Can Walking Reduce the Risk of Alzheimer's Disease?
Walking time may be beneficial for females and those at risk of Alzheimer’s.
Posted May 6, 2026 | Reviewed by Davia Sills
Co-authored by Justin M. Palmer, Ph.D., and Scott M. Hayes, Ph.D., Director of the Buckeye Brain Aging Lab at Ohio State University
The apolipoprotein (APOE) gene is often referred to as the “Alzheimer’s disease” gene. APOE comes in three forms: e2, e3, and e4. An individual receives one APOE copy from each parent, resulting in six potential combinations. For example, someone could have a copy of both e3 and e4, or someone could have two copies of e2.
Most people have at least one e3 allele, whereas the e4 and e2 forms are less common. Those who carry e2 are at a decreased risk of developing Alzheimer’s disease. Individuals who carry e3 are not more or less at risk for developing Alzheimer’s disease. On the other hand, carriers of at least one copy of e4 are at a greater risk of accelerated cognitive decline and developing Alzheimer’s disease later in life.
Although possessing APOE e4 increases your risk for Alzheimer’s, it does not mean that you will develop Alzheimer’s disease. That is, increased risk does not equate to an eventual diagnosis. In fact, a recent paper reviewed many longitudinal studies and noted that most e4 carriers will not develop Alzheimer’s disease in their lifetime (Palmer et al., 2023).
The risk for Alzheimer’s disease is based on more than our genetics . It’s a complex story, impacted by many variables, including sex . For example, among APOE e4 carriers, females are at a greater risk of developing Alzheimer’s disease than males (Farrer, 1997). Additionally, physical activity may benefit cognition in APOE e4 carriers more than non-carriers (Jensen et al., 2019).
A recent study by Burma and colleagues (2026) published in Biology of Sex Differences examined some of these complex relationships between genetics, sex, physical activity, and cognition (Burma et al., 2026).
Who participated in the study, and what did they do?
The study included 3,000 older adults from the Pittsburgh and Memphis areas. Compared with other aging studies, the study sample included both Black and White participants with a wide range of educational attainment. This is important because studies that include participants with a variety of backgrounds make the study findings more generalizable . This means that the results of the study may be more applicable to the general population.
The study was longitudinal, which means the same participants were followed over a period of time. Here, participants completed tasks assessing general cognitive function, attention , and processing speed multiple times over 10 years. At each annual appointment, participants also reported the amount of time they spent walking each week (weekly walking time). This information was used to evaluate how walking time was associated with cognition for males and females for each APOE type: e2, e3, and e4.
This study had three main findings:
What does this mean if you are an APOE e4 carrier?
Results from this study suggest that increased walking time may be an important habit to build for those at increased risk of cognitive decline and Alzheimer’s disease (APOE e4 carriers). Of course, this does not eliminate risk for Alzheimer’s disease or completely stop cognitive decline. However, it may slow these processes and is an accessible option that may make a real difference for someone’s cognitive abilities.
This study is not suggesting that every e4 carrier must run a marathon every weekend—no matter how fun that may sound. The study reported that APOE e4 carriers who maintained 94 percent of their walking time from the prior year experienced less cognitive decline. This means that APOE e4 carriers should continue to prioritize their walking time as they age.
On average, over 10 years, participants walked 90 minutes per week (~12 minutes per day). This is not a prescription, meaning that 90 minutes isn’t a magic number to follow. Rather, this illustrates the potential feasibility of implementing a walking routine as a daily habit. Note that it may not even be necessary to have a single 12-minute walk. Rather, increasing your walking time in brief bouts throughout the day (two minutes here or there) may suffice.
Why does this matter?
The significance of walking impacting cognition is underscored by the lack of available and effective medications for cognitive decline. Emerging amyloid-targeting treatments for Alzheimer’s disease have limited improvements in cognition and daily functioning. Moreover, these drugs may not be available for APOE e4 carriers due to the risks associated with the treatment, indicating that there may be barriers to treatment for those at genetic risk for cognitive decline and Alzheimer’s disease.
One surprising finding was that a change in walking time was not associated with slower cognitive decline for the other APOE types. There can be several explanations for this, and it does not mean that physical activity is not helpful for people who have APOE e2 or e3. One potential reason may be that the duration or intensity of physical activity was not sufficient for the maintenance of cognitive performance. This is referred to as a dosage effect. It may be the case that physical activities beyond walking are necessary to see benefits.
With limited available and effective treatment options for Alzheimer’s disease, those at genetic risk for Alzheimer’s disease may feel overwhelmed. It is important to understand that increased genetic risk, such as being an APOE e4 carrier, does not mean that one will develop the disease. This study highlights the significance of focusing on lifestyle variables that can be modified as a feasible way to slow cognitive decline as we age, especially among those who carry APOE e4.
Burma, J. S., Rosano, C., Best, J. R., Simonsick, E. M., Liu-Ambrose, T., & Barha, C. K. (2026). Walking to protect against cognitive decline: The role of APOE genotype and sex. Biology of Sex Differences , 17 (1), 58. https://doi.org/10.1186/s13293-026-00860-6
Farrer, L. A. (1997). Effects of Age, Sex, and Ethnicity on the Association Between Apolipoprotein E Genotype and Alzheimer Disease: A Meta-analysis. JAMA , 278 (16), 1349. https://doi.org/10.1001/jama.1997.03550160069041
Jensen, C. S., Simonsen, A. H., Siersma, V., Beyer, N., Frederiksen, K. S., Gottrup, H., Hoffman, K., Høgh, P., Frikke‐Schmidt, R., Sobol, N. A., Waldemar, G., Wermuth, L., & Hasselbalch, S. G. (2019). Patients with Alzheimer’s disease who carry the APOE ε4 allele benefit more from physical exercise. Alzheimer’s & Dementia: Translational Research & Clinical Interventions , 5 (1), 99–106. https://doi.org/10.1016/j.trci.2019.02.007
Palmer, J. M., Huentelman, M., & Ryan, L. (2023). More than just risk for Alzheimer’s disease: APOE ε4’s impact on the aging brain. Trends in Neurosciences , 46 (9), 750–763. https://doi.org/10.1016/j.tins.2023.06.003
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Scott Hayes, Ph.D., is an Associate Professor in the Department of Psychology and a core member of the Center for Brain Injury Recovery and Discovery at The Ohio State University.
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