# Optimal type and dose of exercise to improve cognitive function in healthy and pre-sarcopenic older adults: a bayesian network meta-analysis of randomized controlled trials

## TL;DR

This study finds that specific types and amounts of exercise can improve cognitive function in older adults, with different recommendations for healthy individuals and those with pre-sarcopenia.

## Contribution

The study provides novel, evidence-based exercise prescriptions for cognitive health in aging populations using a Bayesian network meta-analysis.

## Key findings

- Aerobic, resistance, and multimodal exercise significantly improved cognition compared to no exercise.
- Healthy older adults benefited most from aerobic or resistance training, while pre-sarcopenic individuals saw best results from multimodal programs.
- Optimal cognitive benefits occurred at 700–1,200 MET·min/week, with no additional gains from higher volumes in pre-sarcopenic individuals.

## Abstract

Exercise is increasingly recognized as a non-pharmacological strategy for cognitive aging; however, comparative evidence across modalities, phenotypes, and doses is limited.

We conducted a Bayesian network meta-analysis of 38 randomized controlled trials (N = 4,047; 88 arms). The interventions included aerobic, resistance, multimodal, and other exercise formats compared with non-exercise controls. The primary outcome was global cognition. Analyses were stratified by age (< 70 vs. ≥70 years) and phenotype (healthy vs. pre-sarcopenic). Dose–response relationships were modeled using the weekly volume (MET·min/week).

Aerobic (standardized mean difference [SMD] 0.58, 95% CI 0.33–0.83), resistance (0.62, 0.35–0.88), and multimodal programs (0.68, 0.40–0.95) significantly improved cognition compared to the control, with smaller effect sizes. Healthy older adults benefited most from aerobic (0.88, 0.55–1.20) and resistance training (0.80, 0.42–1.19), whereas multimodal programs were most effective for pre-sarcopenia (0.60, 0.29–0.90). Dose–response analysis showed clinically meaningful benefits from ~ 600 MET·min/week, with optimal effects between 700 and 1,200 MET·min/week. Higher volumes conferred no consistent additional gains in pre-sarcopenia.

Exercise is a scalable, safe, and clinically effective approach for preserving late-life cognition. For healthy older adults, aerobic or resistance training at ≥ 600 MET·min/week is recommended; for pre-sarcopenic individuals, multimodal programs at approximately 700–800 MET·min/week offer the best balance of efficacy and sustainability. These findings provide actionable targets for clinicians and policymakers, advancing precision exercise prescriptions for cognitive health in aging populations.

The online version contains supplementary material available at 10.1186/s11556-026-00404-2.