Effects of exercise on executive function in cognitively healthy older adults: a systematic review and three-level meta-analysis.

objectiveTo systematically evaluate the effect of exercise on the executive function of cognitively healthy older adults through a three-level Meta-analysis.

methodsRandomized controlled trials (RCTs) related to the effects of exercise on the executive function of cognitively healthy older adults were retrieved from eight databases, including PubMed, Web of Science, The Cochrane Library, EBSCOhost, Embase, CNKI, Wanfang, and VIP, with a search period from the establishment of the databases to February 27, 2025. The quality of the literature was assessed using the PEDro scale and the evidence quality was evaluated using GRADE. Meta-analysis was performed using a three-level random effects model in R, and publication bias was tested. Hedges’ g value and its 95% confidence interval (CI) were used for assessment, and a 95% prediction interval (PI) was calculated to determine the expected range of effect sizes in future similar studies. Funnel plots and Egger’s regression were used to assess publication bias.

resultsA total of 50 RCTs were included, involving 4,826 cognitively healthy older adults. The PEDro scale scores ranged from 5 to 8, with an average of 6.4, indicating that the overall quality of the included literature was good. After excluding outliers, the meta-analysis revealed that exercise significantly improved overall executive function in older adults (g= 0.155, 95% CI 0.084, 0.226, p < 0.001). Significant improvements were also observed in the subdomains of working memory (g = 0.208, 95% CI 0.093, 0.322,P<0.001) and cognitive flexibility (g = 0.150, 95% CI 0.001, 0.299,P= 0.049). Regarding exercise parameters, significant benefits were found for a frequency of ≥3 times/week (g = 0.188, 95% CI 0.097, 0.280, p < 0.001), a duration of ≤26 weeks (g = 0.193, 95% CI 0.114, 0.272, p< 0.001), a session time of ≤60 minutes (g = 0.190, 95% CI 0.115, 0.264, p < 0.001), and moderate-intensity exercise (g = 0.254, 95% CI 0.117, 0.390, p < 0.001), with both aerobic (g = 0.130, 95% CI 0.043, 0.218, p = 0.003) and resistance training (g = 0.232, 95% CI 0.077, 0.388, p = 0.003) being effective. Furthermore, these improvements were consistent across all population subgroups, including those aged 60-69 years (g = 0.134, 95% CI 0.049, 0.218, p = 0.002), those ≥70 years (g = 0.203, 95% CI 0.075, 0.330, p = 0.002), those with ≤12 years of education (g = 0.322, 95% CI 0.135, 0.510, p < 0.001), those with >12 years of education (g = 0.149, 95% CI 0.016, 0.283, p = 0.028), studies with ≥50% female participants (g = 0.137, 95% CI 0.067, 0.206, p < 0.001), studies with <50% female participants (g = 0.359, 95% CI 0.083, 0.635, p = 0.010), and studies employing a usual care control design (g = 0.205, 95% CI 0.113, 0.296, p < 0.001). The Egger's test (t = 2.630，p= 0.009) indicates a potential publication bias. The GRADE evidence quality for the impact of exercise on executive function in cognitively healthy older adults is rated as moderate.

conclusionExercise is an effective way to enhance overall executive function, as well as working memory and cognitive flexibility in cognitively healthy older adults. Compared to the control group, moderate-intensity aerobic exercise and resistance training performed ≥3 times/week, each session lasting ≤60 minutes and with a duration of ≤26 weeks, can improve overall executive function, working memory, and cognitive flexibility, especially for older adults with higher age and lower education levels. However, future exercise programs should be tailored to the individual needs and physical conditions of older adults.

trial registrationThis study has been registered on PROSPERO with the registration number CRD420251000402. Registration platform: www.crd.york.ac.uk .