Exercise-only interventions and exercise-based multidomain lifestyle interventions to promote cognitive function in older adults without dementia: a systematic review and meta-analysis.

OBJECTIVE: To assess the effect of exercise training as a single intervention (ie, Exercise-Only) and exercise combined with other lifestyle interventions (ie, Exercise-Plus) on executive functions, memory and processing speed of older adults living without dementia. DESIGN: We performed a systematic review with pairwise meta-analyses and network meta-analysis to examine the effects of: (1) Exercise-Only versus Control; (2) Exercise-Plus versus Control; and (3) Exercise-Plus versus Exercise-Only. DATA SOURCES: We searched four databases (Medline, Embase, PsycINFO and CINAHL) between database inception and March 2026. ELIGIBILITY CRITERIA: We included randomised controlled trials that examined the effects of exercise training as a single domain or multidomain intervention on cognitive function of adults aged over 60 living without dementia. RESULTS: We included 227 studies in the pairwise meta-analyses (Exercise-Only=178, Exercise-Plus=67) and 105 studies in the subset for the network meta-analysis (Exercise-Only=76, Exercise-Plus=36). Cognitive training and cognitively engaging activities were the most common Plus component in the included studies. Exercise-Only produced statistically significant improvements across all three cognitive domains compared with Control. Exercise-Plus was only significantly better than Control for memory. Exercise-Plus was also significantly better than Exercise-Only for executive functions and processing speed but not for memory. CONCLUSION: We recommend the promotion of exercise training to improve cognitive outcomes of older adults. Further research is needed to determine the added benefit of multidomain exercise interventions. PROSPERO REGISTRATION NUMBER: CRD42022322199.