An umbrella review of randomized control trials on the effects of physical exercise on cognition
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Abstract
Extensive research links regular physical exercise to an overall enhancement of cognitive function across the lifespan. Here we assess the causal evidence supporting this relationship in the healthy population, using an umbrella review of meta-analyses limited to randomized controlled trials (RCTs). Despite most of the 24 reviewed meta-analyses reporting a positive overall effect, our assessment reveals evidence of low statistical power in the primary RCTs, selective inclusion of studies, publication bias and large variation in combinations of pre-processing and analytic decisions. In addition, our meta-analysis of all the primary RCTs included in the revised meta-analyses shows small exercise-related benefits (d = 0.22, 95% confidence interval 0.16 to 0.28) that became substantially smaller after accounting for key moderators (that is, active control and baseline differences; d = 0.13, 95% confidence interval 0.07 to 0.20), and negligible after correcting for publication bias (d = 0.05, 95% confidence interval -0.09 to 0.14). These findings suggest caution in claims and recommendations linking regular physical exercise to cognitive benefits in the healthy human population until more reliable causal evidence accumulates.
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Physical exercise has a small cognitive benefit (umbrella review).
“Findings are in line with the small cognitive benefit shown in an umbrella review of RCTs on the effects of physical exercise on cognition.(170)”
From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [170]
The Influential variables and publication bias section (page not provided) reports a small estimated cognitive benefit after accounting for control activity and baseline differences (d = 0.13). But its publication-bias-adjusted estimate was negligible and the evidence for a positive effect inconclusive; the Discussion likewise calls the evidence inconclusive. Saying the review 'showed' a small benefit omits that qualification. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn that prior umbrella review, the effect became negligible after correcting for publication bias (d=0.05, 95% CI −0.09 to 0.14).
“although this effect became negligible after correcting for publication bias (d=0.05, 95% CI −0.09 to 0.14).16”
From Effectiveness of exercise for improving cognition, memory and executive function: a systematic umbrella review and meta-meta-analysis (2025) · cites this paper as [16]
The ‘Influential variables and publication bias’ section reports a bias-adjusted posterior mean of d = 0.05 with limits of −0.09 to 0.14. The citing sentence reproduces those values but calls the interval a 95% confidence interval; the paper identifies it as a 95% Bayesian credible interval (CrI). (LLM, conf=0.88)
Experimental — accuracy not yet measuredOnly one systematic review of systematic reviews (umbrella review) has examined the effect of exercise on cognition.
“only one systematic review of systematic reviews (ie, an umbrella review) has examined the effect of exercise on cognition.16”
From Effectiveness of exercise for improving cognition, memory and executive function: a systematic umbrella review and meta-meta-analysis (2025) · cites this paper as [16]
The Introduction identifies this paper as an umbrella review examining meta-analytic reviews of exercise and cognition, and the Results say it selected 24 meta-analyses. Those passages support citing it as an example of such a review, but they do not establish that it was the only one. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe prior umbrella review was limited in scope because it exclusively focused on healthy populations and excluded individuals with cognitive impairment or chronic diseases.
“Their findings, while valuable, remain limited in scope, as the review exclusively focused on healthy populations and excluded individuals who might derive the greatest benefit from exercise interventions, such as those with cognitive impairment or chronic diseases.”
From Effectiveness of exercise for improving cognition, memory and executive function: a systematic umbrella review and meta-meta-analysis (2025) · cites this paper as [16]
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Sorted by citations
Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission
Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)01296-0 · Cited by 3,860 · see citing works
Physical Activity and Cognitive Decline Among Older Adults: A Systematic Review and Meta-Analysis
Iso-Markku, P., Aaltonen, S., Kujala, U. M., Halme, H.-L., Phipps, D., Knittle, K., Vuoksimaa, E., & Waller, K. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.54285 · Cited by 227 · see citing works
Singh, B., Bennett, H., Miatke, A., Dumuid, D., Curtis, R., Ferguson, T., Brinsley, J., Szeto, K., Petersen, J. M., Gough, C., et al. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108589 · Cited by 157 · see citing works
Reparaz-Escudero, I., Izquierdo, M., Bischoff-Ferrari, H. A., Martínez-Lage, P., & Sáez de Asteasu, M. L. (2024) · Ageing Research Reviews · doi:10.1016/j.arr.2024.102463 · Cited by 45 · see citing works
Li, G., Xia, H., Teng, G., & Chen, A. (2025) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2025.106008 · Cited by 24 · see citing works
Reply to: Do not underestimate the cognitive benefits of exercise
Ciria, L. F., Román-Caballero, R., Vadillo, M. A., Holgado, D., Luque-Casado, A., Perakakis, P., & Sanabria, D. (2024) · Nature Human Behaviour · doi:10.1038/s41562-024-01950-4 · Cited by 6 · see citing works
Self-citationDupont, F., Oliva, F., Pitois, L., Chagnon, M., DeFátima Guimarães, R., & Mathieu, M.-E. (2025) · Journal of American College Health · doi:10.1080/07448481.2024.2427065 · Cited by 3 · see citing works
Physical activity, cognitive health and learning in youth: a narrative umbrella review
Unterguggenberger, S. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph23010011 · Cited by 2 · see citing works
- Authors
- Ciria, L. F., Román-Caballero, R., Vadillo, M. A., Holgado, D., Luque-Casado, A., Perakakis, P., & Sanabria, D.
- Affiliations
- Universidad de Granada (ES)
- Universidad Autónoma de Madrid (ES)
- Universidad Complutense de Madrid (ES)
- Corresponding author
- Sanabria, Daniel
- ORCID
- Venue
- Nature Human Behaviour
- Published
- 2023-03-27
- Volume
- 7
- Issue
- 6
- Pages
- 928-941
- ISSN
- 2397-3374 (ISSN-L)
- OpenAlex
- W4360999057
- Semantic Scholar
- 569df907773242ec015910f5bd72e8e1be7fc046
- Cited by
- 157
- References
- 89
- Citations by year
- 2026: 37 · 2025: 45 · 2024: 53 · 2023: 20 · 2022: 1 · 2021: 1
- FWCI
- 27.53
- Type
- journal article
- Language
- en
- Update notices
- correction (2026-09-02)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Nature Human Behaviour (publishedVersion)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- BURJC Digital (King Juan Carlos University) (submittedVersion, cc-by)
- Hispana (submittedVersion)
- Hispana (submittedVersion, cc-by)
- IRIS (submittedVersion)
- Biblos-e Archivo (Universidad Autónoma de Madrid) (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Comunidad de Madrid - Atraccion de Talento
- Spanish Ministery of Science and Innovation
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Keywords
- physical activity, cognitive function, exercise and cognition, umbrella review, publication bias, statistical power, active control, causal evidence, healthy population, cognitive enhancement
- MeSH terms
- Cognition, Health Status, Humans, Longevity, Meta-Analysis as Topic, Exercise, Randomized Controlled Trials as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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