Comparative efficacy of exercise interventions for cognitive health in older adults: A network meta-analysis

Previous studies have consistently demonstrated that exercise mitigates cognitive decline in older adults. However, the most effective types of exercise, along with optimal frequency and duration of interventions, remain inadequately defined. To address these gaps, we conducted a network meta-analysis synthesizing direct and indirect evidence from existing literature to identify the most effective exercise interventions for enhancing cognitive function in older adults.

We conducted a systematic search across databases including PubMed and Web of Science to identify randomized controlled trials (RCTs) evaluating the impact of various exercise interventions on cognitive function in older adults. We assessed the quality of included studies and performed a traditional meta-analysis with Review Manager 5.3. Subsequently, a network meta-analysis was conducted using Stata 17.0 to evaluate the effects of different exercise modalities on cognitive outcomes, specifically memory, inhibitory control, and task-switching abilities.

A total of 37 studies encompassing 2585 older adults met the inclusion criteria. The network meta-analysis revealed that resistance training exerted the strongest effect on overall cognitive improvement. Aerobic exercise, multimodal exercise, and physical-mental training followed in effectiveness. Specifically, resistance training significantly enhanced inhibitory control compared to high-intensity interval training (HIIT), aerobic exercise, and other modalities. Physical-mental training emerged as the most effective intervention for improving task-switching ability and demonstrated superior efficacy in enhancing working memory compared to aerobic exercise. Conversely, aerobic exercise showed the strongest effect on memory function, outperforming resistance training, multimodal exercise, and physical-mental training.

Resistance training is the most effective exercise modality for enhancing overall cognitive function and inhibitory control in older adults. Physical-mental training offers the greatest benefits for improving working memory and task-switching ability, while aerobic exercise is most beneficial for enhancing memory function. Based on these findings, the recommended exercise protocols are: Resistance Training: 12 weeks, 2-3 times per week, 45 min per session. Aerobic Exercise: 21 weeks, twice per week, 60 min per session. These tailored exercise interventions can inform public health strategies and clinical practices aimed at optimizing cognitive health in the aging population.

The protocol for this review was registered in PROSPERO (CRD42024597545).