A Piece of the Neuroeconomic Puzzle: Effort-Based Decision-Making and Physical Activity-A Systematic Review

Regular physical activity protects body and mind, yet most adults remain insufficiently active-a shortfall increasingly understood not as a failure of knowledge but as a problem of decision, in which an immediate cost in physical effort is weighed against delayed, uncertain rewards. Neuroeconomics frames this valuation, yet the effort cost most intrinsic to exercise has drawn little attention beside delay. This systematic review synthesised evidence on the relationship between effort-based decision-making and real-world physical activity in both directions. Following PRISMA 2020 and a pre-registered protocol, Scopus, Web of Science, and PubMed/MEDLINE were searched up to June 2026; records were screened against two criteria-an effort-based decision construct and an exercise outcome-independently and in duplicate, and appraised with the MMAT. Of 485 database records, nine studies met eligibility; backward citation searching added three (twelve in total). Evidence emerged for associations in both hypothesised directions: steeper effort discounting accompanied lower activity, while exercise appeared to reshape effort valuation. The largely observational designs, however, preclude causal inference. Most used real, enacted exercise; one recent study added hypothetical choices. Effort-based decision-making emerges as a neglected yet malleable piece of the neuroeconomic puzzle of activity, with clinical and methodological implications.