The Impact of Exercise On The Cognitive Functioning of Healthy Older

Ageing Research Reviews 16 (2014) 1231
Contents lists available at ScienceDirect
Ageing Research Reviews

journal homepage: www.elsevier.com/locate/arr
Review
The impact of exercise on the cognitive functioning of healthy older

adults: A systematic review and meta-analysis
Michelle E. Kelly a, , David Loughrey a , Brian A. Lawlor a , Ian H. Robertson a ,
Cathal Walsh b , Sabina Brennan a
a
b
The NEIL Programme, Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
Department of Statistics, Trinity College Dublin, Dublin 2, Ireland
a r t i c l e
i n f o
Article history:
Received 7 January 2014
Received in revised form 8 May 2014
Accepted 13 May 2014
Available online 23 May 2014
Keywords:
Systematic review
Meta-analysis
Exercise
Physical activity
Cognitive functioning
Healthy older adults
a b s t r a c t
Data from epidemiological, cross-sectional, and neuroimaging research show a relationship between
higher levels of exercise and reduced risk of cognitive decline but evidence from randomised controlled
trials (RCTs) is less consistent. This review examines the impact of aerobic exercise, resistance training,
and Tai Chi on the cognitive function of older adults without known cognitive impairment. We investigate explanations for inconsistent results across trials and discrepancies between evidence from RCTs
and other research data. Twenty-ve RCTs were included in the review. Meta-analysis results revealed
signicant improvements for resistance training compared to stretching/toning on measures of reasoning (p < 0.005); and for Tai Chi compared to no exercise controls on measures of attention (p < 0.001) and
processing speed (p < 0.00001). There were no signicant differences between exercise and controls on
any of the remaining 26 comparisons. Results should be interpreted with caution however as differences
in participant proles, study design, exercise programmes, adherence rates, and outcome measures contribute to both discrepancies within the exercise research literature and inconsistent results across trials.
2014 Elsevier B.V. All rights reserved.
Contents
1.
2.
3.
4.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.1.
Search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.2.
Selection criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.3.
Statistical analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.1.
Included studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.2.
Aerobic exercise versus stretching/toning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.3.
Aerobic exercise versus no exercise active control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.4.
Aerobic exercise versus no intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.5.
Resistance versus stretching/toning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.6.
Resistance versus no exercise active control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.7.
Tai Chi versus no exercise active control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1.
Exercise-types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1.1.
Aerobic exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Corresponding author at: The NEIL Programme, Institute of Neuroscience, Trinity College Dublin, The Alzheimer Society of Ireland, Room 3.10, Lloyd Building, Dublin 2,
Ireland. Tel.: +353 1 896 4505.
E-mail addresses: kellym50@tcd.ie (M.E. Kelly), loughred@tcd.ie (D. Loughrey), lawlorb@stjames.ie (B.A. Lawlor), iroberts@tcd.ie (I.H. Robertson), walshc@tcd.ie (C. Walsh),
brennas1@tcd.ie (S. Brennan).
http://dx.doi.org/10.1016/j.arr.2014.05.002
1568-1637/ 2014 Elsevier B.V. All rights reserved.
M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231
4.1.2.
Resistance training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1.3.
Tai Chi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2.
Discrepancies between RCT evidence and other exercise literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2.1.
Baseline physical performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2.2.
Length of intervention and follow-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2.3.
Efciency of the intervention and adherence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2.4.
Physical tness and cognitive health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3.
Inconsistent results across RCTs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.4.
Limitations of the review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.5.
Conclusions and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Conicts of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix A.
Supplementary data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Introduction
As the incidence of age-related cognitive impairment increases,
there is an interest in explaining the role of physical activity in
improving cognitive function of older adults and delaying the onset
of cognitive decline. Although accumulating research evidence
from epidemiological, cross-sectional and neuroimaging studies
shows that exercise is benecial to cognitive health, evidence from
randomised controlled trials (RCTs) is less consistent. Further clarication is necessary to determine if exercise interventions truly
benet cognitive function, particularly for older adults who are at
a greater risk of cognitive decline.
Epidemiological research shows a consistent relationship
between higher levels of physical activity and reduced risk of cognitive decline and dementia. A meta-analysis of 16 prospective
studies examining the relationship between physical activity and
risk of neurodegenerative disease reported that engaging in the
highest physical activity category reduced the risk of dementia by
28% and Alzheimers Disease (AD) by 45%, compared to the lowest physical activity category, even after controlling for possible
confounding factors including age, education, vascular risk factors,
other medical conditions, and ApoE4 genotype (Hamer and Chida,
2009). In a more recent meta-analysis of 15 prospective cohort
studies, over thirty thousand healthy older adults were followed
for periods of 112 years. Results showed that individuals who
engaged in higher levels of physical activity at baseline had a 38%
reduced risk of cognitive decline at follow-up compared to those
who led a sedentary lifestyle at baseline (So et al., 2011).
Epidemiological evidence is supported by cross-sectional studies that show that older adults who reported greater engagement
in physical activity, compared to those who reported being inactive, had a reduced risk of cognitive impairment (e.g. Middleton
et al., 2010) and improved performance on a range of executive function tasks (see Guiney and Machado, 2013 for a review).
Cross-sectional studies using actigraphy as an objective measure of
exercise engagement reported that compared with elderly individuals in the lowest tertile of physical activity, those in the highest
tertile performed signicantly better on tests of global cognition and executive functioning (Barnes et al., 2008; Brown et al.,
2012). Neuroimaging research provides further supportive evidence, showing that compared to those who were less t or led
sedentary lifestyles, older adults with higher aerobic tness levels
had reduced rates of age-related atrophy of grey and white matter
(Colcombe et al., 2003), greater grey matter density in prefrontal
and temporal regions (Gordon et al., 2008), superior white matter
density in the corpus callosum (Johnson et al., 2012), and larger hippocampal volumes (Erickson et al., 2009). Despite the accumulating
evidence from epidemiological, cross-sectional, and neuroimaging
research on the benets of exercise for cognitive function, data from
RCTs is largely inconsistent.
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A plethora of RCTs have been designed to investigate the effects

of different types of exercise on cognition, including aerobic exercise, resistance training (also referred to as strength training), and
exercise programmes that combine aspects of aerobic, strength,
and exibility or balance training such as Tai Chi, with largely varying results across trials. Two separate meta-analyses of randomised
trials reported that aerobic exercise improved the cognitive performance of healthy older adults (Colcombe and Kramer, 2003; Smith
et al., 2010); however three additional reviews of RCTs including a Cochrane review failed to show any consistent benets of
aerobic exercise or tness on cognition (Angevaren et al., 2008;
Clifford et al., 2009; Snowden et al., 2011). Similarly, reviews of
RCTs examining the effects of resistance training (Chang et al.,
2012; Liu-Ambrose and Donaldson, 2009) or Tai Chi (Chang et al.,
2010; Wayne et al., 2014) show that although some evidence supports an improvement in cognitive functioning in older adults, no
reviews to date have reported consistent signicant cognitive benets (Chang et al., 2010, 2012; Snowden et al., 2011; van Uffelen
et al., 2008).
The inconsistencies observed in the results of RCTs preclude
clinicians and researchers from making any rm conclusions about
the impact of physical activity on the cognitive health of older
adults. Previous reviews of the impact of exercise on cognitive function have focused on one exercise type, included data from all age
groups, included older adults with cognitive impairment, or failed
to provide explanations for divergences in the exercise research
literature. Our review updates the extant literature by examining
the effects of aerobic exercise, resistance training, and Tai Chi on
the cognitive performance of healthy older adults without cognitive impairment. We compared our results with evidence from
prior reviews with a view to investigating possible explanations for
inconsistent results across trials, and have provided some clarity
around the discrepancies observed between consistent epidemiological, cross sectional and neuroimaging data, and inconsistent
evidence from RCTs.
2. Methods
2.1. Search strategy
We searched the databases PubMed, Medline, and ClinicalTrials.gov to identify randomised controlled trials written in
English and published between 2002 and 2012. Search terms
included exercise, tness, physical endurance, physical
activity, physical training combined with cognition, cognitive
performance, cognitive decline, cognitive function, cognitive processes; and healthy elderly, elderly, older adults
(full search strategy, Appendix A). We supplemented database
searches with reference lists in review papers, authors own
les, and Google Scholar. We screened titles and abstracts to
14
exclude articles that did not meet inclusion criteria. Full texts
of remaining studies were then screened for eligibility by two
independent reviewers. Disagreements were resolved through
discussions with our expert authors (study selection owchart,
Appendix B).
2.2. Selection criteria
We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Trials were included
that investigated the effects of aerobic exercise, resistance training,
or Tai Chi interventions on the cognitive function of community
dwelling older adults (>50) with no known cognitive impairment.
The exercise categories were chosen based on a scope of the available literature that found that the majority of RCTs fell into one of
these three categories. Studies required at least ten participants per
condition in order to be included in the review. We also excluded
studies if participants had been diagnosed with any cardiovascular
disease, or other signicant medical, psychiatric, or neurological
problems (see excluded studies table, Appendix C). The risk of bias
in individual studies was assessed by two independent reviewers
(Appendix D) using guidelines outlined in Section 8 of the Cochrane
Handbook.
The primary outcome of interest was cognitive function, divided
into the domains of memory and executive function. Sub-categories
were created within each domain. Memory domain sub-categories
were: recognition, immediate recall, delayed recall, face-name
recall, and paired associates. Executive function domain subcategories were: working memory, verbal uency, reasoning,
attention, and processing speed. Composite measures of cognitive function were also included. Secondary outcomes of interest
were subjective cognitive performance and activities of daily living
(ADL).
2.3. Statistical analysis
Data extraction was conducted by two independent reviewers
and cross-checked by a member of the expert panel. Review Manager Version 5.2.6 software for Windows was used to conduct the
analysis. We calculated treatment effects based on pooled data
from individual trials that were deemed clinically homogenous.
The neuropsychological measures in included articles are listed in
Tables 16. For the purpose of meta-analysis, some cognitive tests
were not included as double representation of studies in their cognitive category would compromise the validity of the outcomes. All
trials reported outcomes as continuous data. The summary statistics required for each outcome were the number of participants in
the intervention and control groups at baseline and post-test, the
mean change from baseline and the standard deviation (SD) of the
mean change. If change from baseline scores were not provided,
they were calculated using baseline and post-test mean and SDs.
Change SDs were calculated assuming zero correlation between
the measures at baseline and follow-up. Although this method may
overestimate the SD of the change from baseline, it is a conservative approach which is preferable in a meta-analysis (Levy et al.,
2012).
As pooled trials used different rating scales or tests, the
summary measure of treatment effect was the standardised
mean difference (SMD the absolute mean difference divided
by the standard deviation). Where trials used the same rating scale or test, the weighted mean difference was calculated.
Individual effect sizes were combined using the inverse variance random-effects method (Braun et al., 2009). This was
used to allow the incorporation of heterogeneity among studies. Statistical heterogeneity was assessed by the I2 test, which
describes the percentage of variability among effect estimates
beyond that expected by chance. Overall estimates of the treatment difference are presented in forest plots (Figs. 16). As
it was not possible to pool data from all included studies, a
summary of results from individual trials are outlined and presented in Tables 16.
3. Results
3.1. Included studies
Twenty-ve randomised controlled trials were eligible for inclusion with 731 participants in aerobic exercise, 304 in resistance
training, and 106 in Tai Chi exercise experimental groups; and 332
in stretching/toning, 572 in no exercise active controls, and 172
in no intervention control groups. The most common intervention was aerobic exercise. The stretching/toning control consisted
of stretching and toning or yoga exercises. The no exercise active
control groups received either health education, watched movies or
engaged in general conversation and socialising. The no intervention controls received either no contact, minimum social support,
or were placed on a waiting list. Study characteristics are presented
in Tables 16.
3.2. Aerobic exercise versus stretching/toning
Available data from individual trials were pooled for metaanalyses (Fig. 1). Despite a trend towards improved performance for
experimental versus control groups on each of the included measures, there were no signicant differences between aerobic exercise
versus stretching/toning on immediate recall (p = 0.62), delayed
recall (p = 0.16), working memory (p = 0.30), attention (p = 0.15),
or processing speed (p = 0.28). Data were not available for the
remaining outcomes of interest including recognition, face-name
recall, paired associates, verbal uency, reasoning, overall cognitive
performance, subjective cognitive measures, or ADLs. A summary
of results from individual studies (Table 1) showed signicant
improvements for aerobic exercise compared to stretching/toning
groups in three of 17 memory outcome measures reported in four
trials (Barnes et al., 2013; Erickson et al., 2011; Kramer, Hahn,
McAuley, et al., 2002; Oken et al., 2006), with signicant pre- to
post-intervention improvements for the intervention group but not
for the control group on one additional memory outcome measure
(Kramer et al., 2002). Signicant improvements for aerobic exercise
versus stretching were reported in two out of 40 separate measures of executive function in ve trials (Albinet et al., 2010; Barnes
et al., 2013; Kramer et al., 2002; Oken et al., 2006; Smiley-Oyen
et al., 2008), with signicant pre- to post-intervention improvements reported for the experimental but not for the control groups
on one additional measure of executive function (Kramer et al.,
2002). None of the included studies measured maintenance effects.
3.3. Aerobic exercise versus no exercise active control
Results from the meta-analysis (Fig. 2) revealed no significant differences between aerobic exercise and no exercise
active control groups on the measures of recognition (p = 0.51),
immediate recall (p = 1.00), delayed recall (p = 0.67), verbal uency (p = 0.58), reasoning (p = 0.28), working memory (p = 0.75),
attention (p = 0.56), processing speed (p = 0.76), or cognitive function (p = 0.26). Data were not available for face-name recall,
paired associates, subjective cognitive function or ADLs. Across
individual trials (Table 2), signicant improvements for aerobic
exercise versus active controls were reported in one out of 10
memory outcome measures (Lautenschlager et al., 2008; Legault
et al., 2011; Maki et al., 2012; Mortimer et al., 2012) and two
out of 38 measures of executive function (Barella et al., 2010;
Table 1
Characteristics of studies aerobic exercise versus stretching/toning.
Ref. author (year)
Intervention
Methods
Participants (at PT)
Outcomes of interest
Albinet (2010)
Aerobic exercise programme versus stretching

exercise control
EG: 3 1 h per week for 12 weeks; 4060% of

max HRR
FU: PT
EG: 12
CG: 12
Executive functiona
Additional notes
Age: 6578
Mage EG: 70.9 (4.9)
Mage CG: 70.4 (3.4)
Barnes (2013)
Kramer et al., 2002
Double-blind
EG: Exer. Int.: 3 1 h per week for 12 weeks.
Target 6075% of max HRR
CG: Exer. Cont.: 3 1 h per week for 12 weeks
FU: PT
Aerobic exercise programme versus stretching

and toning exercise control
EG: 3 40 min per week for 1 year. 5060% of

max HRR for weeks 17; 6075% thereafter
CG: 3 days per week for 1 year
FU: PT
Aerobic (walking) versus anaerobic (toning and

stretching) control
EG: 3 (1040) min per week for 6 months

with warm-up + cool-down session
CG: 3 (1040) min per week for 6 months
with 10 min warm-up + cool-down session
FU: PT
Immediate recallc
Delayed recallc
Verbal uencyc
Proc. speed (DSSTc , Trails Ac )
Exec function/inhibitionc
Proc. speed (UFOV)c
Attention (Trails Bc , dividedc , selectivec )
No differences between aerobic versus

stretching on any measures.
ITT analysis. Results similar when dropouts
excluded.
Memoryc
Both groups memory performance improved.
Face recognition (immediatec , delayedc )

Immediate recall (RAVLT, trials 1b , 5c , 6c )
RAVLT: inhibition/recall (trial 7a ), temporal
order ranking (trial 10a )
Delayed recallc
Word recognitiona
Procedural memory (pursuit rotor task, Trial 1c ,
6c , 7c , 8c )
Attention (stopping taskc , task switchinga ,
response-compatibilityc , spatial attention task
RTc and accuracyc , visual search RT slopeb and
accuracyc )
Working memory (n back verbal 1c , 2c , n back
spatial 1c , 2c , self-ordered pointingc , DSFc ,
DSBc )
Processing speed (digit-digit match RTc and
accuracyc , digit-symbol match RTc and
accuracyc )
Tasks that involved executive control processes

improved for the walking group but not toning
group, albeit not all executive tasks.
Signicant relationship between improved VO2
max and improved performance on attention,
working memory and memory measures.
EG1:38
CG: 38
Age: 6585
Mage EG2: 73.6 (5.1)
Mage CG1: 71.5 (4.9)
Delayed recallc
Working memoryc
Attention (Stroopc , Cov. Orient.c )
Divided attention (UFOV)c
Proc. speed (simple RTc , choice RTc )
The yoga intervention group members rated

themselves signicantly better than the
exercise group on several subscales on HRQL
and fatigue tests at FU.
EG: 28
CG: 29
Age: 6579
Mage EG: 69.9 (4.6)
Mage CG: 70.5 (4.5)
Processing speed (simple RTc , incompatible

8-choice RTc , 8-choice RTc )
Attention (Go/No-Goc , Stroop W-Cb , Stroop
W&Cc , WCSTc )
Signicant decrease in RT and errors in the

Stroop (W-C) task among the participants in
EG.
CC/EI: 31
CC/EC: 32
Age: 65
Mage EG: 71.1 (5.5)
Mage CG: 73.9 (6.3)
EG: 60
CG: 60
Age: 5580
Mage EG: 67.6 (5.8)
Mage CG: 65.5 (5.4)
EG: 58
CG: 66
Age: 6075
Mage EG: 67.3 (5.2)
Mage CG: 66.0 (5.3)
Oken (2006)
Three conditions:
1. Aerobic exercise (EG)
2. Yoga (stretching/toning) (CG)
3. Wait-list control
Smiley-Oyen (2008)
Aerobic exercise versus strength-and-exibility
EG: 1 1.5 h per week for 6 months; 70% of

max HRR-adjusted as needed
CG: 1 1 h per week for 6 months; 30 s pose,
<1 min rest
Also encouraged to exercise daily
FU: PT
EG: 3 50 min per week for 10 months;
6070% progressed to 6580% of max HRR
CG: 3 50 min per week for 10 months
FU: PT
Erickson (2011)
Four conditions: aerobic exercise (Exer. Int.) or

stretching (Exer. Cont.) + Computer games (Cog.
Int.) or educational DVDs (Cog. Cont.)
1. Cog. Int./Exer. Int.
2. Cog. Int./Exer. Cont.
3. (EG): Cog. Cont./Exer. Int.
4. (CG): Cog. Cont./Exer. Cont.
Cog. Int. = cognitive intervention; Exer. Int. = exercise intervention; Cog. Cont. = cognitive control; Exer. Cont. = exercise control; EG = experimental group; CG = control group; FU = follow up; PT = post training; Mage = mean age (SD);
DSST = digit symbol substitution test; UFOV = Useful Field of View; HRQL = Health Related Quality of Life; WCST = Wisconsin Card Sort Test; RT = reaction time; Stroop W-C = Stroop word colour; RAVLT = Rey Auditory Verbal
Learning Test; HRR = heart rate reserve.
a
Signicantly greater improvement for training compared to control.
b
Signicant training effects for experimental group from BL to PT; no signicant effect for controls.
c
No signicant intervention difference between experimental and control groups.
15
16
Table 2
Characteristics of studies aerobic exercise versus no exercise active control.
Ref. author (year)
Intervention
Methods
Additional notes
Barella (2010)
Walking exercise
programme versus
sitting quietly control
RCT
EG: 1 20 min session (with 5 min
warm-up); 5763% of max HRR
FU: PT, and 5, 10, 15, 20, 30, 45, 60, 75, 90,
105, and 120 min post-treatment
EG: 20
CG: 20
Attention (Stroop
colourb , interferencec ,
inhibitionc )
Effects maintained at 12
month post intervention.
Immed. recallc
Delayed recalla
Proc speed (DSCT)c
Verbal uencyc
Pre-morbid IQ (CCRT)c
Cognitive function
(ADAS-Coga , CDRSa )
For outcomes that

reported sig. effects of
intervention effects
persisted up to 12
months after
intervention.
Recognitionc
Immediate recall
(HVLTc , LM1c )
Delayed recallc
Attention (task
switchingc , Trails BAc )
Working memory
(self-ordered pointing
taskc , 1-backc , 2-backc )
Response inhibitionc
No signicant outcomes
reported.
Delayed recallc
Verbal uencya
Reasoningc
Proc speedc
Attention (dual task
testc , Trailsc )
Clock drawingc
Signicant benets for

EG in quality of life,
social interaction, and
motor function.
Lautenschlager
(2008)
Maki (2012)
Single blind RCT

EG: 3 50 min per week for 24 weeks
FU: PT, 12 months, 18 months after
baseline
Four conditions:
1. Physical activity
training (EG)
2. Health ageing (CG)
3. Cognitive training
4. Combined
intervention
Single-blind RCT
EG: 3 150 min per week for 4 months
FU: PT
Walking programme
versus educational
lectures control
RCT
EG:1 1.5 h per week for 12 weeks
FU: PT
EG: 69
CG: 69
Age: 50
Mage EG: 68.6 (8.7)
Mage CG: 68.7 (8.5)
EG: 16
CG: 17
Age: 7085
Mage EG: 77.5 (4.8)
Mage CG: 75.4 (4.8)
EG: 66
CG: 67
Age: 65
Mage EG: 71.9 (4.1)
Mage CG: 72.0 (3.9)
Mortimer (2012)
Four conditions:
1. Tai Chi
2. Walking (EG)
3. Social interaction (CG)
4. No intervention
RCT
1. 3 50 min per week for 40 weeks
2 (EG). 3 50 min per week for 40 weeks
FU: PT
EG: 30
CG: 30
Age: 6079
Mage EG: 67.8 (5.0)
Mage CG: 67.9 (6.5)
Social interaction group

Recognitionc
improved on verbal
Immediate recallc
c
uency as well as trend
Delayed recall
for improvement on
Working memory (DSFc , DSBc )
c
Verbal uency (Category , Boston time to complete Trails A
and recall after the third
Naming Testc )
Attention (Stroop wordc , colourc , learning trial of the
c
c
AVLT.
colour-word , Trails B ,)
Proc. speed (Trails Ac )
c
Verbal comprehension
Working memory (Clock drawingc ,
Rey Figurec )
Visual neglect (Bell cancellation testc )
Cognitive function (MDRSc )
Legault (2011)
Physical activity
programme versus
education and usual care
group
Age: 6090
Mage EG: 70.1(8.5)
Mage CG: 68.5 (8.3)
Table 2 (Continued)
Ref. author (year)
Intervention
Methods
Muscari (2010)
Exercise in community
gym versus educational
materials control
RCT
EG: 3 1 h per week for 12 months, 70%
of max HRR
FU: PT
EG: 60
CG: 60
Cognitive functiona
Williamson (2009)
1. Moderate exercise
2. Moderately-intense
exercise (EG)
3. Movie-watching
control group (CG)
RCT
1. 60% of HRR
2. (EG): single 44 min training session;
70% of HRR
FU: PT
Moderate intensity
physical activity versus
health education control
Single-blind RCT
Three phases:
1. 3 centre-based (4060 min/week) for
2 months
2. 2 centre based
sessions + 3 home-based sessions/week
for 4 months
3. Home based interventions + optional 1
or 2 centre based interventions for 6
months
FU: PT
Age: 6574
Mage EG: 68.8 (2.5)
Mage CG: 69.6 (2.8)
EG1: 20
EG2: 20
CG: 18
Age: 5064
Mage : 67.8 (7.4)
EG: 45
CG: 48
Working memoryc
Cognitive
exibility/attentiona
Response inhibition
(AUT persev. withinc ,
betweenc , rule breakc )
Working memoryc
Proc. speed (DSSTb)
Attentionc
Cognitive functionc
Improvements in DSST
were sig. associated with
improvements in chair
stand score, and balance
score.
Age: 7089
Mage EG: 76.8 (4.4)
Mage CG: 78.1 (4.1)
Netz (2007)
Additional notes
EG = experimental group; CG = control group; FU = follow up; PT = post training; Mage = mean age (SD); DSST = digit symbol substitution test; UFOV = Useful Field of View; HRQL = Health Related Quality of Life; WCST = Wisconsin
Card Sort Test; ADAS-Cog = Alzheimers Disease Assessment Scale; DSCT = Digit Symbol Coding Test; CDRS = Clinical Dementia Rating Scale; CCRT = Cambridge Contextual Reading Test; MDRS = Mattis Dementing Rating Scale;
AUT = Alternative Uses Test; HRR = heart rate reserve.
a
b
c
17
18
Table 3
Characteristics of studies aerobic exercise versus no intervention.
Ref. author (year)
Intervention
Methods
Klusmann (2010)
Three conditions:
1. Computer course
2. Exercise course (EG)
3. Control group (CG)
Double-blind
EG: 3 1.5 h per week for 6 months
FU: PT
EG: 80
CG: 69
Age: 7093
Mage EG: 73.6 (4.0)
Mage CG: 73.5 (4.3)
Immediate recall (storya , wordc )

Delayed recall (storya , worda )
Verbal uencyc
Attention (Stroopc , Trails BAa )
Maillot (2012)
Active video game training

programme versus no
treatment control
EG: 2 1 h per week for 12

weeks
FU: PT
EG: 15
CG: 15
Attention (Trailsb , Stroopb , task switchingb )

Reasoning (Letter Setsb , Matrix Reasoning Testb )
Proc. speed (DSSTb , cancellationb , number comparisonb )
Working memory (Spatial Span Testc , backwardsc )
Visuospatial (Direction Headingsc , mental rotationc )
Perceptual speedb
Psychomotor speedb
Additional notes
Marmeleira (2009)
Cognitive-exercise group versus EG: 3 1 h per week for 12

weeks
control group
FU: PT
EG: 16
CG: 16
Attention (Trails Bc , simple RTa , dual-task RTa , Stroop

incongruentc , interferencec )
Proc. speed (UFOVa )
Motion perception (target-onlyc , self-onlyc )
Psychomotor testsa / c
Age: 6082
Mage EG: 68.2 (6.5)
Mage CG: 68.4 (6.7)
Mortimer (2012)
Four conditions:
1. Tai Chi
2. Walking (EG)
3. Social interaction
4. No intervention
(CG)
1. 3 50 min per
week for 40 weeks
2. (EG): 3 50 min
per week for 40
weeks
FU: PT
EG: 30
CG: 30
Age: 6079
Mage EG: 67.8 (5.0)
Mage CG: 68.2 (6.5)
Oken (2006)
Three conditions:
1. Yoga
2. Aerobic exercise (EG)
3. Wait-list control (CG)
1. 1 1.5 h per week for 6

months; 30 s pose, <1 min rest
2. (EG): 1 1 h per week for 6
months. 70% of max
HRRadjusted as needed
FU: PT
EG: 38
CG: 42
Recognitionc
Immediate recallc
Delayed recallc
Working memory (DSFc , DSBc , Rey Osterreichc , clock
drawingc )
Attention (Stroopc , Trailsc )
Verbal uency (categoriesc , Boston namingc )
Reasoningc
Cognitive functionc
No statistically signicant
changes in brain volume or
neuropsychological
performance in the walking
group compared to the
no-intervention group.
Delayed recallc
Working memoryc
Attention (Stroopc , Cov. Orient.c , CRTc )
Divided attention (UFOV)c
Proc. speedc
Age: 6585
Mage EG: 73.6 (5.1)
Mage CG: 71.2 (4.4)
AUT = Alternative Uses Test; RT = reaction time; DSF = Digit Span Forward; DSB = Digit Span Back; CRT = Choice Reaction Time; Cov. Orient. = Covert Orienting; HRR = heart rate reserve.
a
b
c
Age: 6578
Mage EG: 73.5 (4.1)
Mage CG: 73.5 (3.0)
Table 4
Characteristics of studies resistance training versus stretching/toning.
Intervention
Methods
Additional notes
Brown (2009)
Three conditions:
1. Resistance and
balance training
exercises (EG)
2. Flexibility relaxation
programme (AC)
3. No-exercise control
(CG)
EG and AC: 2 1 h
(515 min warm-up;
40 min training; 10 min
cool-down)/week for 6
months
FU: PT
EG: 66
AC: 26
CG: 34
Paired associates
(verbalc , visualc )
Reasoningb
Attention (Trails-Bc ,
Stroopc )
Verbal uencyc
Proc speedc
Working memory
(DSFc
DSBc )
Fluid intelligence
(arithmeticb , PCb )
Both groups showed

similar levels of
improvement in mood.
Cassilhas (2007)
Three conditions:
1. High intensity
training group (EG)
2. Moderate training
group
3. Warm
up + stretching control
group (CG)
EG: 3 1-h sessions

(including 10 min
warm-up) per week for
24 weeks. 80% of 1RM
FU: PT
EG1: 20
EG2: 19
CG: 23
Age: 6575
Mage EG1: 68.4
(0.67)
Mage EG2: 69.01
(1.1)
Mage CG: 67.04
(0.54)
Immediate recall
(ROF-IRa )
Reasoninga
Working memory
(DSFa , DSBc , ROF-Cc ,
CBTFc , CBTBa )
Attention (TPCNc ,
TPCEc )
Two resistance groups:

moderate and high.
Both groups showed
similar improvements
over control.
Liu-Ambrose (2010)
Three conditions:
1. Once-weekly
resistance training
2. Twice-weekly
resistance training (EG)
3. Twice-weekly
balance and tone
training (CG)
Single-blind
EG: 2 1 h per week for
52 weeks; progressive
7RM method
FU: PT
EG1: 47
EG2: 46
CG: 42
Age: 6575
Mage EG1: 69.5 (2.6)
Mage EG2: 69.4 (3.0)
Mage CG: 69.9 (3.0)
Attention (Stroopa ,
Trails B-Ac )
Working memoryc
Performance improved
by 10.9% in the 2 RT
group, the BAT group
demonstrated 0.5%
deterioration.
Age: 6295
Mage EG: 79.5 (5.9)
Mage AC: 81.5 (6.9)
Mage CG: 78.1 (6.4)
Ref. author (year)
EG = experimental group; AC = active control; CG = control group; FU = follow up; PT = post training; Mage = mean age (SD); DSST = digit symbol substitution test; UFOV = Useful Field of View; HRQL = Health Related Quality of Life;
WCST = Wisconsin Card Sort Test; ADAS-Cog = Alzheimers Disease Assessment Scale; DSCT = Digit Symbol Coding Test; CDRS = Clinical Dementia Rating Scale; CCRT = Cambridge Contextual Reading Test; MDRS = Mattis Dementing
Rating Scale; AUT = Alternative Uses Test; CBTF = Corsis block-tapping forward; CBTB = Corsis block-tapping backward; TPCN = ToulousePieron Cancellations numbers; TPCE = ToulousePieron Cancellations errors; ROF-C = Rey
Osterrieth Figure Copy; ROF-IR = Rey Osterrieth Figure Immediate Recall; RM = repetition maximum.
a
b
c
19
20
Table 5
Characteristics of studies resistance training versus no exercise active control.
Intervention
Methods
Additional notes
Brown (2009)
Three conditions:
1. Resistance and
balance training
exercises (EG)
2. Flexibility relaxation
programme (AC)
3. No-exercise control
(CG)
RCT
EG and AC: 2 1 h
(515 min warm-up;
40 min training; 10 min
cool-down)/week for 6
months
FU: PT
EG: 66
AC: 26
CG: 34
Paired associates
(verbalc , visualc )
Reasoningb
Attention (Trails-Bc ,
Stroopc )
Verbal uencyc
Proc speedc
Working memory
(DSFc
DSBc )
Fluid intelligence
(arithmeticb , PCb )
EG showed signicant
improvement in mood
compared to CG.
Age: 6295
Mage EG: 79.5 (5.9)
Mage AC: 81.5 (6.9)
Mage CG: 78.1 (6.4)
Kimura (2010)
Strength training
programme versus
health education
classes
Single-blind RCT
EG: 2 1.5 h/week for
12 weeks; 60% of 1RM
FU: PT
EG: 65
CG: 54
Age: 65
Mage EG: 73.6 (4.7)
Mage CG: 75.2 (6.3)
Executive functionc
Liu-Ambrose (2008)
Home-based resistance
and balance training
(Otago Exercsie
Program; OEP) versus
control
EG: 28
CG: 24
Age: 70
Mage EG: 81.4 (6.2)
Mage CG: 83.1 (6.3)
Attention (Stroopa ,
Trails Bc )
Working memoryc
OEP group 12.8%

improvement in Stroop
while control had
10.2% deterioration.
Venturelli (2010)
Upper-body physical
training versus control
Single-blind RCT
EG: 3 30 min/week,
0.9 kg increments as
required, and walk
2/week for 6 months
FU: PT, 6 months
RCT
EG: 3 45 min for 12
weeks; 50% of
1RM-adjusted as
needed, 5362% of max
HRR
FU: PT
EG: 12
CG: 11
Age: 65
Mage EG: 83.3 (6.7)
Mage CG: 84.1 (5.8)
Cognitive functiona
Activities of daily
livinga
Individual ADL items:

feeding, grooming,
dressing, transfer from
bed to chair
statistically sign
improvement relative
to control
AUT = Alternative Uses Test; RM = repetition maximum; HRR = heart rate reserve.
a
b
c
Ref. author (year)
Table 6
Characteristics of studies Tai Chi versus no exercise.
Intervention
Methods
Additional notes
Mortimer (2012)
Four conditions:
1. Tai Chi (EG)
2. Walking
3. Social interaction
4. No intervention (CG)
Comparison: Tai Chi
versus no intervention
1. (EG): 3 50 min per

week for 40 weeks
2. 3 50 min per week
for 40 weeks
FU: PT
EG: 30
CG: 30
Recognitionb
Immediate recallb
Delayed recalla
Working memory
(DSFb , DSBb , Rey
Osterreichb , clock
drawingb )
Attention (Stroopb ,
Trails Aa , Trails Ba )
Verbal uency
(categoriesa , Boston
namingb )
Reasoningb
Cognitive functiona
Compared to CG,
participants in the Tai
Chi group showed
signicant increases in
total brain volume over
the intervention
period.
Age: 6079
Mage EG: 67.3 (5.3)
Mage CG: 68.2 (6.5)
Nguyen and Kruse, 2012
Tai Chi group versus no

intervention control
EG: 2 1 h per week

for 6 months
FU: PT
EG: 39
CG: 34
Age: 6079
Mage EG: 69.2 (5.3)
Mage CG: 68.7 (4.9)
Proc speed (Trails Aa )

Attention (Trails Ba )
Taylor-Piliae (2010)
Two phase study
1. (EG): 1 45 min per

week for 12 weeks
2. 1 (10 min
warm-up/25 min
aerobic/20 min
resistance and
exibility) + 3 home
based exercises
(30 min
walking + 25 min
resistance and
exibility)
FU: measured at 6
months at end of 1st
phase and at 12
months at end of 2nd
phase
First phase
EG1: 37
EG2: 39
CG: 56
Second phase
EG1: 26
EG2: 34
Verbal uencyb
Working memory
(DSFb , DSBa )
First phase: three

conditions
1. Tai Chi (EG)
2. Western exercise
3. Healthy ageing
classes (CG)
Second phase: two
conditions
1. Tai Chi (EG)
2. Western exercise
Ref. author (year)
Age: 6084
Mage EG1: 70.6 (5.9)
Mage EG2: 68.5 (5.0)
Mage CG: 68.2 (6.2)
EG = experimental group; CG = control group; FU = follow up; PT = post training; Mage = mean age (SD); MIA = Meta-Memory in Adulthood; CFQ = Cognitive Failures Questionnaire; Subjective CF = subjective measures of cognitive
function.
a
b
No signicant intervention effects for experimental compared to control.
21
22
Fig. 1. Aerobic exercise versus stretching/toning.
Lautenschlager et al., 2008; Legault et al., 2011; Maki et al., 2012;

Mortimer et al., 2012; Netz et al., 2007; Williamson et al., 2009).
Signicant within-group differences were reported on two further executive measures (Barella et al., 2010; Williamson et al.,
2009), and in three out of six measures of cognitive function
(Lautenschlager et al., 2008; Mortimer et al., 2012; Muscari et al.,
2010; Williamson et al., 2009). Two trials conducted follow-up
assessments and reported maintenance of effects at 12 months
post-intervention (Barella et al., 2010; Lautenschlager et al.,
2008).
3.4. Aerobic exercise versus no intervention

Meta-analyses on available data revealed no signicant differences between aerobic exercise and no intervention control
groups on measures of immediate recall (p = 0.30), delayed recall
(p = 0.13), verbal uency (p = 0.14), reasoning (p = 0.48), working
memory (0.70), and processing speed (p = 0.17) (Fig. 3). Differences
between the groups on measures of attention approached signicance (p = 0.09). Data were not available for the remaining primary
and secondary outcomes measures. In individual trials, aerobic
exercise groups signicantly outperformed controls on three out

of eight memory measures (Klusmann et al., 2010; Mortimer et al.,
2012; Oken et al., 2006), with no differences on one measure of
cognitive function (Mortimer et al., 2012). For executive measures there were signicant between group differences in ve out
of 41 executive measures, and signicant pre-post intervention
improvements for exercise but not control groups on a further
10 measures of executive function (Klusmann et al., 2010; Maillot
et al., 2012; Marmeleira et al., 2009; Mortimer et al., 2012; Oken
23
et al., 2006). None of the above studies measured maintenance of

intervention effects.
3.5. Resistance versus stretching/toning
Three trials provided data comparing resistance training to
a stretching/toning control (Brown et al., 2009; Cassilhas et al.,
2007; Liu-Ambrose et al., 2010). Meta-analyses revealed signicant
improvements in performance for experimental versus control on
Fig. 2. Aerobic exercise versus no exercise active control.
24
Fig. 2. (Continued).
measures of reasoning (p < 0.005) but not on measures of working memory (p = 0.47) or attention (0.37) (Fig. 4). Data were not
available for the remaining outcomes of interest. Results from individual studies (Table 4) revealed that resistance groups performed
signicantly better than stretching/toning controls on one out of
three measures of memory and on four out of 18 measures of
executive function. One trial reported pre- to post-intervention
improvement for the resistance group but not stretching controls
on one measure of reasoning (Brown et al., 2009). None of the three
studies in this category reported follow-up data.
comparisons revealing no signicant differences on measures of

working memory (p = 0.31) or attention (p = 0.62) (Fig. 5). Comparisons of results across three individual trials (Table 5) revealed
no signicant differences between resistance training and control
groups on two measures of memory and nine out of eleven measures of executive function (Brown et al., 2009; Kimura et al., 2010;
Liu-Ambrose et al., 2008). Venturelli et al. (2010) reported that their
resistance group performed signicantly better than controls on
measures of cognitive function and activities of daily living. None
of the four studies included follow-up assessments.
3.6. Resistance versus no exercise active control
3.7. Tai Chi versus no exercise active control
It was only possible to pool data for two outcome measures

comparing resistance training and no exercise controls, with
Meta-analysis on pooled data from two individual trials

revealed signicant differences between Tai Chi experimental
groups and no exercise control groups on measures of attention

(p < 0.001) and processing speed (p < 0.00001), with differences for
working memory approaching signicance (p = 0.07). There were
no signicant differences between the groups on measures of verbal uency (p = 0.27) (Fig. 6). Across individual trials (Table 6),
participants in Tai Chi groups outperformed no exercise controls
on one out of three measures of memory, ve out of 15 measures
of executive function, and on one measure of cognitive function
(Mortimer et al., 2012; Nguyen and Kruse, 2012; Taylor-Piliae et al.,
25
2010). One study conducted follow-up assessments and reported

maintenance of improvements in cognitive functioning for the Tai
Chi group after 12 months (Taylor-Piliae et al., 2010)
4. Discussion
We examined the effects of aerobic exercise, resistance training,
and Tai Chi on the cognitive performance of older adults without known cognitive impairment. Meta-analysis results revealed
Fig. 3. Aerobic exercise versus no intervention.
26
Fig. 3. (Continued).
that resistance training signicantly improved performance on

measures of reasoning compared to a stretching/toning control.
Compared to a no exercise control, Tai Chi signicantly improved
performance on measures of attention and processing speed, and
the effect for working memory approached signicance. There
were no signicant differences between exercise and controls
on any of the remaining 26 comparisons. Across individual trials, 15 of the 25 studies reported some signicant improvements
for exercise versus controls on measures of executive function, memory, and on composite measures of cognitive function.
Despite this, the majority of comparisons yielded no signicant
differences.
Fig. 4. Resistance training versus stretching/toning.
Fig. 5. Resistance training versus no exercise active control.
Fig. 6. Tai Chi versus no exercise active control.
27
28
4.1. Exercise-types
4.1.1. Aerobic exercise
Our lack of consistent signicant ndings for aerobic exercise
are surprising considering conclusions of Colcombe and Kramer
(2003) and Smith et al. (2010) who reported that aerobic exercise
was associated with improvements in neurocognitive functioning,
particularly executive functions (see also Guiney and Machado,
2013). We found some supportive evidence for executive benets as differences for aerobic exercise versus no intervention
approached signicance on measures of attention; and across individual trials, aerobic exercise more reliably improved performance
on executive function tasks. Despite this our results are consistent with four reviews of aerobic RCTs that concluded that there
is a lack of consistent evidence to show that aerobic interventions
(Angevaren et al., 2008; Clifford et al., 2009; Snowden et al., 2011)
or aerobic tness (Angevaren et al., 2008; Etnier et al., 2006) result
in improved performance on cognitive tasks for older adults without known cognitive impairment. Factors that may contribute to a
lack of signicant ndings are discussed in more detail below.
4.1.2. Resistance training
Although some reviews report evidence to suggest that resistance training has cognitive benets among seniors (Liu-Ambrose
and Donaldson, 2009), the results of this review, and others (Chang
et al., 2012; Snowden et al., 2011; van Uffelen et al., 2008) fail to
show any consistent evidence for the benet of resistance training
on the cognitive function of older adults. We did nd signicant
improvements on measures of reasoning for resistance training
compared to a stretching and toning control, but no differences for
working memory or attention. Chang et al. (2012) suggested that
similar to aerobic exercise, resistance training may have differential effects on cognitive function, perhaps affecting performance on
specic executive tasks. Our ndings support this view, and may go
some way towards explaining inconsistent results because many
resistance studies fail to include measures of reasoning, or other
executive measures. Better comparability in measures of executive function across studies that examine the effects of resistance
training on cognition would bring greater clarity.
4.1.3. Tai Chi
Our results on the effect of Tai Chi on attention, processing
speed, and working memory are consistent with those of Chang
et al. (2010) who reported that Tai Chi might have task-specic benets for executive function tasks. A recent meta-analysis similarly
reported signicant benets of Tai Chi for older adults executive
functioning (Wayne et al., 2014). Interestingly, both Colcombe and
Kramer (2003) and Smith et al. (2010) reported that combining
aerobic exercise and resistance training was more effective than
aerobic exercise alone at improving performance on executive tasks
of attention and working memory. As Tai Chi combines aspects of
aerobic, resistance, and exibility training, this provides further
support to the ndings of Colcombe and Smith. More research is
required to determine the possible cognitive benets of combined
exercise programmes such as Tai Chi however as not all studies
show consistent cognitive benets (Hall et al., 2009). Our results
were based on only two studies and lacked comparison with an
active control.
4.2. Discrepancies between RCT evidence and other exercise
literature
Inconsistent results from RCTs that examine the benet of exercise on the cognitive function of older adults stands in sharp
contrast to the consistent evidence from epidemiological, crosssectional, and neuroimaging research. There are however a number
of possible explanations for the apparent contradictory ndings,

which also contribute to explanations for inconsistent results
across exercise trials.
4.2.1. Baseline physical performance
The rst factor to consider is baseline levels of physical activity. Some RCTs recruit participants who are already engaging in
regular physical exercise. For example Oken et al. (2006) allowed
participants to already be engaged in 30 min of aerobic exercise
per day at entry into their study, while Barella et al. (2010) permitted participants who regularly exercised to maintain their normal
exercise schedules. In contrast, epidemiological and cross-sectional
studies derive evidence of the benets of physical activity on cognitive function through comparisons of different baseline activity
levels. These studies show that individuals engaged in higher levels of exercise at baseline have better cognitive function, or are at a
reduced risk of experiencing cognitive decline relative to counterparts who led sedentary lives, were less t, or inactive at baseline
(Barnes et al., 2008; Brown et al., 2012; Hamer and Chida, 2009; So
et al., 2011). Considering this, it is unsurprising that intervention
trials investigating the effect of exercise on cognition in participants
who are already physically active may not observe similar results,
as the variance in improvement may be too small to predict cognitive benet. Indeed RCTs that examine the effects of exercise on
less physically active or frail older adults tend to show more consistent positive results (Guiney and Machado, 2013; Langlois et al.,
2013). Future trials would benet from control of baseline levels of
physical activity.
4.2.2. Length of intervention and follow-up
A lack of long-term monitoring in intervention trials may be
further contributing to discrepancies in the exercise literature. If
exercise is to be benecial in ameliorating the effects of age-related
cognitive decline, then the rate of change over longer periods of
time will be more relevant than any short-term, post-intervention
gain in cognitive performance (Angevaren et al., 2008; Salthouse,
2006). Observational data from epidemiological studies that examine cohorts over long periods indicate that physical activity may
take years to impact brain health (Beason-Held et al., 2007; Rovio
et al., 2005). RCTs are typically much shorter in duration and therefore may not be long enough to capture intervention effects. Also
by virtue of recruitment of healthy older adults, participants may
already be functioning cognitively at ceiling level, thus improvements in cognitive performance would be difcult to ascertain over
short RCT intervention and follow-up periods. In this review, trials
most commonly ranged from 12 weeks to 6 months in duration,
and only two trials provided follow-up data. Interestingly, longer
interventions such as one year (Liu-Ambrose et al., 2010; Muscari
et al., 2010); and trials that included assessments up to 18 months
post-intervention (Lautenschlager et al., 2008; Taylor-Piliae et al.,
2010) reported more consistent positive effects (see also Clifford
et al., 2009; Colcombe and Kramer, 2003; Kramer et al., 1999; Smith
et al., 2010). Importantly these studies reported that while exercise
either improved or maintained cognitive performance; cognitive
performance in control groups declined over time (Liu-Ambrose
et al., 2008, 2010; Muscari et al., 2010). Future intervention studies
would benet from longer intervention and follow-up periods to
assess whether cognitive differences between trained participants
and controls increase as a function of age.
4.2.3. Efciency of the intervention and adherence
When comparing groups receiving exercise interventions with
controls, the eventual intervention effect will depend on both the
efciency of the intervention in the intervention group and adherence to the intervention; and the behaviour of participants in
the control group. In relation to efciency, insufciently designed
exercise programmes may explain a lack of signicant ndings in

many exercise RCTs (e.g. Barnes et al., 2013; Brown et al., 2009;
Kimura et al., 2010; Legault et al., 2011; Oken et al., 2006), and
other divergent results. Although the optimum exercise dose to
benet cognition has yet to be established (Chang et al., 2012;
Colcombe and Kramer, 2003), RCT interventions commonly fail to
meet current public health exercise recommendations for older
adults of 150 min of moderate intensity aerobic activity per week
(Haskell et al., 2007); and two sessions per week of moderate
intensity strength training working multiple muscle groups, with
one or more sets of 1015 repetitions, and a rest interval of
23 min (Medicine, 2009). In contrast, in epidemiological and crosssectional studies, participants in high activity groups reported
engaging in 47 h of exercise per week (Schuit et al., 2001; Sumic
et al., 2007) at moderate to high intensity levels (Brown et al., 2012).
Research indicates that exercise intensity might be more important than duration in benetting cognitive function (Angevaren
et al., 2007; van Gelder et al., 2004). Despite this, trials more often
focus on duration rather than intensity in intervention designs (see
Tables 16). Designing interventions that meet all minimum recommendations for exercise for older adults would allow for more
rigorous comparisons of results across trials, and might reveal more
consistent positive results.
There is a lack of standardised reporting of the characteristics
of exercise interventions (i.e. frequency, intensity, time and type
(F.I.T.T.)) in the RCT exercise research literature. This makes it difcult to determine the efciency of interventions, or indeed what
constitutes an effective exercise intervention. Guidelines on reporting of F.I.T.T. components for RCT research would improve study
comparability. In addition, data are often not available on the effect
of the training intervention on pre-post tness or physical measures. In our review, 16 out of 25 studies reported physical or tness
outcomes but there was little consistency in measures used and
outcomes reported. Making these data available in exercise RCTs in
a standardised way could facilitate the interpretation of cognitive
outcomes in RCTs more directly in the context of epidemiological
research.
Variability in adherence to prescribed interventions might
also be contributing to discrepant results. Even with adequately
designed exercise regimes, low adherence can result in low activity levels for exercise groups. For example, Brown et al. (2009)
reported that their intervention group attended between 3 and 51
of 52 classes, with 68% of participants attending less than 25 classes.
Similarly, Oken et al. (2006) reported that of all participants completing their aerobic exercise intervention, the attendance rate at
the weekly class was 69%, and participants exercised an average
of only 54% of all required days. Results from exercise interventions that do not actually engage participants in regular physical
activity will logically differ from epidemiological data where participants report actual active engagement in physical activity over
long periods. Future RCTs should attempt to control for or exclude
participants who do not comply with the target intervention (e.g.
Smiley-Oyen et al., 2008).
Confounds associated with relevant behaviours of participants
in control groups might help to explain the divergence between RCT
evidence and other exercise literature. As previously mentioned,
some exercise trials recruit participants that are already engaging
in, and continue to engage in regular physical activity during the
course of the RCT. In some instances when these participants are
randomised into control groups, their behaviour patterns might
be similar to those of intervention participants. These potential
confounds compromise the validity of comparisons with epidemiological data, because both groups would ultimately be considered
as high activity groups in a prospective study. Control groups in
RCTs need to be categorised as low activity groups relative to high
activity intervention groups.
29
4.2.4. Physical tness and cognitive health

Longitudinal (Sturman et al., 2005) and prospective studies
(Weuve et al., 2004) show an association between physical tness and improved cognitive performance (Kramer et al., 2002).
Based on the assumption that improvements in physical tness
mediate benets in cognitive function, a prediction that exercise
resulting in enhanced tness would improve cognitive outcomes
is not unreasonable. Systematic reviews of RCTs however fail
to show consistent evidence for a relationship between physical tness and cognitive performance (Angevaren et al., 2008;
Etnier et al., 2006). A possible explanation for this is that brief
programmes of exercise may not be of sufcient duration or
intensity to impact tness to a level observed in longitudinal
studies. Longitudinal data indicate that high levels of tness are
achieved after years rather than months of training (Kramer
et al., 2002). Short-term improvements in cognitive function in
RCTs may therefore be driven by mechanisms other than physical tness (Angevaren et al., 2008; Etnier et al., 2006; Kramer
et al., 2002); which may help to explain why similar results are
not seen in epidemiological data. Further research is required to
determine what factors, other than tness, might mediate the
relationship between physical activity and cognitive function. Individuals with the APOE4 gene have been identied as a possible
sub-group whose cognitive performance is differentially affected
by aerobic tness (Etnier et al., 2007; Podewils et al., 2005),
but the identication of additional subgroups might be benecial.
4.3. Inconsistent results across RCTs
Additional factors contributing to inconsistent RCT results
include differences in participant inclusion criteria, study design,
exercise programmes, and cognitive outcome measures. Variations
in inclusion criteria are common where some trials recruit physically active participants (Oken et al., 2006) while others recruit
those who are frail (Langlois et al., 2013), or sedentary (Barnes
et al., 2013); some trials recruit only older adults (Legault et al.,
2011) while others include data from younger, middle-aged and
older adults (Hoffman et al., 2008; Munguia-Izquierdo and LegazArrese, 2008); and some trials recruit participants with no cognitive
impairment (Klusmann et al., 2010) while others include data
from individuals with cognitive complaints (Lautenschlager et al.,
2008). Standards of reporting, attempts to reduce bias, and overall study quality also differ greatly across studies (Snowden et al.,
2011). Exercise programmes are often incomparable, even within
the same exercise-type, with large variations in frequency, duration, and intensity of exercise programmes in RCTs. In terms of
recording outcomes, a lack of consensus around appropriate or
necessary measures of cognitive function remains an issue despite
repeated recommendations for standardisation (Angevaren et al.,
2008; Chang et al., 2012; Smith et al., 2010).
4.4. Limitations of the review
A meta-analysis of data from such a broad age range (50+) might
be masking intervention effects that would be evident in older
adults had we used a narrower age band (Barella et al., 2010). In
addition, more robust effects of exercise on cognitive processes
have been reported for older adults (65+) compared to youngerolder adults (aged 5064) (Kramer et al., 2002). In this review,
the inclusion of participants aged 50+ allowed for the examination of a greater number of relevant trials (e.g. Erickson et al., 2011;
Kramer et al., 2002; Marmeleira et al., 2009), and also increased the
likelihood that a meta-analysis could be conducted. We undertook
further analysis to determine the results when limiting analyses to
studies of persons aged >65, and aged >6575. Where meta-analysis
30
was possible, there were no signicant differences between

intervention and control groups, as was the case with the broader
band that included over 50s. Meta-analysis was not possible in
the Tai Chi condition as all three studies (Mortimer et al., 2012;
Nguyen and Kruse, 2012; Taylor-Piliae et al., 2010) included participants aged 60+. It is important to note that while participants
aged over 50 were included, the mean age of participants was over
65 across all included studies; and under 75 in 21 out of 25 studies
(see Tables 15).
The most notable limitation was the variation in methodologies
and cognitive outcome measures across trials. This made conducting a meta-analysis quite difcult. Although we made a distinct
effort to only combine homogenous data, it was necessary to compromise on the heterogeneity of included studies in some of the
analyses. The lack of available homogenous data also limited our
ability to combine large numbers of studies for meta-analysis.
Where a synthesis involved a small number of studies, the power
to detect heterogeneity and ability to detect publication bias were
limited. Nonetheless pooled estimates of effect sizes were obtainable. When that was the case, it was determined reasonable to
combine data regardless of the small number of studies in order
to allow for further exploration of results (Angevaren et al., 2008;
Higgins and Green, 2011). In light of the methodological issues
associated with conducting a meta-analysis with limited data, we
include a descriptive analysis of individual results across trials to
supplement the analysis, and to allow the reader to draw conclusions from both the meta-analyses and individual results across
trials.
4.5. Conclusions and recommendations

Results from our review, combined with reports from Colcombe
and Kramers meta-analysis (2003), Clifford et al. (2009) and Wayne
et al. (2014) suggest that interventions that combine aerobic tness
with resistance training, such as Tai Chi, may be most benecial for
promoting healthy cognitive function for older adults, particularly
executive function. As studies of combined exercise programmes
are less common however, further investigation into their effectiveness is warranted. In general, researchers should ensure that
participants are engaging in exercise programmes that meet minimum requirements for duration and intensity of exercise per
week as recommended by public health authorities. Minimum
intervention-length and follow-up phases would also be benecial
with interventions approximately one year in duration with 1218
month follow-up preferable. Standardisation of a cognitive test battery across studies to include measures of executive function (e.g.
Etnier and Chang, 2009) would be benecial as both cross-sectional
and RCT evidence suggest that exercise is likely to benet performance on executive tasks (Guiney and Machado, 2013). Overall,
standardisation is required to produce more genuinely comparable results across trials and to minimise discrepancies between RCT
research and epidemiological, cross-sectional, and neuroimaging
data.
Conicts of interest
All authors declare that we have no conicts of interest.
Acknowledgements
We would like to thank Dr Joanna McHugh for her edits. MK was
employed by the Alzheimer Society of Ireland during the writing of
this paper.
Appendix A. Supplementary data

Supplementary data associated with this article can be found, in
the online version, at http://dx.doi.org/10.1016/j.arr.2014.05.002.
References
Albinet, C.T., Boucard, G., Bouquet, C.A., Audiffren, M., 2010. Increased heart rate
variability and executive performance after aerobic training in the elderly. Eur.
J. Appl. Physiol. 109, 617624.
Angevaren, M., Aufdemkampe, G., Verhaar, H.J., Aleman, A., Vanhees, L., 2008. Physical activity and enhanced tness to improve cognitive function in older people
without known cognitive impairment. Cochrane Database Syst. Rev., CD005381
(online).
Angevaren, M., Vanhees, L., Wendel-Vos, W., Verhaar, H.J., Aufdemkampe, G.,
Aleman, A., Verschuren, W.M., 2007. Intensity, but not duration, of physical
activities is related to cognitive function. Eur. J. Cardiovasc. Prev. Rehabil. 14,
825830.
Barella, L.A., Etnier, J.L., Chang, Y.K., 2010. The immediate and delayed effects of an
acute bout of exercise on cognitive performance of healthy older adults. J. Aging
Phys. Activ. 18, 8798.
Barnes, D.E., Blackwell, T., Stone, K.L., Goldman, S.E., Hillier, T., Yaffe, K., 2008. Cognition in older women: the importance of daytime movement. J. Am. Geriatr. Soc.
56, 16581664.
Barnes, D.E., Santos-Modesitt, W., Poelke, G., Kramer, A.F., Castro, C., Middleton, L.E.,
Yaffe, K., 2013. The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. JAMA Intern. Med.,
18.
Beason-Held, L.L., Moghekar, A., Zonderman, A.B., Kraut, M.A., Resnick, S.M., 2007.
Longitudinal changes in cerebral blood ow in the older hypertensive brain.
Stroke 38, 17661773.
Braun, M., Scholz, U., Bailey, B., Perren, S., Hornung, R., Martin, M., 2009. Dementia
caregiving in spousal relationships: a dyadic perspective. Aging Ment. Health
13, 426436.
Brown, A.K., Liu-Ambrose, T., Tate, R., Lord, S.R., 2009. The effect of group-based
exercise on cognitive performance and mood in seniors residing in intermediate
care and self-care retirement facilities: a randomised controlled trial. Br. J. Sports
Med. 43, 608614.
Brown, B.M., Peiffer, J.J., Sohrabi, H.R., Mondal, A., Gupta, V.B., Rainey-Smith, S.R.,
Taddei, K., Burnham, S., Ellis, K.A., Szoeke, C., Masters, C.L., Ames, D., Rowe,
C.C., Martins, R.N., 2012. Intense physical activity is associated with cognitive
performance in the elderly. Transl. Psychiatry 2, e191.
Cassilhas, R.C., Viana, V.A., Grassmann, V., Santos, R.T., Santos, R.F., Tuk, S., Mello,
M.T., 2007. The impact of resistance exercise on the cognitive function of the
elderly. Med. Sci. Sports Exerc. 39, 14011407.
Chang, Y.K., Nien, Y.H., Tsai, C.L., Etnier, J.L., 2010. Physical activity and cognition in
older adults: the potential of Tai Chi Chuan. J. Aging Phys. Activ. 18, 451472.
Chang, Y.K., Pan, C.Y., Chen, F.T., Tsai, C.L., Huang, C.C., 2012. Effect of resistanceexercise training on cognitive function in healthy older adults: a review. J. Aging
Phys. Activ. 20, 497517.
Clifford, A., Bandelow, S., Hogervorst, E., 2009. The effects of physical exercise on
cognitive function in the elderly: a review. In: Garipy, Q., Mnard, R. (Eds.),
Handbook of Cognitive Aging: Causes, Processes and Effects. Nova Science Publishers, New York.
Colcombe, S., Kramer, A.F., 2003. Fitness effects on the cognitive function of older
adults: a meta-analytic study. Psychol. Sci. 14, 125130.
Colcombe, S.J., Erickson, K.I., Raz, N., Webb, A.G., Cohen, N.J., McAuley, E., Kramer,
A.F., 2003. Aerobic tness reduces brain tissue loss in aging humans. J. Gerontol.
A: Biol. Sci. Med. Sci. 58, 176180.
Erickson, K.I., Prakash, R.S., Voss, M.W., Chaddock, L., Hu, L., Morris, K.S., White, S.M.,
Wojcicki, T.R., McAuley, E., Kramer, A.F., 2009. Aerobic tness is associated with
hippocampal volume in elderly humans. Hippocampus 19, 10301039.
Erickson, K.I., Voss, M.W., Prakash, R.S., Basak, C., Szabo, A., Chaddock, L., Kim, J.S.,
Heo, S., Alves, H., White, S.M., Wojcicki, T.R., Mailey, E., Vieira, V.J., Martin,
S.A., Pence, B.D., Woods, J.A., McAuley, E., Kramer, A.F., 2011. Exercise training increases size of hippocampus and improves memory. Proc. Natl. Acad. Sci.
U.S.A. 108, 30173022.
Etnier, J.L., Caselli, R.J., Reiman, E.M., Alexander, G.E., Sibley, B.A., Tessier, D.,
McLemore, E.C., 2007. Cognitive performance in older women relative to ApoEepsilon4 genotype and aerobic tness. Med. Sci. Sports Exerc. 39, 199207.
Etnier, J.L., Chang, Y.K., 2009. The effect of physical activity on executive function: a
brief commentary on denitions, measurement issues, and the current state of
the literature. J. Sport Exerc. Psychol. 31, 469483.
Etnier, J.L., Nowell, P.M., Landers, D.M., Sibley, B.A., 2006. A meta-regression to examine the relationship between aerobic tness and cognitive performance. Brain
Res. Rev. 52, 119130.
Gordon, B.A., Rykhlevskaia, E.I., Brumback, C.R., Lee, Y., Elavsky, S., Konopack, J.F.,
McAuley, E., Kramer, A.F., Colcombe, S., Gratton, G., Fabiani, M., 2008. Neuroanatomical correlates of aging, cardiopulmonary tness level, and education.
Psychophysiology 45, 825838.
Guiney, H., Machado, L., 2013. Benets of regular aerobic exercise for executive
functioning in healthy populations. Psychon. Bull. Rev. 20, 7386.
Hall, C.D., Miszko, T., Wolf, S.L., 2009. Effects of Tai Chi intervention on dual-task
ability in older adults: a pilot study. Arch. Phys. Med. Rehabil. 90, 525529.

Hamer, M., Chida, Y., 2009. Physical activity and risk of neurodegenerative disease:
a systematic review of prospective evidence. Psychol. Med. 39, 311.
Haskell, W.L., Lee, I.M., Pate, R.R., Powell, K.E., Blair, S.N., Franklin, B.A., Macera,
C.A., Heath, G.W., Thompson, P.D., Bauman, A., 2007. Physical activity and public health: updated recommendation for adults from the American College of
Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39,
14231434.
Higgins, J.P.T., Green, S., (Eds.). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011].
Hoffman, B.M., Blumenthal, J.A., Babyak, M.A., Smith, P.J., Rogers, S.D., Doraiswamy,
P.M., Sherwood, A., 2008. Exercise fails to improve neurocognition in depressed
middle-aged and older adults. Med. Sci. Sports Exerc. 40, 13441352.
Johnson, N.F., Kim, C., Clasey, J.L., Bailey, A., Gold, B.T., 2012. Cardiorespiratory tness
is positively correlated with cerebral white matter integrity in healthy seniors.
Neuroimage 59, 15141523.
Kimura, K., Obuchi, S., Arai, T., Nagasawa, H., Shiba, Y., Watanabe, S., Kojima, M.,
2010. The inuence of short-term strength training on health-related quality of
life and executive cognitive function. J. Physiol. Anthropol. 29, 95101.
Klusmann, V., Evers, A., Schwarzer, R., Schlattmann, P., Reischies, F.M., Heuser, I.,
Dimeo, F.C., 2010. Complex mental and physical activity in older women and
cognitive performance: a 6-month randomized controlled trial. J. Gerontol. A:
Biol. Sci. Med. Sci. 65, 680688.
Kramer, A.F., Hahn, S., Cohen, N.J., Banich, M.T., McAuley, E., Harrison, C.R., Chason, J., Vakil, E., Bardell, L., Boileau, R.A., Colcombe, A., 1999. Ageing, tness and
neurocognitive function. Nature 400, 418419.
Kramer, A.F., Hahn, S., McAuley, E., Cohen, N.J., Banich, M.T., Harrison, C., Chason,
J., Boileau, R.A., Bardell, L., Colcombe, A., Vakil, E., 2002. Exercise, aging, and
cognition: healthy body healthy mind? In: Rogers, W., Fisk, A.D. (Eds.), Human
Factors Interventions for the Health Care of Older Adults. Erlbaum, Mahwah, NJ,
pp. 91120.
Langlois, F., Vu, T.T., Chasse, K., Dupuis, G., Kergoat, M.J., Bherer, L., 2013. Benets of
physical exercise training on cognition and quality of life in frail older adults. J.
Gerontol. B: Psychol. Sci. Soc. Sci. 68, 400404.
Lautenschlager, N.T., Cox, K.L., Flicker, L., Foster, J.K., van Bockxmeer, F.M., Xiao, J.,
Greenop, K.R., Almeida, O.P., 2008. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 300,
10271037.
Legault, C., Jennings, J.M., Katula, J.A., Dagenbach, D., Gaussoin, S.A., Sink, K.M., Rapp,
S.R., Rejeski, W.J., Shumaker, S.A., Espeland, M.A., 2011. Designing clinical trials
for assessing the effects of cognitive training and physical activity interventions
on cognitive outcomes: the Seniors Health and Activity Research Program Pilot
(SHARP-P) study, a randomized controlled trial. BMC Geriatr. 11, 27.
Levy, K., Lanctot, K.L., Farber, S.B., Li, A., Herrmann, N., 2012. Does pharmacological
treatment of neuropsychiatric symptoms in Alzheimers disease relieve caregiver burden? Drugs Aging 29, 167179.
Liu-Ambrose, T., Donaldson, M.G., 2009. Exercise and cognition in older adults: is
there a role for resistance training programmes? Br. J. Sports Med. 43, 2527.
Liu-Ambrose, T., Donaldson, M.G., Ahamed, Y., Graf, P., Cook, W.L., Close, J., Lord, S.R.,
Khan, K.M., 2008. Otago home-based strength and balance retraining improves
executive functioning in older fallers: a randomized controlled trial. J. Am. Geriatr. Soc. 56, 18211830.
Liu-Ambrose, T., Nagamatsu, L.S., Graf, P., Beattie, B.L., Ashe, M.C., Handy, T.C., 2010.
Resistance training and executive functions: a 12-month randomized controlled
trial. Arch. Intern. Med. 170, 170178.
Maillot, P., Perrot, A., Hartley, A., 2012. Effects of interactive physical-activity videogame training on physical and cognitive function in older adults. Psychol Aging
27, 589600.
Maki, Y., Ura, C., Yamaguchi, T., Murai, T., Isahai, M., Kaiho, A., Yamagami, T., Tanaka,
S., Miyamae, F., Sugiyama, M., Awata, S., Takahashi, R., Yamaguchi, H., 2012.
Effects of intervention using a community-based walking program for prevention of mental decline: a randomized controlled trial. J. Am. Geriatr. Soc. 60,
505510.
Marmeleira, J.F., Godinho, M.B., Fernandes, O.M., 2009. The effects of an exercise
program on several abilities associated with driving performance in older adults.
Accid. Anal. Prev. 41, 9097.
Medicine, A.C.o.S., 2009. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med. Sci. Sports Exerc.
41, 687708.
Middleton, L.E., Barnes, D.E., Lui, L.Y., Yaffe, K., 2010. Physical activity over the life
course and its association with cognitive performance and impairment in old
age. J. Am. Geriatr. Soc. 58, 13221326.
Mortimer, J.A., Ding, D., Borenstein, A.R., DeCarli, C., Guo, Q., Wu, Y., Zhao, Q., Chu, S.,
2012. Changes in brain volume and cognition in a randomized trial of exercise
and social interaction in a community-based sample of non-demented Chinese
elders. J. Alzheimers Dis. 30, 757766.
31
Munguia-Izquierdo, D., Legaz-Arrese, A., 2008. Assessment of the effects of aquatic

therapy on global symptomatology in patients with bromyalgia syndrome: a
randomized controlled trial. Arch. Phys. Med. Rehabil. 89, 22502257.
Muscari, A., Giannoni, C., Pierpaoli, L., Berzigotti, A., Maietta, P., Foschi, E., Ravaioli,
C., Poggiopollini, G., Bianchi, G., Magalotti, D., Tentoni, C., Zoli, M., 2010.
Chronic endurance exercise training prevents aging-related cognitive decline
in healthy older adults: a randomized controlled trial. Int. J. Geriatr. Psychiatry
25, 10551064.
Netz, Y., Tomer, R., Axelrad, S., Argov, E., Inbar, O., 2007. The effect of a single aerobic
training session on cognitive exibility in late middle-aged adults. Int. J. Sports
Med. 28, 8287.
Nguyen, M.H., Kruse, A., 2012. A randomized controlled trial of Tai chi for balance,
sleep quality and cognitive performance in elderly Vietnamese. Clin. Interv.
Aging 7, 185190.
Oken, B.S., Zajdel, D., Kishiyama, S., Flegal, K., Dehen, C., Haas, M., Kraemer, D.F.,
Lawrence, J., Leyva, J., 2006. Randomized, controlled, six-month trial of yoga in
healthy seniors: effects on cognition and quality of life. Altern. Ther. Health Med.
12, 4047.
Podewils, L.J., Guallar, E., Kuller, L.H., Fried, L.P., Lopez, O.L., Carlson, M., Lyketsos, C.G., 2005. Physical activity, APOE genotype, and dementia risk: ndings
from the Cardiovascular Health Cognition Study. Am. J. Epidemiol. 161,
639651.
Rovio, S., Kareholt, I., Helkala, E.L., Viitanen, M., Winblad, B., Tuomilehto, J., Soininen, H., Nissinen, A., Kivipelto, M., 2005. Leisure-time physical activity at
midlife and the risk of dementia and Alzheimers disease. Lancet Neurol. 4,
705711.
Salthouse, T.A., 2006. Mental exercise and mental aging: evaluating the validity of
the use it or lose it hypothesis. Perspect. Psychol. Sci. 1, 6887.
Schuit, A.J., Feskens, E.J., Launer, L.J., Kromhout, D., 2001. Physical activity and cognitive decline, the role of the apolipoprotein e4 allele. Med. Sci. Sports Exerc. 33,
772777.
Smiley-Oyen, A.L., Lowry, K.A., Francois, S.J., Kohut, M.L., Ekkekakis, P., 2008.
Exercise, tness, and neurocognitive function in older adults: the selective
improvement and cardiovascular tness hypotheses. Ann. Behav. Med. 36,
280291.
Smith, P.J., Blumenthal, J.A., Hoffman, B.M., Cooper, H., Strauman, T.A., WelshBohmer, K., Browndyke, J.N., Sherwood, A., 2010. Aerobic exercise and
neurocognitive performance: a meta-analytic review of randomized controlled
trials. Psychosom. Med. 72, 239252.
Snowden, M., Steinman, L., Mochan, K., Grodstein, F., Prohaska, T.R., Thurman, D.J.,
Brown, D.R., Laditka, J.N., Soares, J., Zweiback, D.J., Little, D., Anderson, L.A., 2011.
Effect of exercise on cognitive performance in community-dwelling older adults:
review of intervention trials and recommendations for public health practice
and research. J. Am. Geriatr. Soc. 59, 704716.
So, F., Valecchi, D., Bacci, D., Abbate, R., Gensini, G.F., Casini, A., Macchi, C., 2011.
Physical activity and risk of cognitive decline: a meta-analysis of prospective
studies. J. Intern. Med. 269, 107117.
Sturman, M.T., Morris, M.C., Mendes de Leon, C.F., Bienias, J.L., Wilson, R.S., Evans,
D.A., 2005. Physical activity, cognitive activity, and cognitive decline in a biracial
community population. Arch. Neurol. 62, 17501754.
Sumic, A., Michael, Y.L., Carlson, N.E., Howieson, D.B., Kaye, J.A., 2007. Physical activity and the risk of dementia in oldest old. J. Aging Health 19, 242259.
Taylor-Piliae, R.E., Newell, K.A., Cherin, R., Lee, M.J., King, A.C., Haskell, W.L., 2010.
Effects of Tai Chi and Western exercise on physical and cognitive functioning in healthy community-dwelling older adults. J. Aging Phys. Activ. 18,
261279.
van Gelder, B.M., Tijhuis, M.A., Kalmijn, S., Giampaoli, S., Nissinen, A., Kromhout, D.,
2004. Physical activity in relation to cognitive decline in elderly men: the FINE
Study. Neurology 63, 23162321.
van Uffelen, J.G., Chin, A.P.M.J., Hopman-Rock, M., van Mechelen, W., 2008. The
effects of exercise on cognition in older adults with and without cognitive
decline: a systematic review. Clin. J. Sport Med. 18, 486500.
Venturelli, M., Lanza, M., Muti, E., Schena, F., 2010. Positive effects of physical training
in activity of daily living-dependent older adults. Exp. Aging Res. 36, 190205.
Wayne, P.M., Walsh, J.N., Taylor-Piliae, R.E., Wells, R.E., Papp, K.V., Donovan, N.J., Yeh,
G.Y., 2014. Effect of Tai Chi on cognitive performance in older adults: systematic
review and meta-analysis. J. Am. Geriatr. Soc..
Weuve, J., Kang, J.H., Manson, J.E., Breteler, M.M., Ware, J.H., Grodstein, F., 2004.
Physical activity, including walking, and cognitive function in older women.
JAMA 292, 14541461.
Williamson, J.D., Espeland, M., Kritchevsky, S.B., Newman, A.B., King, A.C., Pahor,
M., Guralnik, J.M., Pruitt, L.A., Miller, M.E., 2009. Changes in cognitive function
in a randomized trial of physical activity: results of the lifestyle interventions
and independence for elders pilot study. J. Gerontol. A: Biol. Sci. Med. Sci. 64,
688694.

The Impact of Exercise On The Cognitive Functioning of Healthy Older

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Ageing Research Reviews 16 (2014) 1231

Contents lists available at ScienceDirect

Ageing Research Reviews

The impact of exercise on the cognitive functioning of healthy older

M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231

A plethora of RCTs have been designed to investigate the effects

M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231

Participants (at PT)

Aerobic exercise programme versus stretching

EG: 3 1 h per week for 12 weeks; 4060% of

Kramer et al., 2002

Aerobic exercise programme versus stretching

EG: 3 40 min per week for 1 year. 5060% of

Aerobic (walking) versus anaerobic (toning and

EG: 3 (1040) min per week for 6 months

No differences between aerobic versus

Both groups memory performance improved.

Face recognition (immediatec , delayedc )

Tasks that involved executive control processes

The yoga intervention group members rated

Processing speed (simple RTc , incompatible

Signicant decrease in RT and errors in the

Aerobic exercise versus strength-and-exibility

EG: 1 1.5 h per week for 6 months; 70% of

M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231

Four conditions: aerobic exercise (Exer. Int.) or

Participants (at PT)

For outcomes that

Signicant benets for

Single blind RCT

Social interaction group

M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231

Participants (at PT)

M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231

Participants (at PT)

Immediate recall (storya , wordc )

Active video game training

EG: 2 1 h per week for 12

Attention (Trailsb , Stroopb , task switchingb )

Cognitive-exercise group versus EG: 3 1 h per week for 12

Attention (Trails Bc , simple RTa , dual-task RTa , Stroop

1. 1 1.5 h per week for 6

M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231

Participants (at PT)

Both groups showed

EG: 3 1-h sessions

Two resistance groups:

M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231

Ref. author (year)

Participants (at PT)

OEP group 12.8%

Individual ADL items:

M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231

Ref. author (year)

Participants (at PT)

1. (EG): 3 50 min per

Tai Chi group versus no

EG: 2 1 h per week

Proc speed (Trails Aa )

Two phase study

1. (EG): 1 45 min per

First phase: three

M.E. Kelly et al. / Ageing Research Reviews 16 (2014) 1231