Exercise prescriptions for older adults with different degrees of cognitive impairment: A dose-response network meta-analysis

Objective This study aims to determine the optimal exercise types and dosages for improving cognitive function in older adults with mild cognitive impairment or dementia. Data sources PubMed, Web of Science, Scopus, PsycINFO, and SPORTDiscus databases were searched from inception to August 26, 2025. Review methods Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the revised Cochrane risk-of-bias tool. A dose-response network meta-analytic model was applied to explore how exercise dosage within different exercise modalities influences cognitive outcomes in older adults with varying degrees of cognitive impairment. Results Our search identified 10,721 records, from which 68 studies comprising 6544 participants were included in the final analysis. A nonlinear dose-response relationship between physical activity and cognitive function was observed. A minimum threshold of 336 Metabolic Equivalent of Task minutes per week was required to yield cognitive benefits, while 934 Metabolic Equivalent of Task minutes per week was the minimum dose for clinically meaningful improvements. However, substantial variability was observed, particularly between individuals with mild cognitive impairment and those with dementia. The dose-response relationship varied by exercise modalities, with some modalities showing significant effects at lower doses. Aerobic exercise combined with resistance training exhibited superior efficacy compared to other modalities. Conclusion For older adults with mild cognitive impairment or dementia, combining aerobic exercise with resistance training is most effective for boosting cognitive function, even with modest activity levels. It is important to choose specific exercise modalities and adjust their amounts to maximize cognitive gains in rehabilitation programs.