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.

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 older adults (≥60 years) with cognitive impairment. Mind-body exercise emerged as the most effective intervention, demonstrating the greatest improvements in global cognition (SUCRA = 95.9 %; SMD = 0.91; 95 % CI: 0.65-1.16) and significantly higher adherence (SUCRA = 93.6 %; OR = 1.31; 95 % CI: 1.02-1.68) compared to controls. Aerobic, resistance, and multicomponent exercises also improved cognition significantly, but adherence was comparatively lower. Mind-body exercise additionally showed consistent benefits across cognitive subdomains, functional outcomes and follow-up global cognition.

CONCLUSIONS

All physical exercise modalities significantly improved cognition, yet mind-body exercise was identified as the optimal intervention, exhibiting superior cognitive effects, adherence, and related functional benefits. These findings can guide clinicians in developing evidence-based exercise prescriptions tailored specifically to older adults with cognitive impairment.