Frontiers in aging neuroscience · 2026
Comparative efficacy and certainty of evidence of exercise interventions for cognitive outcomes in older adults with mild cognitive impairment: a systematic review and network meta-analysis of randomized controlled trials.
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Liu Bu-Yu, Zhuang Chang-Kuan, Ruan Hui
Аннотация
BACKGROUND: Mild cognitive impairment (MCI) is common in older adults and is linked to dementia, functional decline, and poorer quality of life. Exercise is recommended as a non-pharmacological strategy, but comparative effects of exercise modalities, alone or combined with cognitive training, remain uncertain. This systematic review and network meta-analysis compared exercise-based interventions for cognitive and psychological outcomes in older adults with MCI.
METHODS: Following a registered PROSPERO protocol (CRD420261372312), we searched PubMed, Embase, Cochrane Library, and Web of Science from inception to March 1, 2026. Eligible studies were randomized controlled trials in older adults with MCI. Intervention nodes included aerobic exercise, resistance training, mind-body exercise, multicomponent exercise, digital or virtual reality-based exercise, cognitive training, and combined exercise-cognitive training. Outcomes included global cognition, executive function, attention/working memory, depression-related assessments (DRA), and memory function assessments (MFA). Risk of bias, rankings, and certainty were assessed using RoB 2, SUCRA, and GRADE.
RESULTS: Seventy-four RCTs involving 5,578 participants and 12 intervention nodes were included. Compared with wait-list control, mind-body exercise was associated with higher MoCA (MD = 3.94, 95% CI 2.28-5.59) and MMSE scores (MD = 4.52, 95% CI 2.34-6.70; moderate certainty). Resistance training was associated with lower ADAS-Cog scores (MD = -5.02, 95% CI -7.30 to -2.74; high certainty). Digital or virtual reality-based exercise was associated with faster TMT-B performance (MD = -48.40, 95% CI -77.22 to -19.58; moderate certainty). Multicomponent exercise was associated with lower DRA scores (SMD = -0.56, 95% CI -0.96 to -0.16; moderate certainty) and better DST performance (SMD = 1.70, 95% CI 0.71-2.69; high certainty). SCWT and MFA showed favorable but statistically uncertain trends.
CONCLUSION: Exercise-based interventions may be associated with favorable cognitive and psychological outcomes in older adults with MCI, with effects varying by domain. Favorable estimates were observed for mind-body exercise in global cognition, resistance training in ADAS-Cog, digital or virtual reality-based exercise in executive function, and multicomponent exercise in DST and DRA. Findings should be interpreted cautiously given evidence certainty, network sparsity, and estimate precision. Further head-to-head trials with standardized protocols are warranted.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261372312, identifier CRD420261372312.
METHODS: Following a registered PROSPERO protocol (CRD420261372312), we searched PubMed, Embase, Cochrane Library, and Web of Science from inception to March 1, 2026. Eligible studies were randomized controlled trials in older adults with MCI. Intervention nodes included aerobic exercise, resistance training, mind-body exercise, multicomponent exercise, digital or virtual reality-based exercise, cognitive training, and combined exercise-cognitive training. Outcomes included global cognition, executive function, attention/working memory, depression-related assessments (DRA), and memory function assessments (MFA). Risk of bias, rankings, and certainty were assessed using RoB 2, SUCRA, and GRADE.
RESULTS: Seventy-four RCTs involving 5,578 participants and 12 intervention nodes were included. Compared with wait-list control, mind-body exercise was associated with higher MoCA (MD = 3.94, 95% CI 2.28-5.59) and MMSE scores (MD = 4.52, 95% CI 2.34-6.70; moderate certainty). Resistance training was associated with lower ADAS-Cog scores (MD = -5.02, 95% CI -7.30 to -2.74; high certainty). Digital or virtual reality-based exercise was associated with faster TMT-B performance (MD = -48.40, 95% CI -77.22 to -19.58; moderate certainty). Multicomponent exercise was associated with lower DRA scores (SMD = -0.56, 95% CI -0.96 to -0.16; moderate certainty) and better DST performance (SMD = 1.70, 95% CI 0.71-2.69; high certainty). SCWT and MFA showed favorable but statistically uncertain trends.
CONCLUSION: Exercise-based interventions may be associated with favorable cognitive and psychological outcomes in older adults with MCI, with effects varying by domain. Favorable estimates were observed for mind-body exercise in global cognition, resistance training in ADAS-Cog, digital or virtual reality-based exercise in executive function, and multicomponent exercise in DST and DRA. Findings should be interpreted cautiously given evidence certainty, network sparsity, and estimate precision. Further head-to-head trials with standardized protocols are warranted.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261372312, identifier CRD420261372312.