Comparative effects of different physical exercises on cognitive function and intervention adherence in older adults with cognitive impairment: A systematic review and network meta-analysis
Abstract
BACKGROUND
Physical exercise is increasingly recognized as a beneficial nonpharmacological intervention for cognitive impairment in older adults; however, comparative evidence regarding the optimal exercise type and its sustainability remains unclear. This study aimed to compare and rank different exercise modalities based on their effects on cognition and intervention adherence among older adults (≥60 years) with cognitive impairment.
METHODS
This systematic review, preregistered in PROSPERO (CRD42024497896), systematically searched MEDLINE, Web of Science, Scopus, PsycINFO, PubMed, and SPORTDiscus databases through February 1, 2024, with an updated search on March 16, 2025, to identify randomized controlled trials (RCTs). Two reviewers independently screened and evaluated eligible studies assessing the effects of physical exercise interventions on global cognition and adherence among older adults aged ≥60 years with cognitive impairment. Secondary outcomes included follow-up global cognition, cognitive subdomains, activities of daily living (ADL), physical function, and neuropsychiatric symptoms. A network meta-analysis using a frequentist framework was conducted. Interventions were ranked according to the Surface Under the Cumulative Ranking Curve (SUCRA), and a two-dimensional cluster ranking plot was used to identify the optimal intervention balancing cognitive improvement and adherence.
RESULTS
Our network meta-analysis evaluated 128 qualified RCTs involving 12,403…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 12,403 participants or records.
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