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Cited by 1,214Physical Activity and HealthDementia and Cognitive Impairment ResearchCardiovascular and exercise physiology

Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines

Open access
ERICKSON, KIRK I., HILLMAN, CHARLES, STILLMAN, CHELSEA M., BALLARD, RACHEL M., BLOODGOOD, BONNY, CONROY, DAVID E., MACKO, RICHARD, MARQUEZ, DAVID X. +2 more·2019·Medicine & Science in Sports & Exercise
DOI 10.1249/mss.0000000000001936PMC PMC6527141
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Abstract

Purpose: Physical activity (PA) is known to improve cognitive and brain function, but debate continues regarding the consistency and magnitude of its effects, populations and cognitive domains most affected, and parameters necessary to achieve the greatest improvements (e.g., dose). Methods: In this umbrella review conducted in part for the 2018 Health and Human Services Physical Activity Guidelines for Americans Advisory Committee, we examined whether PA interventions enhance cognitive and brain outcomes across the life span, as well as in populations experiencing cognitive dysfunction (e.g., schizophrenia). Systematic reviews, meta-analyses, and pooled analyses were used. We further examined whether engaging in greater amounts of PA is associated with a reduced risk of developing cognitive impairment and dementia in late adulthood. Results: Moderate evidence from randomized controlled trials indicates an association between moderate- to vigorous-intensity PA and improvements in cognition, including performance on academic achievement and neuropsychological tests, such as those measuring processing speed, memory, and executive function. Strong evidence demonstrates that acute bouts of moderate- to vigorous-intensity PA have transient benefits for cognition during the postrecovery period after exercise. Strong evidence demonstrates that greater amounts of PA are associated with a reduced risk of developing cognitive impairment, including Alzheimer’s disease. The strength of the findings varies across the life span and in individuals with medical conditions influencing cognition. Conclusions: There is moderate-to-strong support that PA benefits cognitive functioning during early and late periods of the life span and in certain populations characterized by cognitive deficits.

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Written from the paper’s full text.

TL;DR

This umbrella review for the 2018 Physical Activity Guidelines Advisory Committee concludes there is moderate-to-strong evidence that physical activity benefits cognition and brain outcomes across parts of the lifespan and in some clinical populations. Evidence is strongest for acute cognitive benefits, reduced risk of cognitive impairment/dementia with greater physical activity, and effects in preadolescent children and older adults.

Key findings

  • Moderate evidence from randomized controlled trials indicates moderate-to-vigorous physical activity improves cognition, including academic achievement and neuropsychological tests of processing speed, memory, and executive function.
  • Strong evidence shows acute bouts of moderate-to-vigorous physical activity produce transient post-exercise cognitive benefits; acute executive-function effects were larger in preadolescent children (Hedges’ g = 0.54 [0.21, 0.87]) and older adults (0.67 [0.40, 0.93]) than adolescents (0.04 [−0.14, 0.23]) and young adults (0.20 [0.07, 0.34]).
  • Strong evidence from prospective observational studies links greater physical activity to reduced risk of cognitive impairment and Alzheimer’s disease: one meta-analysis of 15 prospective studies with >33,000 participants found a 38% reduced risk of cognitive decline, and another of 10 prospective studies with >20,000 participants found a 40% reduced risk of developing Alzheimer’s disease.
  • Evidence grades varied by population: Moderate for children 6–13 years and older adults >50 years; Limited for adolescents; Not Assignable for children ≤6 years and young/middle-aged adults 18–50 years; Moderate for several clinical populations; and insufficient/Not Assignable for optimal dose parameters.

Methods

  • Umbrella review conducted in part for the 2018 Health and Human Services Physical Activity Guidelines for Americans Advisory Committee, using systematic reviews, meta-analyses, and pooled analyses.
  • Searches in PubMed, CINAHL, and Cochrane included English-language systematic reviews, meta-analyses, or pooled analyses published 2003 to February 2017, with an updated search adding 44 studies from 2017–2018; 76 articles were identified (35 meta-analyses; 41 systematic reviews).
  • Evidence was graded as Not Assignable, Limited, Moderate, or Strong; studies of non-ambulatory people, hospitalized patients, or animals were excluded, and the protocol was registered at PROSPERO #CRD42018095774.

Limitations

  • The paper states significant heterogeneity in study designs, cognitive instruments, lack of consistent reporting of blinding and adherence/compliance, poor descriptions of whether interventions maintained moderate-intensity physical activity, and variability in physical activity measurement.
  • The paper states insufficient data on optimal dose parameters, few high-quality data in adolescents and young/middle-aged adults, and that many executive-function instruments were developed for clinical diagnosis rather than detecting normative variation.
  • The paper states that MCI/dementia risk evidence comes largely from prospective observational studies often using self-reported physical activity, unlike RCT-based sections; it also notes small/underpowered studies and inability to assess clinical significance in some dementia-prevention evidence. An evident limitation is that this is an umbrella review of reviews rather than a new primary-data synthesis.

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Integrity signals

Registry

Crossref · 10.1249/mss.0000000000001936

Cites

90 of 90 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 73 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    The subcommittee assigned a grade of Not Assignable for the effect of physical activity on cognitive development in early preschool years because evidence was insufficient.

    “Due to insufficient evidence, the subcommittee decided a grade was Not Assignable regarding the effect of PA on cognitive development in the early, pre-school years.”
    Quote in the paperSubstantial claim
  • Findingreasoning

    There is Moderate evidence that physical activity benefits cognition and brain structure and function during preadolescence.

    “Collectively, there is Moderate evidence that PA is beneficial to cognition and brain structure and function during preadolescence.”
    Quote in the paperSubstantial claim
  • Findingreasoning

    Across the included articles, findings consistently indicated a small-to-moderate effect of physical activity on cognitive and academic outcomes in preadolescents, with effect sizes from 0.13 to 0.30.

    “Across the included articles, there were consistent findings indicating a small-to-moderate effect (effect sizes = 0.13-0.30) of PA on cognitive and academic outcomes.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Strong evidence shows that a single acute bout of moderate-to-vigorous physical activity produces temporary cognitive benefits during recovery after exercise.

    “Strong evidence demonstrates that acute bouts of moderate-to-vigorous PA have transient benefits for cognition during the post-recovery period following exercise.”
    Quote in the paperSubstantial claim
  • Findingcitation

    The largest body of evidence for an effect of physical activity on cognitive outcomes in children concerned preadolescents.

    “The greatest wealth of evidence for an effect of PA on cognitive outcomes in children was found for preadolescents.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 36
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingcitation

    Several systematic reviews and meta-analyses report beneficial effects of physical activity on cognitive and academic outcomes in preadolescents, with consistent benefits for executive function, attention, and academic achievement including academic behaviors.

    “Several SRs and meta-analyses report beneficial effects (using SR criteria, Cohen’s d, or Hedges’ g) of PA on cognitive and academic outcomes (20, 21, 23, 25, 26, 29–31, 35, 36). Specifically, consistent benefits of PA were observed for executive function (21, 23, 26), attention (25), and academic achievement (20, 26), including academic behaviors (e.g., time on task) (30).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [20] Álvarez-Bueno C, Pesce C, Cavero-Redondo I, Sánchez-López M, Garrido-Miguel M, Martínez-Vizcaíno V. Academic Achievement and Physical Activity: A Meta-analysis [Internet]. Pediatrics. 2017; 140(6) doi: 10.1542/peds.2017-1498. 29175972 source

      Not checked in the free run.

    • cites [21] Álvarez-Bueno C, Pesce C, Cavero-Redondo I, Sánchez-López M, Martínez-Hortelano JA, Martínez-Vizcaíno V. The Effect of Physical Activity Interventions on Children’s Cognition and Metacognition: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2017; 56(9): 729– 38. 28838577 source

      Not checked in the free run.

    • cites [23] Bustamante EE, Williams CF, Davis CL. Physical Activity Interventions for Neurocognitive and Academic Performance in Overweight and Obese Youth: A Systematic Review. Pediatr Clin North Am. 2016; 63(3): 459– 80. 27261545 source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    There is moderate-to-strong support that physical activity benefits cognitive functioning in early and late life and in some populations with cognitive deficits.

    “There is moderate-to-strong support that PA benefits cognitive functioning during early and late periods of the lifespan and in certain populations characterized by cognitive deficits.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The strength of the evidence differs by age across the lifespan and by whether individuals have medical conditions that affect cognition.

    “The strength of the findings varies across the lifespan and in individuals with medical conditions influencing cognition.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Few large-scale studies with sufficient sample sizes have examined physical activity intervention effects on hippocampal volume in older adults, leaving long-term effects ambiguous.

    “Yet, despite these promising results, few large-scale studies with sufficient sample sizes have examined the effects of PA interventions on hippocampal volume in older adults, leading to ambiguity about the long-term effects (75).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Frederiksen KS, Gjerum L, Waldemar G, Hasselbalch SG. Effects of Physical Exercise on Alzheimer’s Disease Biomarkers: A Systematic Review of Intervention Studies. J Alzheimers Dis. 2018; 61(1): 359– 72. 29154278

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Most systematic reviews and meta-analyses reported small-to-moderate effects of randomized controlled trials on cognitive performance in older adults, moderated by sex and the cognitive domain assessed.

    “In sum, despite heterogeneity across studies, the majority of SRs and meta-analyses reported small-to-moderate sized effects of RCTs on cognitive performance in older adults, which were moderated by both sex and the cognitive domain assessed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In older adults, effect sizes were greatest for executive function, global cognition, and attention.

    “Effect sizes were greatest for measures of executive function (6), global cognition (18), and attention (15).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [6] Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003; 14(2): 125– 30. 12661673 source

      Not checked in the free run.

    • cites [18] Wu Y, Wang Y, Burgess EO, Wu J. The effects of Tai Chi exercise on cognitive function in older adults: A meta-analysis. Journal of Sport and Health Science. 2013; 2(4): 193– 203. source

      Not checked in the free run.

    • cites [15] Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C, Brennan S. The impact of exercise on the cognitive functioning of healthy older adults: a systematic review and meta-analysis. Ageing Res Rev. 2014; 16: 12– 31. 24862109 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Physical activity is a possible approach for managing dementia symptoms and may improve cognition in individuals with a clinical dementia diagnosis, including Alzheimer's disease.

    “PA is also a possible approach for managing the symptoms of dementia, indicating that PA interventions may help to improve cognition in individuals with a clinical dementia diagnosis, including AD (45, 47, 49, 50, 52, 84).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [45] Cammisuli DM, Innocenti A, Franzoni F, Pruneti C. Aerobic exercise effects upon cognition in Mild Cognitive Impairment: A systematic review of randomized controlled trials. Archives Italiennes de Biologie. 2017; 155(1/2): 55– 63. 28715598

      Not checked in the free run.

    • cites [47] Groot C, Hooghiemstra AM, Raijmakers PGHM, The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Res Rev. 2016; 25: 13– 23. 26607411 source

      Not checked in the free run.

    • cites [49] Lee HS, Park SW, Park YJ. Effects of Physical Activity Programs on the Improvement of Dementia Symptom: A Meta-Analysis [Internet]. Bio Med Research International. 2016; available from: https://www.hindawi.com/journals/bmri/2016/2920146/. doi: 10.1155/2016/2920146. PMC5081454 27819000

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  • May combine two claims.

    Findingcitation

    Reported acute effects were most consistent for executive function, but significant benefits were also found for processing speed, attention, and memory.

    “Reported effects were most consistent for domains of executive function (65–68), but significant benefits were also realized for processing speed, attention (although see (27) for a discrepant finding) and memory (65, 66, 68).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [65] Chang YK, Labban JD, Gapin JI, Etnier JL. The effects of acute exercise on cognitive performance: a meta-analysis. Brain Res. 2012; 1453: 87– 101. 22480735 source

      Not checked in the free run.

    • cites [66] Lambourne K, Tomporowski P. The effect of exercise-induced arousal on cognitive task performance: a meta-regression analysis. Brain Res. 2010; 1341: 12– 24. 20381468 source

      Not checked in the free run.

    • cites [68] McMorris T, Hale BJ. Differential effects of differing intensities of acute exercise on speed and accuracy of cognition: a meta-analytical investigation. Brain Cogn. 2012; 80(3): 338– 51. 23064033 source

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  • May combine two claims.

    Findingcitation

    Overall, findings strongly indicate that transient cognitive benefits can follow single acute bouts of physical activity; these effects appear strongest for preadolescent children and older adults and for moderate intensity, with 11 to 20 minutes as the optimal duration.

    “Overall, the findings strongly indicate that transient cognitive benefits may be derived following single acute bouts of PA. Such effects appear strongest for preadolescent children and older adults and for a PA dose of moderate intensity (65–68), with further evidence supporting 11-20 minutes in duration as the optimal range for enhancing cognitive function (65).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [65] Chang YK, Labban JD, Gapin JI, Etnier JL. The effects of acute exercise on cognitive performance: a meta-analysis. Brain Res. 2012; 1453: 87– 101. 22480735 source

      Not checked in the free run.

    • cites [66] Lambourne K, Tomporowski P. The effect of exercise-induced arousal on cognitive task performance: a meta-regression analysis. Brain Res. 2010; 1341: 12– 24. 20381468 source

      Not checked in the free run.

    • cites [67] Ludyga S, Gerber M, Brand S, Holsboer-Trachsler E, Pühse U. Acute effects of moderate aerobic exercise on specific aspects of executive function in different age and fitness groups: A meta-analysis. Psychophysiology. 2016; 53(11): 1611– 26. 27556572 source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Most studies reported beneficial associations between physical activity and cognition, but some reported weaker or absent effects.

    “While most studies reported beneficial associations of PA on cognition, others reported less robust or even absent effects.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    The moderate grade reflects inadequate description of whether interventions maintained moderate-intensity physical activity.

    “poor descriptions of whether the interventions were successful at maintaining moderate-intensity PA through the course of the intervention”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Moderate-intensity physical activity is the most commonly reported dose.

    “Moderate-intensity PA is the most commonly reported dose”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    In the mild cognitive impairment and dementia literature, studies were prospective and observational and typically used self-reported physical activity, unlike the RCT-focused sections of the review.

    “In other sections of this review, the meta-analyses and SRs were primarily focused on RCTs while in the context of MCI and dementia the studies were prospective and observational and typically used self-reported measures of PA.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Moderate-intensity interventions of longer duration had larger effect sizes than lighter-intensity and shorter-duration studies.

    “Several reports find that moderate-intensity interventions of longer durations had larger effect sizes than lighter intensity and shorter duration studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Few studies examine sedentary behavior or light-intensity activity in relation to cognitive outcomes, because most RCTs manipulate moderate-intensity activity.

    “there are few studies examining the impact of sedentary behavior or light intensity activity on cognitive outcomes as most RCTs manipulate moderate intensity activity and not light intensity or sedentary behaviors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    In observational mild cognitive impairment and dementia studies, physical activity was often self-reported, whereas in RCTs it was generally controlled and experimentally manipulated.

    “In these observational studies, PA was often measured by self-report whereas in RCTs it was generally controlled and experimentally manipulated.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Systematic reviews and meta-analyses varied in their guiding principles and criteria, with some using stronger theoretical and methodological approaches.

    “Not all SRs and meta analyses were conducted using the same set of guiding principles and criteria, with some utilizing stronger theoretical and methodological approaches than others.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Esteban-Cornejo and colleagues found mixed results in adolescents: 70% of studies showed a positive relationship of physical activity with cognitive or academic outcomes, 20% showed no relationship, and 10% showed a negative relationship.

    “Esteban-Cornejo et al. (33) observed mixed results, such that 70% of the studies observed a positive relationship of PA (broadly defined as physical education, sport, athletic participation and exercise behavior) with cognitive or academic outcomes, 20% observed no relationship, and 10% observed a negative relationship.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Esteban-Cornejo I, Tejero-Gonzalez CM, Sallis JF, Veiga OL. Physical activity and cognition in adolescents: A systematic review. J Sci Med Sport. 2015; 18(5): 534– 9. 25108657 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Zeng and colleagues reviewed five randomized controlled trials of physical activity on cognitive development in children aged 4 to 6 years; four observed positive effects on attention, memory, language, and academic achievement, and they concluded only preliminary evidence supports a positive effect.

    “Further, Zeng et al. (32) reviewed five RCTs of PA on cognitive development in children aged 4-6 years. Four of the five studies (80%) observed a positive effect of PA on attention, memory, language, and academic achievement. Similarly, they concluded that there is only preliminary evidence to support a positive effect of PA on cognition during early childhood.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Zeng N, Ayyub M, Sun H, Wen X, Xiang P, Gao Z. Effects of Physical Activity on Motor Skills and Cognitive Development in Early Childhood: A Systematic Review [Internet]. BioMed Research International. 2017; doi: 10.1155/2017/2760716. PMC5745693 29387718

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Carson and colleagues rated six of the seven studies as having weak experimental quality and high risk of reporting bias using PRISMA guidelines.

    “However, the authors rated six of the seven studies as having weak experimental quality and a high risk of reporting bias using PRISMA guidelines.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Carson V, Hunter S, Kuzik N, Systematic review of physical activity and cognitive development in early childhood. J Sci Med Sport. 2016; 19(7): 573– 8. 26197943 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some effects in older adults were large, such as Hedges' g of 2.06 for aerobic training on executive functions, but were moderated by activity mode, with larger effects for aerobic than resistance or multi-modal training.

    “Some of these effects were large (Hedges’ g=2.06 for aerobic training effects on executive functions), but were moderated by the mode of activity with larger effect sizes for aerobic training compared to resistance or multi-modal (i.e., resistance and aerobic) interventions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Barha CK, Davis JC, Falck RS, Nagamatsu LS, Liu-Ambrose T. Sex differences in exercise efficacy to improve cognition: A systematic review and meta-analysis of randomized controlled trials in older humans. Front Neuroendocrinol. 2017; 46: 71– 85. 28442274 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Measures of reasoning improved significantly across 25 randomized controlled trials, but this effect was specific to resistance exercise.

    “For example, measures of reasoning were significantly improved across 25 RCTs, but this effect was specific to resistance exercise (15)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C, Brennan S. The impact of exercise on the cognitive functioning of healthy older adults: a systematic review and meta-analysis. Ageing Res Rev. 2014; 16: 12– 31. 24862109 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In one meta-analysis of 39 randomized controlled trials, physical activity training improved executive function, episodic memory, visuospatial function, word fluency, processing speed, and global cognitive function in older adults.

    “In one meta-analysis of 39 RCTs, PA training improved executive function, episodic memory, visuospatial function, word fluency, processing speed, and global cognitive function (14).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] Barha CK, Davis JC, Falck RS, Nagamatsu LS, Liu-Ambrose T. Sex differences in exercise efficacy to improve cognition: A systematic review and meta-analysis of randomized controlled trials in older humans. Front Neuroendocrinol. 2017; 46: 71– 85. 28442274 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    For executive functions, larger effect sizes have been reported in studies with a greater percentage of women, suggesting sex is an important moderator of physical activity effects on cognition.

    “In addition, for executive functions, larger effect sizes have been reported for studies with a greater percentage of women, suggesting sex is an important moderator of the effect of PA on cognition (6, 14).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003; 14(2): 125– 30. 12661673 source

      Not checked in the free run.

    • cites [14] Barha CK, Davis JC, Falck RS, Nagamatsu LS, Liu-Ambrose T. Sex differences in exercise efficacy to improve cognition: A systematic review and meta-analysis of randomized controlled trials in older humans. Front Neuroendocrinol. 2017; 46: 71– 85. 28442274 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with acute and chronic stroke, physical activity improves global cognition, attention, memory, and visuospatial abilities.

    “In patients with both acute and chronic stroke, PA improves global cognition, attention, memory, and visuospatial abilities (53, 64).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [53] Zheng G, Zhou W, Xia R, Tao J, Chen L. Aerobic Exercises for Cognition Rehabilitation following Stroke: A Systematic Review. Journal of Stroke and Cerebrovascular Diseases. 2016; 25(11): 2780– 9. 27554073 source

      Not checked in the free run.

    • cites [64] Oberlin LE, Waiwood AM, Cumming TB, Marsland AL, Bernhardt J, Erickson KI. Effects of Physical Activity on Poststroke Cognitive Function: A Meta-Analysis of Randomized Controlled Trials. Stroke. 2017; 48(11): 3093– 100. 28931620 PMC5784766 source

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  • May combine two claims.

    Premisecitation

    In individuals with schizophrenia, increases in brain volume and connectivity and elevated serum BDNF are observed after 8 weeks to 6 months of physical activity.

    “Further, increases in brain volume and connectivity and elevated levels of serum BDNF are observed following 8 weeks to 6 months of PA in individuals with schizophrenia (70).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Firth J, Cotter J, Carney R, Yung AR. The pro-cognitive mechanisms of physical exercise in people with schizophrenia. Br J Pharmacol. 2017; 174(19): 3161– 72. 28261797 PMC5595765 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The meta-analysis by Tan and colleagues included children with autism spectrum disorder, ADHD, or both, with an overall Hedges' g of 0.24, making effects of physical activity on autism spectrum disorder alone difficult to interpret.

    “However, the meta-analysis included children with ASD, ADHD, or both disorders (overall Hedges’ g = 0.24) and, as such, it is difficult to interpret effects of PA on ASD alone (41).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Tan BWZ, Pooley JA, Speelman CP. A Meta-Analytic Review of the Efficacy of Physical Exercise Interventions on Cognition in Individuals with Autism Spectrum Disorder and ADHD. J Autism Dev Disord. 2016; 46(9): 3126– 43. 27412579 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    One meta-analysis of 18 randomized controlled trials from 802 dementia patients reported an overall standardized mean difference of 0.42, with significant effects for Alzheimer's disease and for combined Alzheimer's and non-Alzheimer's dementias.

    “For example, one meta-analysis of 18 RCTs from 802 dementia patients reported an overall standardized mean difference of 0.42; this effect was also significant for individuals with AD (N=8 studies) or in studies that combined AD and non-AD dementias (N=7) (47).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Groot C, Hooghiemstra AM, Raijmakers PGHM, The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Res Rev. 2016; 25: 13– 23. 26607411 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In schizophrenia, moderate-to-vigorous physical activity interventions improve global cognition, working memory, and attention, with an average Hedges' g of 0.43.

    “In schizophrenia, moderate-to-vigorous PA interventions improve global cognition, working memory, and attention, with an average Hedges’ g of 0.43 (58).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] Firth J, Stubbs B, Rosenbaum S, Aerobic Exercise Improves Cognitive Functioning in People With Schizophrenia: A Systematic Review and Meta-Analysis. Schizophr Bull. 2017; 43(3): 546– 56. 27521348 PMC5464163

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  • Classified as probably not a substantial claim.

    Premisecitation

    One systematic review published after the PAGAC search concluded there was insufficient evidence that physical activity could be used for dementia prevention.

    “One additional SR published after the PAGAC search was completed examined the effects of PA interventions (of any type) lasting at least 6 months on delaying cognitive impairment in currently undiagnosed individuals (44). The authors concluded that there was insufficient evidence that PA could be used for dementia prevention.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Brasure M, Desai P, Davila H, Physical Activity Interventions in Preventing Cognitive Decline and Alzheimer-Type Dementia: A Systematic Review. Ann Intern Med. 2018; 168(1): 30– 8. 29255839 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In ADHD, effect sizes for physical activity improving cognitive performance ranged from Hedges' g of 0.18 to 0.77, with attention and executive function most commonly affected.

    “In studies examining effects of PA in ADHD, the effect sizes (Hedges’ g) ranged from 0.18 to 0.77 in favor of PA improving cognitive performance (39–41). The cognitive domains most commonly affected included attention and executive function (e.g., inhibition, impulsivity) (39, 41).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [39] Cerrillo-Urbina AJ, García-Hermoso A, Sánchez-López M, Pardo-Guijarro MJ, Gómez JL Santos, Martínez-Vizcaíno V. The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev. 2015; 41(6): 779– 88. 25988743 source

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    • cites [41] Tan BWZ, Pooley JA, Speelman CP. A Meta-Analytic Review of the Efficacy of Physical Exercise Interventions on Cognition in Individuals with Autism Spectrum Disorder and ADHD. J Autism Dev Disord. 2016; 46(9): 3126– 43. 27412579 source

      Not checked in the free run.

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    Premisecitation

    Other studies indicate that very light-, light-, and moderate-intensity physical activity benefited cognition, but hard-, very hard-, and maximal-intensity physical activity showed no benefit.

    “and other studies indicate that very light-, light-, and moderate-intensity PA benefited cognition, but hard-, very hard-, and maximal-intensity PA demonstrated no benefit (65, 80).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [65] Chang YK, Labban JD, Gapin JI, Etnier JL. The effects of acute exercise on cognitive performance: a meta-analysis. Brain Res. 2012; 1453: 87– 101. 22480735 source

      Not checked in the free run.

    • cites [80] Brown BM, Rainey-Smith SR, Castalanelli N, Study protocol of the Intense Physical Activity and Cognition study: The effect of high-intensity exercise training on cognitive function in older adults. Alzheimer’s & Dementia: Translational Research & Clinical Interventions. 2017; 3(4): 562– 70. 29124115 PMC5671630 source

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  • May combine two claims.

    Premisecitation

    Physical activity bouts lasting 11 to 20 minutes produced the greatest cognitive benefits, while bouts shorter than 11 minutes or longer than 20 minutes had smaller effects.

    “PA bouts lasting 11-20 minutes demonstrated the greatest benefits, with bouts lasting less than 11 minutes or more than 20 minutes having smaller effects on cognition (65).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [65] Chang YK, Labban JD, Gapin JI, Etnier JL. The effects of acute exercise on cognitive performance: a meta-analysis. Brain Res. 2012; 1453: 87– 101. 22480735 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review protocol was registered at PROSPERO #CRD42018095774.

    “The protocol for this review was registered at PROSPERO #CRD42018095774.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Increased BDNF concentrations were observed after longer bout durations, more than 30 minutes versus less than 30 minutes, in those with higher cardiorespiratory fitness, and the findings were selective to males, although 75% of participants across studies were male.

    “Findings further indicated that increased BDNF concentrations were observed following longer bout durations (>30 min relative to <30 min) in those who had higher cardiorespiratory fitness (i.e., > VO2 peak), and that the findings were selective to males (although 75% of participants across studies were male) (74).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Dinoff A, Herrmann N, Swardfager W, Lanctôt KL. The effect of acute exercise on blood concentrations of brain-derived neurotrophic factor in healthy adults: a meta-analysis. Eur J Neurosci. 2017; 46(1): 1635– 46. 28493624 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Myers and colleagues reported that 7 of 11 randomized controlled trials indicated improved cognitive function due to physical activity, but only two studies used objective measures of cognition.

    “Myers et al., (63) reported that 7 of 11 RCTs indicated improved cognitive function due to PA (aerobic, resistance, mindfulness-based exercise, or a combination of PA modes). However, only two of the studies used objective measures of cognition (63).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [63] Myers JS, Erickson KI, Sereika SM, Bender CM. Exercise as an Intervention to Mitigate Decreased Cognitive Function From Cancer and Cancer Treatment: An Integrative Review [Internet]. Cancer Nurs. 2017; doi: 10.1097/NCC.0000000000000549. PMC5975081 29194066 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The benefits of physical activity can be seen immediately after an acute bout and can accumulate over time with more chronic physical activity.

    “These findings are important and relevant to the Physical Guidelines for Americans because they suggest that the benefits of engaging in PA can be seen immediately (i.e., following an acute bout) and accumulate over time (i.e., following more chronic PA behavior).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Titles, abstracts, and full-text articles were independently screened by two reviewers, and disagreements were resolved by discussion or by a third person.

    “Titles, abstracts, and full-text articles were independently screened by two reviewers. Disagreement between reviewers was resolved by discussion or by a third person.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    For executive function, larger acute effects were found for preadolescent children, Hedges' g 0.54 [0.21, 0.87], and older adults, 0.67 [0.40, 0.93], than for adolescents, 0.04 [−0.14, 0.23], and young adults, 0.20 [0.07, 0.34].

    “Although effects were observed across the lifespan, larger effects (Hedges’ g) were realized for preadolescent children (0.54 [0.21, 0.87]) and older adults (0.67 [0.40, 0.93]) relative to adolescents (0.04 [−0.14, 0.23]) and young adults (0.20 [0.07, 0.34]) for executive function (67).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] Ludyga S, Gerber M, Brand S, Holsboer-Trachsler E, Pühse U. Acute effects of moderate aerobic exercise on specific aspects of executive function in different age and fitness groups: A meta-analysis. Psychophysiology. 2016; 53(11): 1611– 26. 27556572 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The inclusion criteria for the review were pre-defined.

    “The inclusion criteria were pre-defined”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    One meta-analysis in older adults reported larger effects in randomized controlled trials where physical activity bouts lasted 46 to 60 minutes compared with 15 to 30 minutes and 31 to 45 minutes, and in interventions lasting at least 6 months.

    “One meta-analysis in older adults (6) reported that larger effects were observed in RCTs in which PA bouts lasted 46-60 minutes (compared to bout lasting 15-30 minutes and 31-45 minutes) and in interventions lasting for at least 6 months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003; 14(2): 125– 30. 12661673 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    All these factors likely enhance different aspects of brain health.

    “Indeed, it is likely that all of these factors are enhancing different aspects of brain health.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The findings may promote better cognitive function in healthy individuals and improve cognitive function in people with certain cognitive and brain disorders.

    “such findings may serve to promote better cognitive function in healthy individuals, and improve cognitive function in those suffering from certain cognitive and brain disorders.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Physical activity may modify sleep behaviors, which in turn improve cognitive function.

    “PA might be modifying sleep behaviors which in turn improve cognitive function.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    There are many possible mechanisms by which physical activity influences brain health.

    “there are many possible mechanisms by which PA influences brain health”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The findings may lead to more informed policies about using physical activity to improve cognitive function across the lifespan.

    “These findings may lead to more informed policies about using PA to improve and shape cognitive function across the lifespan.”
    Quote in the paperNot a substantial claim
46 of 46

  • The paper relies on this without support.

    Many executive function instruments are traditional neuropsychological tools designed for clinical diagnosis rather than for measuring normative individual differences.

    “many of the instruments used to assess executive functioning are traditional neuropsychological tools that were primarily developed to aid in clinical diagnosis rather than to assess individual variation in normative cognitive functioning.”

  • The paper relies on this without support.

    Self-reported physical activity measures used in prospective observational studies are valid indicators of actual physical activity.

    “the studies were prospective and observational and typically used self-reported measures of PA”

  • The paper relies on this without support.

    The positive effects observed in the reviewed literature are not primarily due to publication bias or selective reporting.

    “Yet, despite these limitations and heterogeneity, 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”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Socially engaging activities such as mindfulness and physical exercise can facilitate the psycho-cognitive process of coping and reduce stress.

    “Emerging empirical evidence suggests socially engaging activities such as mindfulness and physical exercise can facilitate the psycho-cognitive process of coping and reduce stress8–10.”

    From A randomized clinical trial of mindfulness meditation versus exercise in Parkinson’s disease during social unrest (2023) · cites this paper as [8]

    The Results section on chronic physical activity reports cognitive benefits from exercise, including mindfulness-based exercise in studies of cancer-related cognitive deficits. It does not address whether mindfulness or exercise facilitates coping or reduces stress, or characterize them as socially engaging activities (searched: mindfulness, coping, stress). (LLM, conf=0.73)

    Experimental — accuracy not yet measured

  • Physical activity interventions, including those of moderate to vigorous intensity, improve brain structure and function as well as cognitive and academic performance.

    “There is evidence that physical activity interventions, including those of moderate to vigorous intensity, improve brain structure and function as well as cognitive and academic performance.75–79”

    From Physical activity and health in Chinese children and adolescents: expert consensus statement (2020) (2020) · cites this paper as [76]

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Related

Authors
ERICKSON, K. I., HILLMAN, C., STILLMAN, C. M., BALLARD, R. M., BLOODGOOD, B., CONROY, D. E., MACKO, R., MARQUEZ, D. X., PETRUZZELLO, S. J., & POWELL, K. E.
Affiliations
  • University of Pittsburgh (US)
  • Northeastern University (US)
  • National Institutes of Health (US)
  • ICF International (United States) (US)
  • Pennsylvania State University (US)
  • University of Maryland, Baltimore (US)
  • Department of Kinesiology and Nutrition, Center for Research on Health and Aging, University of Illinois at Chicago, Chicago, IL;
  • University of Illinois Urbana-Champaign (US)
  • Centers for Disease Control and Prevention (US)
ORCID
Venue
Medicine & Science in Sports & Exercise
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-06
Volume
51
Issue
6
Pages
1242-1251
ISSN
  • 0195-9131 (ISSN-L)
  • 1530-0315
DOI
10.1249/mss.0000000000001936
PMC
PMC6527141
OpenAlex
W2945893642
Semantic Scholar
5df02efd8ae227b52469cad8c7d2d54a96eb7e37
Cited by
1,214
References
89
Citations by year
2026: 184 · 2025: 216 · 2024: 217 · 2023: 201 · 2022: 176 · 2021: 131 · 2020: 73 · 2019: 12 · 2018: 1
FWCI
11.51
Type
journal article
Language
en
Open access
Locations
  • Medicine & Science in Sports & Exercise (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (Z99 OD999999)
  • National Institute on Aging (P30AG024827, P30AG028747)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
physical activity, cognitive function, brain function, moderate-to-vigorous intensity exercise, acute exercise effects, processing speed, memory, executive function, academic performance, cognitive impairment, dementia risk, Alzheimer's disease, schizophrenia, lifespan, exercise dose
MeSH terms
Aging, Brain, Cognition, Cognition Disorders, Humans, Physical Fitness, Exercise, Practice Guidelines as Topic, Risk Reduction Behavior

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

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