Dose-response relationship between exercise and cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis

Sanders, Lianne; Hortobágyi, Tibor; Gemert, Sacha la Bastide‐van; van der Zee, Eddy A.; van Heuvelen, Marieke J. G. · 2019 · OpenAlex-citations

DOI: 10.1371/journal.pone.0210036

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Summary

This systematic review and meta-analysis investigates the dose-response relationship between exercise and cognitive function in older adults, distinguishing between those with and without cognitive impairments. Motivated by the rising global prevalence of dementia and the potential of exercise as a safe intervention to slow cognitive decline, the study aims to determine if specific exercise parameters—program duration, session duration, frequency, and intensity—predict the magnitude of cognitive improvements. Previous research had established links between exercise and physical fitness, but the specific dosing effects on cognition remained unclear. The authors searched multiple databases for randomized controlled trials involving aerobic, anaerobic, multicomponent, or psychomotor exercise interventions lasting at least four weeks. They included 36 studies comprising 2,007 participants, categorized into healthy older adults (23 studies) and those with cognitive impairments such as mild cognitive impairment or dementia (13 studies). Exercise dose was quantified by calculating total duration in minutes based on program length, session length, and frequency. Intensity was standardized using heart rate or percentage of one-repetition maximum. Cognitive outcomes were grouped into global cognition, executive function, and memory. Multilevel mixed-effects models were used to analyze effect sizes (Hedges’ d and Cohen’s d) and identify predictors of cognitive gains. In healthy older adults, exercise yielded small positive effects on executive function (d = 0.27) and memory (d = 0.24), but no significant effect on global cognition. Crucially, none of the dose parameters predicted the magnitude of these effects. In contrast, older adults with cognitive impairments showed a moderate positive effect on global cognition (d = 0.37). For this group, specific dosing strategies were significant predictors of outcome: programs characterized by shorter session durations and higher frequencies resulted in larger effect sizes (d = 0.43–0.50). The study also noted some publication bias and an inverse correlation between study quality scores and effect sizes. The findings suggest that exercise benefits cognition in older adults, but the optimal prescription depends on cognitive status. For healthy individuals, exercise improves executive function and memory regardless of specific dose parameters. However, for those with cognitive impairments, high-frequency, short-duration sessions appear most effective for improving global cognition. The authors conclude that current evidence supports tailored exercise recommendations and call for future studies that directly compare different exercise doses within randomized conditions to further refine these guidelines.

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• cognitive impairment