Effects of different physical activity interventions on executive function in older adults with dementia: a systematic review and network meta-analysis

Background The executive function impairments in older adults with dementia have profound effects on their daily lives, families, and society. Physical activity has gained recognition as a complementary treatment for enhancing executive function in elderly individuals with dementia. Numerous studies have explored the correlation between physical activity and the enhancement of executive functions in dementia. Nevertheless, there remains a lack of comprehensive, systematic evidence that addresses crucial issues in identifying the most effective physical activity interventions. The primary objective of this study is to evaluate and rank different physical activity intervention strategies, offering valuable therapeutic guidance for improving executive function in older adults with dementia. Methods We conducted a systematic search across four databases—PubMed, the Cochrane Library, Embase, and Web of Science—to locate randomized controlled trials (RCTs) evaluating the effect of physical activity interventions on executive function in individuals diagnosed with dementia. The search covered the period from January 2000 to May 2025. Two independent researchers performed the literature screening, data extraction, and quality assessment. A network meta-analysis was conducted using Stata 15.1. Results A total of 24 studies were included in the analysis. The results indicated that resistance exercise ranked first in enhancing executive function among older adults with dementia, with the highest Surface Under the Cumulative Ranking Curve (SUCRA) (89.2%) and PrBest (59.9%) values. This was followed by mind–body exercises, with SUCRA (71.4%) and PrBest (18.9%), and aerobic exercise ranked third with SUCRA (60.0%) and PrBest (4.2%). Conclusion Our findings suggest that both resistance exercise and mind–body exercise are likely more effective in enhancing executive function in older adults with dementia. Future studies should aim to design personalized physical activity programs that consider genetic factors, phenotypic characteristics, and cognitive baselines. Observing the long-term therapeutic effect and investigating the Intervention Mechanism, such as the regulation of brain-derived neurotrophic factor and the connectivity of the prefrontal cortex, to further optimize strategies for enhancing executive function in older adults with dementia. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251040158.