Digital Physical Exercise Interventions for Cognitive Functions in Older Adults: Systematic Review and Bayesian Network Meta-Analysis (Preprint)

BACKGROUND Digital physical exercise interventions offer a scalable solution to combat age-related cognitive decline. While various modalities exist, their comparative effectiveness across different cognitive domains remains unclear, necessitating a systematic evaluation to guide clinical practice. OBJECTIVE This study aims to evaluate and rank the comparative effectiveness of different digital physical exercise interventions—including immersive VR (IVR_E), non-immersive exergames (NI_ExG), remote exercise (RE), and VR combined with cognitive training (VR_EC)—on global cognition, executive function, and memory function in older adults. METHODS We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs) published between January 1, 2010, and April 30, 2025. Data sources included PubMed, Embase, and Web of Science. Eligible studies involved older adults (aged ≥60 years) and compared digital physical exercise interventions against routine interventions (RI) or non-intervention (NI). The primary outcomes were global cognition, executive function, and memory function. We estimated standardized mean differences (SMDs) and ranked interventions using the surface under the cumulative ranking curve (SUCRA). RESULTS A total of 41 RCTs involving 2919 participants were included. For global cognition, IVR_E emerged as the most effective intervention (SUCRA=96.6%), followed by NI_ExG (SUCRA=76.4%); both modalities were significantly superior to RI. Regarding executive function, RE (SUCRA=73.8%) and NI_ExG (SUCRA=69.3%) ranked highest. Notably, NI_ExG was the only intervention to demonstrate a statistically significant improvement over RI in this domain, while IVR_E showed no significant advantage. For memory function, IVR_E was the dominant intervention (SUCRA=82.8%) and was the only modality significantly more effective than RI. Subgroup analyses further indicated that a cumulative training dose exceeding 1000 minutes is critical for observing significant improvements in memory function. CONCLUSIONS Digital physical exercise interventions significantly enhance cognitive function in older adults, but their optimal application is domain-specific. IVR_E appears most effective for global cognition and memory, likely due to high immersion and standardization. Conversely, NI_ExG and RE are preferable for enhancing executive function, potentially offering more scalable alternatives for home-based care. Future interventions targeting memory improvement should ensure sufficient cumulative training duration. CLINICALTRIAL PROSPERO CRD42025103014