Subcortical ischemic vascular cognitive impairment (SIVCI) is the most preventable form of cognitive dysfunction. There is converging evidence from animal and human studies that indicate vascular injury as the primary cause of SIVCI. Currently, there are no curative pharmaceutical treatments for vascular dementia; however, exercise may be a promising strategy to combat SIVCI. This review will focus on the role of exercise as a strategy to prevent or slow the progression of SIVCI, with particular emphasis on the mechanisms by which exercise may improve cerebrovascular function. We propose that exercise may be an effective strategy to combat SIVCI by improving cognitive function, increasing the bioavailability of neurotrophins, stimulating endothelial function, and controlling vascular risk factors. This article is part of the Special Issue “Vascular Dementia”. Currently, there are no curative pharmaceutical treatments for subcortical ischemic vascular cognitive impairment (SIVCI). However, exercise may combat SIVCI by increasing the bioavailability of neurotrophins, improving cognitive function, stimulating endothelial function, and controlling vascular risk factors. We propose that exercise is a promising strategy to prevent or slow the progression of SIVCI. This article is part of the Special Issue “Vascular Dementia”.