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.