Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis
Open accessAbstract
Background: Physical exercise is seen as a promising intervention to prevent or delay cognitive decline in individuals aged 50 years and older, yet the evidence from reviews is not conclusive. Objectives: To determine if physical exercise is effective in improving cognitive function in this population. Design: Systematic review with multilevel meta-analysis. Data sources: Electronic databases Medline (PubMed), EMBASE (Scopus), PsychINFO and CENTRAL (Cochrane) from inception to November 2016. Eligibility criteria: Randomised controlled trials of physical exercise interventions in community-dwelling adults older than 50 years, with an outcome measure of cognitive function. Results: The search returned 12 820 records, of which 39 studies were included in the systematic review. Analysis of 333 dependent effect sizes from 36 studies showed that physical exercise improved cognitive function (0.29; 95% CI 0.17 to 0.41; p<0.01). Interventions of aerobic exercise, resistance training, multicomponent training and tai chi, all had significant point estimates. When exercise prescription was examined, a duration of 45–60 min per session and at least moderate intensity, were associated with benefits to cognition. The results of the meta-analysis were consistent and independent of the cognitive domain tested or the cognitive status of the participants. Conclusions: Physical exercise improved cognitive function in the over 50s, regardless of the cognitive status of participants. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that patients obtain both aerobic and resistance exercise of at least moderate intensity on as many days of the week as feasible, in line with current exercise guidelines.
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The first meta-analysis of exercise RCTs reported global cognitive improvements for moderate or vigorous resistance or aerobic exercise in cognitively normal adults older than 50, with no difference between them and no effect for yoga.
“The first included 39 RCTs with an unclear total number of participants examining moderate or vigorous exercise of any frequency lasting 45–60 min per session in cognitively normal adults aged older than 50 years. This analysis reported global cognitive improvements (standard mean difference [SMD]=0·3, 95% CI 0·2–0·4) for moderate or vigorous resistance (13 studies) or aerobic exercise (18 studies”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [93]
The Results report 39 studies in the review, including 18 aerobic and 13 resistance-training studies; the Effect of exercise on cognition section reports an overall SMD of 0.29 (95% CI 0.17–0.41) across 36 studies. The Exercise moderators section reports positive estimates for aerobic and resistance exercise and no statistically significant estimate for yoga (p=0.27), not proof of no yoga effect. The review included participants with and without mild cognitive impairment, so its overall estimate is not limited to cognitively normal adults; it also does not establish that aerobic and resistance exercise have identical effects. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere is encouraging evidence for resistance training in people with elevated mental health symptoms.
“There is encouraging evidence for resistance training in people with elevated mental health symptoms [108-114], but this requires further testing in those with mental disorders.”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [111]
The Review and Conclusions report encouraging evidence for resistance training to improve cognitive function in adults over 50. They do not establish that the evidence applies to people with elevated mental health symptoms; the review considers baseline cognitive status instead. Page numbers were not available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPhysical exercise has emerged as a promising non-pharmacological intervention for promoting brain health.
“physical exercise has emerged as a promising non-pharmacological intervention for promoting brain health (Northey et al., 2018).”
From Optimal exercise interventions for enhancing cognitive function in older adults: a network meta-analysis (2025) · cites this paper as Northey et al., 2018
Evidence from the general population indicates resistance training can improve cognition.
“Future interventions should also examine the role of resistance training for improving cognition in serious mental illness, since there is a clear association between increased muscular strength and cognition in people with major depression, bipolar disorder and schizophrenia [108, 109] and evidence from the general population indicates resistance training can improve cognition [110, 111].”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [111]
Pharmacological treatments for cognitive impairment remain limited in efficacy and carry potential adverse effects.
“While pharmacological treatments for cognitive impairment remain limited in efficacy and carry potential adverse effects”
From Optimal exercise interventions for enhancing cognitive function in older adults: a network meta-analysis (2025) · cites this paper as Northey et al., 2018
The Introduction and Trial design moderators discuss exercise and cognitive function, but neither addresses the efficacy or adverse effects of pharmacological treatments. Searches of our copy for pharmacological treatments, medication efficacy, and side effects found no passage addressing the claim; page numbers were unavailable. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Promising results for a protective effect of exercise on cardiotoxicity exist in animal models, and there is some novel evidence in humans for cardiac function, including left ventricular function and vascular endothelial function.
“The effect of exercise to prevent or ameliorate cardiotoxicity is an emerging field of research and promising results for a protective effect of exercise in animal models and some novel evidence in humans for cardiac function(55), including measures of left ventricular function(55), and vascular endothelial function, measured as flow-mediated dilation(56).”
From Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable (2019) · cites this paper as [56]
In another meta-analysis of 39 randomized controlled trials in individuals over age 50, physical activity improved cognition with an effect size of 0.29.
“In another meta-analysis of 39 RCTs examining the effects of PA on cognitive function in individuals over the age of 50, PA improved cognition with an effect size of 0.29 (16).”
From Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines (2019) · cites this paper as [16]
Northey and colleagues reported that moderate-intensity physical activity for 45 to 60 minutes per session was associated with cognitive benefits in adults over age 50.
“Similarly, Northey et al. (16) reported that moderate intensity PA for 45-60 minutes per session were associated with benefits to cognition in adults over the age of 50.”
From Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines (2019) · cites this paper as [16]
The consistency of effect sizes and effects across populations, activity durations, intensities, comorbid conditions, and ages is remarkable.
“we argue that the consistency of effects and of effect sizes across populations (16, 26), durations of PA (including acute bouts), intensities, comorbid conditions (58), and ages (12) is truly remarkable”
From Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines (2019) · cites this paper as [16]
Regular physical exercise may improve physical health, reduce frailty, lower the risk of depression, and improve cognitive function in the short and long term in older adults.
“Regular physical exercise is recommended to all older adults, and indeed to those at increased risk of AD, as it may improve physical health, reduce frailty, lower the risk of depression, improve cognitive function in the short and long term (26–31).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [31]
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- Authors
- Northey, J. M., Cherbuin, N., Pumpa, K. L., Smee, D. J., & Rattray, B.
- Affiliations
- University of Canberra (AU)
- Australian National University (AU)
- Corresponding author
- Northey, Joseph Michael
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2017-04-24
- Volume
- 52
- Issue
- 3
- Pages
- 154-160
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W2608193295
- Cited by
- 1,380
- References
- 74
- Citations by year
- 2026: 168 · 2025: 184 · 2024: 185 · 2023: 162 · 2022: 180 · 2021: 183 · 2020: 155 · 2019: 98 · 2018: 52 · 2017: 12
- FWCI
- 13.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- University of Canberra Research Portal (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- physical activity, cognitive function, older adults, cognitive decline, aerobic exercise, resistance training, Tai Chi, multicomponent training, exercise prescription, exercise intensity, exercise duration, community-dwelling older adults
- MeSH terms
- Attention, Cognition, Exercise Therapy, Humans, Memory, Short-Term, Middle Aged, Exercise, Randomized Controlled Trials as Topic, Tai Ji, Resistance Training, Executive Function
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