Effects of exercise on executive function in cognitively healthy older adults: a systematic review and three-level meta-analysis

OBJECTIVE: To systematically evaluate the effect of exercise on the executive function of cognitively healthy older adults through a three-level Meta-analysis. METHODS: Randomized controlled trials (RCTs) related to the effects of exercise on the executive function of cognitively healthy older adults were retrieved from eight databases, including PubMed, Web of Science, The Cochrane Library, EBSCOhost, Embase, CNKI, Wanfang, and VIP, with a search period from the establishment of the databases to February 27, 2025. The quality of the literature was assessed using the PEDro scale and the evidence quality was evaluated using GRADE. Meta-analysis was performed using a three-level random effects model in R, and publication bias was tested. Hedges’ g value and its 95% confidence interval (CI) were used for assessment, and a 95% prediction interval (PI) was calculated to determine the expected range of effect sizes in future similar studies. Funnel plots and Egger’s regression were used to assess publication bias. RESULTS: A total of 50 RCTs were included, involving 4,826 cognitively healthy older adults. The PEDro scale scores ranged from 5 to 8, with an average of 6.4, indicating that the overall quality of the included literature was good. After excluding outliers, the meta-analysis revealed that exercise significantly improved overall executive function in older adults (g= 0.155, 95% CI 0.084, 0.226, p < 0.001). Significant improvements were also observed in the subdomains of working memory (g = 0.208, 95% CI 0.093, 0.322,P12 years of education (g = 0.149, 95% CI 0.016, 0.283, p = 0.028), studies with ≥50% female participants (g = 0.137, 95% CI 0.067, 0.206, p < 0.001), studies with