Physical activity interventions for executive function in adolescents: a systematic review and meta-analysis

Executive function (EF), including working memory, inhibitory control, and cognitive flexibility, is essential for adolescent learning, self-regulation, and adaptive behavior. Physical activity (PA) has been proposed as a promising strategy to improve EF during adolescence. This systematic review and meta-analysis aimed to examine the effects of exercise interventions on EF in adolescents. PubMed and Web of Science (WOS) were systematically searched for English-language randomized controlled trials published up to July 2024. Study quality was assessed using the Cochrane Risk of Bias tool, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. A total of 12 studies were included. Exercise interventions significantly improved working memory (SMD = 0.37, 95% CI [0.03, 0.71], p = 0.03). Inhibitory control showed a borderline significant improvement (SMD =  -0.27, 95% CI [-0.55, 0.00], p = 0.05), while no significant overall effect was observed for cognitive flexibility (SMD = 0.50, 95% CI [-0.21, 1.21], p = 0.17). Subgroup analyses suggested that single sessions of 30-40 min were associated with larger estimated effects on working memory (SMD = 1.47, 95% CI [1.11, 1.83], p < 0.00001) and cognitive flexibility (SMD = 1.59, 95% CI [0.12, 3.06], p = 0.03), though these findings warrant cautious interpretation given limited study numbersand substantial heterogeneity. Interventions exceeding 10 weeks yielded a significant effect on working memory (SMD = 0.30, 95% CI [0.12, 0.47], p = 0.0009), whereas 8-10 weeks programs showedthe largest subgroup effects for inhibitory control and cognitive flexibility . Overall, exercise interventions may benefit selected domains of EF in adolescents, with the strongest evidence for working memory. However, the findings for inhibitory control and cognitive flexibility should be interpreted cautiously because of borderline significance, nonsignificant overall effects, and substantial heterogeneity across studies.