Effects of different non-pharmacological interventions on executive function in healthy older people: A systematic...

Executive function (EF) is a critical component of healthy aging, and its decline represents a fundamental challenge to neurological health. This network meta-analysis (NMA) systematically compared and ranked the effects of a spectrum of non-pharmacological interventions on overall EF and its key subdomains-working memory, cognitive flexibility, and inhibition-in healthy older adults.

We searched PubMed, Cochrane, Embase, and Web of Science from their inception to February 17, 2025, for randomized controlled trials (RCTs) investigating non-pharmacological interventions in healthy older people (≥ 60 years). All analyses were performed using the R package "netmeta". The risk of bias was assessed using the revised Cochrane Risk of Bias tool (RoB 2), and the confidence in the evidence was evaluated with the CINeMA (Confidence in Network Meta-Analysis) framework.

A total of 115 RCTs with 16,824 healthy older people were included, evaluating 11 types of non-pharmacological interventions. Network meta-analysis revealed comparative effectiveness among the interventions: dance showed favorable outcomes for improving overall executive function (standardized mean difference [SMD] = 0.82, 95 % confidence interval [CI]: 0.40 to 1.24) and cognitive flexibility (SMD = 0.96, 95 % CI: 0.50 to 1.43). Resistance training was associated with greater improvement in working memory (SMD = 0.86, 95 % CI: 0.51 to 1.20), while computerized cognitive training showed a positive effect on inhibition (SMD = 0.48, 95 % CI: 0.28 to 0.68).

This network meta-analysis suggests that dance improves overall executive function and cognitive flexibility, resistance training enhances working memory, and computerized cognitive training benefits inhibition in healthy older adults. These findings offer an evidence-based ranking to inform the selection of targeted non-pharmacological interventions in clinical and community settings.