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Digital Physical Exercise Interventions for Cognitive Functions in Older Adults: Systematic Review and Bayesian
Qing Hu1,2, Siyi Sun1,2, Jingru Zhu1,2
1The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, No. 11, West Section of North Third Ring Road, Haidian District, Beijing, 100191, China, 86 13701287984.
Background:
Cognitive decline in older adults imposes a major global burden, with physical inactivity a leading modifiable risk factor for dementia. Digital physical exercise interventions offer scalable alternatives to traditional programs, but comparative effectiveness across cognitive domains remains unclear.
Objective:
The aim of the study is to compare and rank 4 digital physical exercise interventions-immersive virtual reality exercise (IVR_E), nonimmersive exergame (NI_ExG), remote exercise (RE), and virtual reality exercise combined with cognitive training (VR_EC)-against routine intervention (RI) or nonintervention (NI) on global cognition, executive function, and memory function in older adults aged ≥60 years.
Methods:
Eligible studies were English-language randomized controlled trials evaluating digital physical exercise on any untrained cognitive outcome in older adults. In total, 6 databases (PubMed, Embase, Web of Science, CENTRAL, PsycINFO, and CINAHL) and 2 trial registries were searched from January 2010 to April 2026; reference lists were screened. Screening, data extraction, and risk-of-bias assessment were conducted independently in duplicate using the Cochrane tool. Bayesian network meta-analyses were performed in R, reporting standardized mean differences (SMDs) with 95% CIs and prediction intervals (PIs); surface under the cumulative ranking curve (SUCRA) ranked interventions, and CINeMA (Confidence in Network Meta-Analysis) assessed certainty of evidence, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analyses).
Results:
In total, 51 randomized controlled trials (3673 participants) were included. NI_ExG significantly outperformed both NI (SMD 0.51, 95% CI 0.26-0.78; PI -0.03 to 1.07) and RI (SMD 0.32, 95% CI 0.12-0.53; PI -0.20 to 0.86) for global cognition (30 studies); IVR_E also outperformed NI (SMD 0.74, 95% CI 0.11-1.36; PI -0.04 to 1.53) and ranked highest by SUCRA. For executive function (33 studies), only NI_ExG versus NI was significant (SMD 0.39, 95% CI 0.04-0.76; PI -0.48 to 1.29). For memory function (20 studies), RE was significantly superior to both NI (SMD 1.30, 95% CI 0.15-2.44; PI -0.05 to 2.70) and RI (SMD 1.22, 95% CI 0.15-2.28; PI 0.07-2.56), with its PI also excluding the null; VR_EC was significantly inferior to RE (SMD -1.54, 95% CI -2.89 to -0.24; PI -3.09 to -0.07). Cumulative training ≥1000 minutes was associated with more stable memory benefit. Certainty was very low for most comparisons, downgraded for unclear allocation concealment, heterogeneity, and suspected reporting bias in executive function.
Conclusions:
This Bayesian network meta-analysis compares 4 digital physical exercise categories against active and passive controls across 3 cognitive domains. Comparative effectiveness was domain-specific: NI_ExG most consistently benefited global cognition and executive function; RE produced the only statistically robust memory improvement; and IVR_E achieved the highest rankings but requires confirmatory trials. The scalability of RE and NI_ExG makes them practical for older adults in rural and resource-limited settings, providing an evidence base to inform clinical guidelines and digital health investment.
