Neurodegenerative diseases, including Alzheimer’s disease, are complex multifactorial disorders. They are usually characterized by a chronic course of the disease and very long, clinically silent latency phase. This prolonged latency, during which the disease has not yet manifested itself, opens up the opportunity for targeted or general prevention. While there are to date hardly any lasting and causal therapeutic options for the most important neurodegenerative diseases, in the case of Alzheimer’s disease, for example, an estimated one third of the risk factors is potentially modifiable. Among these physical activity has a prominent position. Its relevance is very well documented, but many details, for example with respect to type and extent of sporting activity, remain unclear. The underlying mechanisms are poorly understood to date. Distinction between effects of actual sports and physical activity in daily living are difficult. The development of specific mechanistic hypotheses permits, however, to pursue more concrete and optimized lifestyle interventions. These hypotheses currently transform from the perception that the consequences of sports on the brain are simply positive side effects to the idea that here specific primary feedback mechanisms become visible, because nervous systems in the first place evolved to permit motility. In order to be successful with prevention, an early integration of sports and motility into the routines of daily life is required. From the perspective of sports medicine this opens important fields of activity, which are not fundamentally new but in the past have been little acknowledged.