The impact of exercise interventions on cognitive frailty: a scoping review of outcomes and biological mechanisms

Background: As the global trend of aging intensifies, the high prevalence of cognitive frailty is expected to impose a substantial burden on healthcare systems. While traditional exercise interventions have demonstrated effectiveness, contemporary models are evolving from conventional in-person formats toward digitally-supported, personalized approaches. Nevertheless, a comprehensive synthesis of evidence comparing the efficacy of different exercise modalities and elucidating their underlying biological mechanisms in the context of cognitive frailty remains lacking. Objective: This scoping review aims to elucidate a multidimensional integrated framework linking "exercise formats-mechanisms-health outcomes" for exercise interventions improving cognitive frailty, thereby systematically revealing the action pathways and synergistic mechanisms of different exercise modalities. Methods: This review adhered to the PRISMA-ScR guidelines and systematically searched PubMed, Cochrane Library, Embase, Web of Science, and Scopus up to October 9, 2025. Literature screening, data extraction, and synthesis were performed to identify studies investigating the effects of exercise interventions on cognitive frailty. Results: Seventeen studies were included. The results indicate that exercise intervention models are diverse, with nearly half of the studies employing digital intervention models, demonstrating new potential for enhancing safety, adherence, and personalization. An integrated analysis of seven studies reporting mechanistic insights indicated that the benefits are supported by multiple synergistic biological pathways, including improvements in brain structure and functional plasticity, enhanced neural efficiency, reduced neuroinflammation and oxidative stress, modulation of neurotransmitters, and increased cerebral blood flow perfusion. Conclusion: This scoping review systematically examines the integrated framework of "exercise formats-mechanisms-health outcomes" to reveal the multidimensional synergistic network through which exercise interventions ameliorate cognitive frailty, while also highlighting the considerable potential of the digital transformation of exercise modalities. Future research should deepen the integration of digital technologies and conduct large-scale, multicenter randomized controlled trials to longitudinally validate the specific mechanisms of different exercise models, thereby advancing the development of personalized, precision intervention protocols. Systematic review registration: Open Science Framework with the registration number (10.17605/OSF.IO/WYSJF).