To systematically evaluate the effect of exercise on the executive function of cognitively healthy older adults through a three-level Meta-analysis. 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. 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 12 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 <50% female participants (g = 0.359, 95% CI 0.083, 0.635, p = 0.010), and studies employing a usual care control design (g = 0.205, 95% CI 0.113, 0.296, p < 0.001). The Egger's test (t = 2.630，p= 0.009) indicates a potential publication bias. The GRADE evidence quality for the impact of exercise on executive function in cognitively healthy older adults is rated as moderate. Exercise is an effective way to enhance overall executive function, as well as working memory and cognitive flexibility in cognitively healthy older adults. Compared to the control group, moderate-intensity aerobic exercise and resistance training performed ≥3 times/week, each session lasting ≤60 minutes and with a duration of ≤26 weeks, can improve overall executive function, working memory, and cognitive flexibility, especially for older adults with higher age and lower education levels. However, future exercise programs should be tailored to the individual needs and physical conditions of older adults. This study has been registered on PROSPERO with the registration number CRD420251000402. Registration platform: www.crd.york.ac.uk.
Chen et al. (Mon,) studied this question.