whilst these guidelines can seem unachievable, even small shifts towards these guidelines can have significant outcomes in helping someone stay functionally independent.

Falls, strength and staying out of hospital

Dementia is progressive, and people often live with it for many years. Over that time, physical decline can lead to loss of muscle mass and a higher risk of falls, fractures and hospital admissions. People living with dementia fall more often than older adults without dementia, and falls are one of the most preventable reasons for hospitalisation in this group (Lach et al., 2017).

Inactivity accelerates this. Older adults can lose measurable muscle strength during even a short hospital stay, and the weakness and instability that follow raise the risk of further falls (Van Ancum et al., 2017). Because muscle strength is so closely tied to independence in later life, regular exercise should be a high priority for people living with dementia, and the earlier the habit is established the better.

Creating the right environment for exercise

The setting and the way we communicate can decide whether a session feels safe and enjoyable or confusing and distressing. A better understanding of how to connect with people living with dementia also helps them keep participating in community life (Pacifico et al., 2022). A few things make a real difference:

• Use their story. Long-term memories often stay intact. Ask about their work, footy team or favourite band. Reminiscence has been linked with small improvements in mood, communication and quality of life (Woods et al., 2018).
• Choose language carefully. Use their name, give one short instruction at a time, and demonstrate the movement. Accept what they say rather than correcting it, as arguing tends to increase distress (Dementia Australia, n.d.).
• Play familiar music. Songs from decades ago can bring back powerful memories and emotions. Playing familiar music may improve mood and emotional wellbeing in people with dementia (Dementia Australia, n.d.; van der Steen et al., 2018).
• Keep the space calm. Remove background noise, book quieter times, avoid crowded gym floors, and keep the same clinician, room and routine where possible (Dementia Australia, n.d.).

Getting started

If you or someone you care for is living with dementia, an Accredited Exercise Physiologist (AEP) can assess strength, balance and falls risk, and build a program around the person’s abilities, interests and routine. Sessions can happen at home, in a clinic or in a community gym, and may be funded through a Medicare chronic disease management plan, DVA, the NDIS for people with younger onset dementia, or aged care funding.

Written by: Alister MacInnes, Senior Exercise Physiologist and Exercise Scientist at The Biomechanics.

Alister’s article was also featured on Exercise Right.

References

Dementia Australia. (2026). Dementia facts and figures. https://www.dementia.org.au/about-dementia/dementia-facts-and-figures

Dementia Australia. (n.d.). Talking to someone with dementia. Retrieved September 21, 2026, from https://www.dementia.org.au/living-dementia/staying-connected/talking-someone-dementia

Department of Health, Disability and Ageing. (2021). Physical activity and exercise guidelines for older Australians (65 years and over). Australian Government. https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-older-australians-65-years-and-over

Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J., & Forbes, S. (2015). Exercise programs for people with dementia. Cochrane Database of Systematic Reviews, (4), Article CD006489. https://doi.org/10.1002/14651858.CD006489.pub4

Guideline Adaptation Committee. (2016). Clinical practice guidelines and principles of care for people with dementia. Guideline Adaptation Committee.

Lach, H. W., Harrison, B. E., & Phongphanngam, S. (2017). Falls and fall prevention in older adults with early-stage dementia: An integrative review. Research in Gerontological Nursing, 10(3), 139–148. https://doi.org/10.3928/19404921-20160908-01

Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., Fox, N. C., Ferri, C. P., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Nakasujja, N., Rockwood, K., ... Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0

Pacifico, D., Fiordelli, M., Fadda, M., Sabatini, S., Piumatti, G., Carlevaro, F., Magno, F., Franscella, G., & Albanese, E. (2022). Dementia is (not) a natural part of ageing: A cross-sectional study on dementia knowledge and misconceptions in Swiss and Italian young adults, adults, and older adults. BMC Public Health, 22(1), Article 2176. https://doi.org/10.1186/s12889-022-14578-8

Van Ancum, J. M., Scheerman, K., Jonkman, N. H., Smeenk, H. E., Kruizinga, R. C., Meskers, C. G. M., & Maier, A. B. (2017). Change in muscle strength and muscle mass in older hospitalized patients: A systematic review and meta-analysis. Experimental Gerontology, 92, 34–41. https://doi.org/10.1016/j.exger.2017.03.006

van der Steen, J. T., Smaling, H. J. A., van der Wouden, J. C., Bruinsma, M. S., Scholten, R. J. P. M., & Vink, A. C. (2018). Music-based therapeutic interventions for people with dementia. Cochrane Database of Systematic Reviews, (7), Article CD003477. https://doi.org/10.1002/14651858.CD003477.pub4

Woods, B., O’Philbin, L., Farrell, E. M., Spector, A. E., & Orrell, M. (2018). Reminiscence therapy for dementia. Cochrane Database of Systematic Reviews, (3), Article CD001120. https://doi.org/10.1002/14651858.CD001120.pub3