The effect of exercise on the improvement of verbal fluency, spatial working memory, and the three major executive functions in elderly alzheimer's patients: a systematic review and meta-analysis.

OBJECTIVE

To evaluate the effects of exercise on verbal fluency (VF), spatial working memory (SWM), and executive functions (EF) in older adults with Alzheimer's disease (AD).

METHODS

A systematic search of PubMed, Embase, Cochrane Library, SPORTDiscus, and Web of Science was conducted up to June 5, 2025. Sixteen randomized controlled trials (RCTs) involving exercise interventions in elderly AD patients were included. Meta-analysis was performed using Stata 17.0 software.

RESULTS

Exercise significantly improved VF (SMD = 0.17, 95% CI 0.05-0.29, P = 0.01), SWM (SMD = 0.61, 95% CI 0.21-1.02, P < 0.01), and EF (SMD = 0.53, 95% CI 0.31-0.75, P < 0.01). Subgroup analyses suggested larger cognitive gains in participants aged ≥ 75 years, while those with < 10 years of education showed limited VF improvement. Cycling did not show significant effects on EF, and open-chain programs did not improve SWM. In contrast, other modalities demonstrated consistent cognitive benefits. Interventions lasting up to 12 weeks were effective for VF and cognitive flexibility but showed minimal impact on inhibitory control.

CONCLUSIONS

Exercise-based interventions are associated with small-to-moderate improvements in verbal fluency, spatial working memory, and executive functions in older adults with AD. The magnitude of benefit may vary according to age, education level, exercise modality, and intervention duration. However, these subgroup findings should be interpreted cautiously due to limited and heterogeneous evidence. Further well-designed trials with standardized reporting of intervention characteristics are warranted to clarify dose-response relationships and enhance the clinical applicability of exercise in neurodegenerative care.