Journal of Aging and Physical Activity, 2012, 20, 497-1

© 2012 Human Kinetics, Inc. Official Journal of ICAPA

www.JAPA-Journal.com
SCHOLARLY REVIEW

Effect of Resistance-Exercise Training

on Cognitive Function
in Healthy Older Adults: A Review
Yu-Kai Chang, Chien-Yu Pan, Feng-Tzu Chen,
Chia-Liang Tsai, and Chi-Chang Huang

Several studies have demonstrated that exercise helps reduce or prevent cognitive
deterioration among older adults, and recent studies have further examined the
effects of resistance-exercise training on cognition. The purpose of this review was
to examine the role of resistance-exercise training on cognition in healthy older
adults. Specifically, it describes the definition, health benefits, and the design of
resistance-exercise training. The authors also review the research related to resis-
tance exercises and cognition and found that this exercise modality may enhance
specific cognitive performances. Next, they examine the potential mechanisms
underlying resistance exercise and cognitive enhancement. Finally, they consider
potential therapeutics and recommendations for further research on resistance-
exercise training and cognition in older adults.

Keywords: chronic exercise, resistance training, strength training, executive func-

tion, cognition

The older population has become the main growth segment in current society.
According to the World Health Organization in 2000, 10%, or approximately 600
million people, were 60 years old or older, and globally, this number is expected to
increase to 1.2 billion by 2025 and 1.9 billion by 2050 (Hutton, 2008). The older
population is also growing significantly in the United States. In 2008, 38.9 million
people age 65 years or older represented 12.8% of the U.S. population, which is
an increase of 4.5 million over the previous decade (U.S. Department of Health
and Human Services, 2010).
Aging is a dynamic and progressive process that results in deterioration of
morphological, functional, hemodynamic, and psychological abilities and leads to
reduced adaptive ability and quality of life, as well as increased morbidity (Roube-
noff, 2000). Studies have shown that aging is negatively associated with volumes of

Chang and Chen are with the Graduate Inst. of Athletics and Coaching Science, and Huang, the Graduate
Inst. of Sports Science, National Taiwan Sport University, Taoyuan County, Taiwan. Pan is with the Dept.
of Physical Education, National Kaohsiung Normal University, Kaohsiung, Taiwan. Tsai is with the Inst.
of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan, Taiwan.

  497
 498  Chang et al.

white matter, gray matter, hippocampus, and amygdala, as well as other brain regions
including prefrontal, temporal, parietal, and occipital cortices (Raz & Rodrigue,
2006). Because these cortical and subcortical regions are involved in cognition, their
deterioration is often accompanied by cognitive decline. Research has indicated
that aging inhibits multiple cognitive functions, including information-processing
speed, reasoning, attention, and multiple memory formations (Budson & Price,
2005; Park et al., 2002; Park & Reuter-Lorenz, 2009; Salthouse, 2003a, 2003b).
A considerable number of reviews have revealed that exercise, as a positive
lifestyle factor, might alleviate or prevent these cognitive declines (Brisswalter,
Collardeau, & Arcelin, 2002; Colcombe & Kramer, 2003; Etnier et al., 1997;
McMorris & Graydon, 2000). Although most of them have primarily focused on
aerobic exercise, a few studies have shifted their attention to emphasize the effects
of other types of exercise modalities, particularly resistance exercise, on cognition
and found positive effects. For example, a meta-analysis conducted by Colcombe
and Kramer revealed that a long-term exercise program significantly enhanced
cognition in the older population (effect size [ES] = 0.48); however, they also
found that an exercise program with a combination of multiple exercise modalities
(e.g., resistance exercise) enhanced cognition to a greater extent (ES = 0.59) than a
program that only included aerobic exercise (ES = 0.41). Similar results were also
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found in older adults with cognitive impairments and dementia (ES = 0.57; Heyn,
Abreu, & Ottenbacher, 2004). Liu-Ambrose and Donaldson’s (2009) commentary
requested further examination of resistance exercise and cognition in older adults.
Recently, several reviews have focused on the effects of aerobic exercise on
cognition, specifically focusing on neurocognition during aging (Colcombe, Kramer,
McAuley, Erickson, & Scalf, 2004), neural plasticity (Erickson & Kramer, 2009),
epidemiology (Kramer, Erickson, & Colcombe, 2006), neurocognitive performance
(Smith et al., 2010), and older adults with and without cognitive declines (van
Uffelen, Chin A Paw, Hopman-Rock, & van Mechelen, 2008). Some reviews also
focused on how a special exercise modality such as Tai Chi Chuan affects cognition
in older adults (Chang, Nien, Tasi, & Etnier, 2010). However, to date, reviews have
not focused on resistance exercise and cognition in healthy older adults. Therefore,
the purpose of this article was to review the research regarding the effects of resis-
tance exercise on cognition in older adults. Specifically, we briefly describe the
definition and designs of resistance-exercise-training program, present reviews of
literatures related to resistance exercise and cognition, and examine the potential
mechanisms underlying resistance exercise and cognition. Finally, potential thera-
peutics and recommendations for further research are addressed.

Resistance-Exercise Training
Definition and Health Benefits
Resistance-exercise training, also known as resistance exercise, resistance training,
or strength training, is a type of exercise that involves the voluntary activation of
specific skeletal-muscle groups against external resistance (Winett & Carpinelli,
2001). Although resistance exercise was performed by only a few body builders
in its early stages, it has become a popular form of exercise and is recommended
by many health organizations, including the American College of Sports Medicine
 Resistance Exercise and Cognition   499

(ACSM), the American Heart Association, and the American Geriatrics Society
(American Geriatrics Society Panel on Exercise and Osteoarthritis, 2001; Kraemer,
Adams, et al., 2002; Nelson et al., 2007).
Particularly for the older population, resistance exercise has been shown to
increase muscle mass, strength, power, energy expenditure, and body-muscle
composition (Haskell et al., 2007; Hunter, McCarthy, & Bamman, 2004). Such
exercise has also been found to reduce the risk factors associated with age-related
diseases including sarcopenia (Johnston, De Lisio, & Parise, 2008; Visvanathan &
Chapman, 2010), coronary heart disease, hypertension, diabetes mellitus, metabolic
syndrome, osteoporosis, osteoarthritis, and disability in the elderly (Hurley &
Roth, 2000; Kraemer, Ratamess, & French, 2002). In addition to physical benefits,
resistance-exercise training has been found to enhance positive well-being in the
obese population (Levinger et al., 2009), as well as quality of life (Dibble, Hale,
Marcus, Gerber, & LaStayo, 2009) and cognition (Cassilhas et al., 2007; Liu-
Ambrose et al., 2008; Ozkaya et al., 2005) in the older population.

Design and Recommendation

Individualization is the primary concern for designing a proper resistance exercise to
achieve maximal results. Kraemer and colleagues (ACSM, 2009; Kraemer, Adams,
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et al., 2002; Kraemer & Ratamess, 2004) have provided detailed descriptions with
several components that should be considered before forming a resistance-exercise-
training program, including muscle action, exercise selection, workout structure,
exercise order, loading, volume, rest periods between sets, repetition velocity,
training frequency, and progressive overload. The descriptions of these components
were briefly addressed based on Kraemer and colleagues, and additional studies
related to specific components were also presented (Rhea, Alvar, Burkett, & Ball,
2003; Simao, Farinatti, Polito, Maior, & Fleck, 2005; Simao, Farinatti, Polito,
Viveiros, & Fleck, 2007).
For muscle action, concentric and eccentric actions play the primary role in
the dynamic repetitions of resistance-exercise training, but additional isometric
actions are recommended to maximize strength gain. With regard to exercise selec-
tion, both single-joint exercises such as leg extensions and leg curls, that focus on
specific muscle groups, and multiple-joint exercises such as bench press, squat, or
power clean, that target multiple muscle groups, should be considered. The work-
out structure involves total-body workouts, upper/lower body split workouts, and
muscle-group split routines. General recommendations are chosen based on the
training goals (e.g., strength, hypertrophy, power, muscle endurance). Simao and
colleagues indicated that the exercise order is based on several principles, including
larger muscle groups before small ones, multiple-joint exercise before single-joint
exercise, less complex movement before basic ones (e.g., squat or bench press),
higher intensity before lower intensity when training individual muscle groups,
and rotating upper and lower body movements or opposing (agonist–antagonist
relationship) muscle groups (Simao et al., 2005; Simao et al., 2007).
Loading is usually applied using the one-repetition-maximum (1RM) method.
Rhea et al. (2003) indicated that untrained individuals who use 60% 1RM gain
maximal results (ES = 2.5–3), whereas trained individuals gain maximal results
using the 80% 1RM (ES = 1.5–2). Volume can be calculated by using either the
 500  Chang et al.

number of sets and repetitions during a training session (Kraemer & Ratamess,
2004) or the sum of the number of sets and repetitions, then multiple loading (kg;
ACSM, 2009). One to six sets or more have been found to increase muscle strength.
For example, Rhea et al. (2003) indicated that four sets per muscle group produced
maximal gains in both trained and untrained individuals (ES = 1–2.5). In addition,
the rest period between sets has been shown to affect metabolic and cardiovas-
cular responses. At least 2–3 min is recommended for untrained, intermediate
individuals and for advanced training, whereas 1–2 min may suffice for assistance
exercises (exercises complementary to core exercises; ACSM, 2009). Repetition
velocity involves dynamic, constant external resistance, as well as unintentional
and intentional slow velocities. All slow-, moderate-, and fast-velocity repetitions
have been shown to be positively associated with the training level of individuals
(ACSM, 2009). Frequency is defined as the number of times per week the exer-
cise is performed, and the recommended frequency is two or three, three or four,
and four or five times/week for untrained, intermediate, and trained individuals,
respectively. Finally, progressive overload can be found by increasing the load,
repetition, velocity, and volume; shortening the rest periods; or any combination
thereof (Kraemer & Ratamess, 2004).
When considering these components, the general exercise recommendation
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of ACSM guidelines for older adults is as follows:

Type: Multiple-joint exercises that affect more than one muscle group are
the primary recommendation, whereas single-joint exercises of major muscle
groups are recommended for additional exercise.
Load: Moderate intensity (60–70% 1RM).
Volume (repetition and set): One or more sets of 10–15 repetitions with a rest
interval of 2–3 min.
Frequency: At least twice per week with at least 48 hr separation for the same
muscle groups to increase improvements (ACSM, 2010).
Moreover, to further improve strength and hypertrophy in older adults, the recom-
mendations of the ACSM position stand that rank in the A category of evidence
(the highest evidence rank, where a large number of well-designed randomized
controlled trials [RCT] reveal consistent findings) involve the following:
Type: both multiple- and single-joint exercises with either free weights or
machines
Load: 60–80% 1RM
Volume: one to three sets per exercise with 8–12 repetitions
Rest and velocity: 1–3 min of rest with slow to moderate lifting velocity
Frequency: two or three times per week (ACSM, 2009)
Additional resistance-exercise training is recommended to focus on specific goals
or expectations, such as muscle hypertrophy, muscle power, muscle endurance, and
motor performance (ACSM, 2009); however, resistance-exercise-training recom-
mendations for mental health and cognition are not yet established.
 Resistance Exercise and Cognition   501

Reviews of the Literature Related to Resistance Exercise and

Cognition
Several approaches were used to comprehensively search the potential research
related to resistance-exercise training and cognition. Computer searches were
conducted using multiple databases: MEDLINE, PubMed, PsycINFO, Educational
Research in Completion (ERIC), and SPORTDiscus. Key terms in the search
included resistance exercise, resistance training, strength exercise, strength training,
muscle training, cognition, cognitive function, cognitive performance, executive
function, and memory. Studies published in English from January 1996 to Febru-
ary 2010 were included. Additional criteria for inclusion were as follows: healthy
adults without cognitive impairment or specific disease, adults with an average
age older than 65 years, cognitive performance assessed by cognitive tasks or
neuropsychological assessments, and studies that included control or comparable
groups. Potential studies were also identified from the reference lists of studies
and reviews found in the search.
Ten studies that examined the effects of resistance training on different aspects
of cognition were identified: Three studies examined resistance exercise versus
nonexercise (Kimura et al., 2010; Liu-Ambrose et al., 2008; Perrig-Chiello, Perrig,
Ehrsam, Staehelin, & Krings, 1998; see Table 1), four studies compared multiple
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exercise modalities (Brown, Liu-Ambrose, Tate, & Lord, 2009; Cancela Carral
& Ayan Perez, 2007; Komulainen et al., 2010; Ozkaya et al., 2005; see Table 2),
and three studies examined dose-response relationships (Cassilhas et al., 2007;
Liu-Ambrose et al., 2010; Tsutsumi, Don, Zaichkowsky, & Delizonna, 1997; see
Table 3).

Resistance Exercise Versus No Exercise

Perrig-Chiello et al. (1998) evaluated the effects of an 8-week resistance-training
program on performance involving multiple cognitive tasks. The effects of short-
and long-term exercise regimens were also examined. Older adults were randomly
assigned into the resistance-training or control group. Cognitive performance was
assessed using free-recall and recognition tests to measure memory and the digit-
symbol test to measure cognitive speed, attention, coordination, and information-
processing speed. The time course was assessed by evaluating performance 1 week
before training, 1 week after training, and 1 year after training. Perrig-Chiello et
al. indicated that although no between-groups differences were found, delayed free
recall and immediate, as well as delayed, recognition, had significant improvements
compared with baseline in resistance-training groups, while no effects were found
in the control group. For long-term effects, resistance-training groups showed more
improvement in free recall than the control group.
While targeting executive functions, a type of higher level cognition, Liu-
Ambrose et al. (2008) examined the effects of an exercise program on specific types
of cognition. They assigned older adults into either the Otago Exercise Program, a
6-month home-based program, or a control group using an RCT design. Cognitive
performances, specifically set shifting, updating, and response inhibition, were
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502
Table 1  Influences of Chronic Resistance Training on Cognition in Older Adults: Resistance Exercise Versus No
Exercise
Resistance-Exercise Intervention Cognitive Tasks
N (age),
Study Design gender Groups Exercise Design Name Time Results
Kimura et SB-RCT 171 ST (combina- Rowing hip, L = 3 mo, F = Task-switch- Pre, NS
al. (2010) (≥65 tion, see text), abductor, knee twice/week, I ing task post
yr), control (health extension, leg = 60% 1RM or
both education) press 10RM, D = 1.5
hr, S = 2–3, R = 2
min, P = yes
Liu- SB-RCT 74 (≥70 Otago exercise Hip abductor, knee L= 6 mo, F = at TMT-B, Pre, Facilitation in Stroop
Ambrose yr), program, con- extensor, knee least twice/week, verbal digits- post CWa
et al. both trol (guideline flexor, ankle plan- D = 30 min, I, S, backward test,
(2008) care) tar flexors, ankle R, P = WD Stroop CW
dorsiflexors
Perrig- Rand. 46 Resistance Preacher curls, L = 8 wk, F = Free-recall Pre Facilitation in delayed
Chiello et (65–95 training, control trunk curls, back once/week, I, D, S, test, recogni- Post free recall,b facilita-
al. (1998) yr), extension, seated R, P = WD tion test, digit- tion in immediate and
both row exercise, symbol test 1 delayed recognition,b
leg press, bench year facilitation in free
press, leg curls, leg post recall 1 yr posta
extension exercise
Note. SB-RCT = single-blinded randomized controlled trial; ST = strength training; L = length; F = frequency; I = intensity; D = during; S = set; R = rest time; P = progression; NS
= nonsignificant; WD = without description; TMT- B = The Trail Making Test Part B; Stroop CW = Stroop Color Word; Rand. = randomized.
aSignificant between-groups differences. bSignificant within-group differences.
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Table 2  Influences of Chronic Resistance Training on Cognition in Older Adults: Multiple Exercises Comparison
Resistance-Exercise Intervention Cognitive Tasks
N (age),
Study Design gender Groups Exercise Design Name Time Results
Brown et al. RCT 154 GE (resis- Leg, truck, and arm L= 6 mo, F = 2/ WAIS-R, TMT-B, Pre, Facilitation in
(2009) (62–95 tance and movements week, D = 60 Stroop CW, post WAIS-Ra
yr), balance), min, I, S, R, P = COWAT, WMS-R
both FR (flex- WD
ibility and
relaxation),
control
Cancela RCT 62 (M ST with Vertical butterfly, L = 5 mo, F MMSE Pre, Facilitation in
Carral and 68.4 aquatic double-arm curl, = 5 times/wk post MMSEb
Ayan Perez yr), exercise, forward shoulder (include 3 times
(2007) female callisthenic press, hip flexion, ST), I = 75%
training with lever seated rear 1RM, D = ~45
aquatic exer- lateral raise, leg min, S = 3, R = 5
cise press, leg extension min, P = yes

(continued)

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504
Table 2 (continued)
Resistance-Exercise Intervention Cognitive Tasks
N (age),
Study Design gender Groups Exercise Design Name Time Results
Komulainen RCT 1335 AE, RE, diet, 10–14 muscle L= 2 yr, F = 2 Word-list memory Pre, VO2max possibly
et al. (2010) (57–78 AE & diet, groups (1,000–1,500 test, word-list recall post correlated with
yr), RE & diet, kcal/wk) or 3 test, verbal-fluency imm. memory
both control (>1,500 kcal/ test, modified
wk), I = 60% Boston naming test,
1RM or 15RM, S constructional praxis
= 2, D, R = WD, & clock-drawing
P = see context test, MMSE
Ozkaya et al. RCT 36 ST, endur- Biceps curl, arm L = 9 wk, F Auditory oddball Pre, Strength-group
(2005) (60–85 ance train- raise, abdominal = 3/wk, I = task post decrease N1,
yr), ing, control crunch, hip exten- 60–80%1RM, D N2, P2 latency
both (sedentary) sion, knee flexion, = WD, S = 1 or and increase
seated lower leg 3, R = 2 min, P N1P2, P2N2,
lift, chair squat = yes N2P3 ampli-
tudea
Note. RCT = randomized controlled trial; GE = group-based exercise; FR = flexibility exercise and relaxation technique; L = length; F = frequency; D = during; I = intensity; S =
set; R = rest time; P = progression; WD = without description; WAIS-R = Wechsler Adult Intelligence Scale-Revised; TMT-B = The Trail Making Test Part B; Stroop CW = Stroop
Color Word; COWAT = Controlled Oral Word Association Test; WSM-R = Wechsler Memory Scale-Revised; ST = strength training; MMSE = Mini-Mental Status Examination;
AE = aerobic exercise; RE = resistance exercise; imm. = immediate.
aSignificant between-groups differences. bSignificant within-group differences.
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Table 3  Influences of Chronic Resistance Training on Cognition in Older Adults: Dose-Response Relationship
Resistance-Exercise Intervention Cognitive Tasks
N (age),
Study Design gender Groups Exercise Design Name Time Results
Cassil- Rand. 62 High int., Chest press, vertical L = 24 wk, F WAIS III, Toulouse- Pre, Both exercise
has et al. (65–75 moderate traction, abdominal = 3/wk, I = Pieron’s concentra- post groups facilitate
(2007) yr), int., control crunch, lower back, 50% 1RM or tion attention test, WAIS III, WSM-R,
male (stretch) leg curl, leg press 80% 1RM, D Rey-Osterrieth & Rey-Osterrieth.
= 60 min, S = complex-figure test High-int. group
2, R = 1 min facilitates additional
30 s, P = yes in Toulouse-Pieron.a
Liu- SB-RCT 155 Once/wk, Biceps curls, triceps L = 1 yr, F Stroop, TMT-A & Pre, Both exercise
Ambrose (65–75 twice/wk, extension, seated = 1/wk or 2/ -B, verbal digit span 6 mo groups facilitate
et al. yr), control (bal- rowing, latissimus wk, I = 6RM forward and back- post, Stroop and reduce
(2010) female ance and dorsi pull-down, leg or 8RM, D = ward test 12 mo whole-brain
tone) press, hamstring curls, 60 min, S = post volume.a
calf raise 2, R = WD, P
= yes
Tsutsumi Rand. 45 High-int. ST, Shoulder press, lateral L = 12 wk, F Mental arithme- Pre, NS
et al. (61–86 low-int. ST, pull-down, fly, triceps = 3/wk, I = tic, computerized post
(1997) yr), both control press-down, arm curl, 75–85% 1RM mirror drawing task
back extension, seated or 55–65%
row, abdominal flex- 1RM, D =
ion, bench press, leg WD, S = 2, R
extension, leg curl = 1–2 min, P
= yes
Note. Rand. = randomized; int. = intensity; L = length; F = frequency; I = intensity; D = during; S = set; R = rest time; P = progression; WAIS III = Wechsler Adult Intelligence
Scale III; WSM-R = Wechsler Memory Scale-Revised; SB-RCT = single-blinded randomized controlled trial; WD = without description; Stroop = Stroop Test; TMT-A and B =
The Trail Making Test Part A and Part B; ST = strength training; NS = nonsignificant.
aSignificant between-groups differences.

  505
 506  Chang et al.

assessed using the Trail Making Test Part B (TMT-B), Verbal Digits-Backward Test,
and Stroop Color-Word Test. The results showed that there was a between-groups
difference in response inhibition, where the exercise group increased by 12.8%.
In contrast, set shifting and updating were only minimally affected by resistance
exercise compared with the control group. Because inhibition is highly associated
with fall prevention (Verghese et al., 2002), Liu-Ambrose et al. (2008) suggested
that the fall-prevention effects of the Otago Exercise Program would be attributable
to improvements in response inhibition.
However, Kimura et al. (2010) failed to find positive effects of strength training
on executive function measured by the task switch. They randomly assigned partici-
pants to either a strength-training (combination of conditioning, strengthening, and
functional training phases) or health-education course/control group. The cognitive
test was conducted before and after a 3-month exercise or health-education program.
The results indicated no significant between-groups differences in response time or
in accuracy. Kimura et al. speculated that this result might be due to an insufficiently
long and intense resistance-training program, which was unable to elicit changes in
IGF-1 levels, a potential mechanism underlying resistance exercise and cognition.
In sum, two of three studies revealed that resistance-exercise training benefits
specific cognitive performances, where both between-groups differences (an exer-
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cise group compared with a control group) and within-group differences (a posttest
compared with a pretest) were found (Liu-Ambrose et al., 2008; Perrig-Chiello
et al., 1998). However, these two studies provided lower sample sizes, as well as
insufficient descriptions of resistance-exercise design, compared with Kimura et
al. (2010). In addition, although both Kimura et al. and Liu-Ambrose et al. (2008)
applied a higher standard single-blinded RCT design, the results yielded notable
differences. These mixed findings might have resulted from discrepancies among
participant characteristics, exercise design, or cognitive tasks among these studies.
Future research is obviously needed in view of these concerns.

Multiple Exercises Comparison

In addition to studies that compared resistance-exercise training and no exercise
training, some studies compared effects of multiple types of exercise modalities on
cognitive performance. Cancela Carral and Ayan Perez (2007) examined the effects
of multiple high-load (frequency and intensity) exercises on older women. They
randomly assigned participants to either a high-intensity strength training combined
with aquatic exercise (Group 1) or callisthenic training (aerobic exercise, mobility,
and flexibility) combined with aquatic exercise (Group 2). Cognitive tasks were
measured using the Spanish version of the Mini-Mental State Examination and
were assessed both pre- and postprogram. The results showed that both exercise
groups showed enhanced cognitive ability compared with baseline, suggesting that
the high-frequency and -intensity program was beneficial for cognitive function
among older women.
Brown et al. (2009) examined the effects of different types of group-based
exercise programs on multiple aspects of cognitive performance in older adults. They
recruited older participants from eight retirement facilities and randomly assigned
each one to either a resistance- and balance-training (GE) group, a flexibility- and
relaxation-training (FR) group, or a control group. Cognitive performances were
 Resistance Exercise and Cognition   507

assessed based on three types of functions including fluid intelligence (measured

by the Wechsler Adult Intelligence Scale-Revised), executive function (measured
by the TMT-B, the Stroop Color-Word Test, and the Controlled Oral Word Asso-
ciation Test), and multiple types of memory (visual, verbal, and working). Brown
et al. found that the GE group had more benefits than the FR and control group in
fluid intelligence, while both the GE and FR groups had improved mood compared
with the control group,
One study used event-related potential (ERP) to examine the underlying dif-
ferences in neuroelectronic activity between exercise modality and cognition in
older adults. Ozkaya et al. (2005) randomly assigned older adults to an endurance-
training group (70% HRR, 50 min/session), a strength-training group, or a control
group. Cognitive performance was assessed using the auditory oddball task, which
induced ERP components before, during, and after intervention. The results revealed
that both training groups had a faster latency in N1, N2, and P2, as well as larger
amplitude in N1P2, P2N2, and N2P3, than the control group. Because latency and
amplitude represented the stimulus classification speed and level of attentional
resource allocation (Hillman, Snook, & Jerome, 2003), these results suggest that
exercise positively influenced the participants’ neuroelectric processes during
cognitive performance. In addition, compared with endurance training, strength
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training produced a shorter latency for P2 and N2, as well as a larger amplitude
for N1P2, P2N2, and N2P3, suggesting that strength training had a better effect
than endurance training.
In contrast, Komulainen et al. (2010) failed to show the same positive effects
on cognition in a long-term multiple-treatment study. Using the RCT design, they
assigned 1,410 subjects into six groups: aerobic exercise, resistance exercise, diet,
aerobic exercise plus diet, resistance exercise plus diet, and control. The interven-
tion was a 2-year program for resistance exercise. Aerobic exercises were 150 min
or 180 min/week with 55–65% VO2max. Primary outcome measures for exercises
included a VO2max test and physical activity questionnaires that could be translated
to metabolic equivalents. Measures used to evaluate cognitive functions included
a word-list memory test for immediate memory; a word-list recall test, a word-list
recognition test, and a delayed constructional praxis test for delayed memory; a
verbal-fluency test and the modified Boston naming test for verbal performance; a
constructional praxis test and a clock-drawing test for visual performance; and the
Mini-Mental State Examination. The initial analysis found no differences in the
2-year change in VO2max or in cognitive performance; however, secondary analyses
indicated that improved VO2max in the aerobic, resistance, diet, and combined aero-
bic and diet groups was positively associated with immediate memory. However,
improvements in delayed memory and verbal performance were found in the diet
and aerobic-exercise groups.
In sum, all four studies were conducted using an RCT design, and two of
them proposed between-groups cognitive differences between resistance-exercise
and control groups (Brown et al., 2009; Ozkaya et al., 2005), while one revealed
within-group cognitive differences in the exercise group (Cancela Carral & Ayan
Perez, 2007). With the largest sample size, although Komulainen et al. (2010)
failed to support the between-groups cognitive differences during the first 2 years,
resistance-exercise-induced VO2max was positively associated with immediate
memory, reflecting the potential link between resistance exercise and cognition.
 508  Chang et al.

Dose-Response Relationship
Another research direction is investigation of the dose-response relationship between
specific resistance-training components (e.g., intensity, duration, length) and cog-
nition in older adults. Examining the dose-response relationship is beneficial for
establishing exercise prescription for specific conditions.
Tsutsumi et al. (1997) examined the dose-response relationship between exer-
cise intensity and neurocognitive function. Older adults were randomly assigned
into a high-intensity resistance-training group, a low-intensity resistance-training
group, or a control group. The high-intensity resistance-training group used resis-
tance exercise of 75–85% 1RM with 8–12 repetitions, whereas the low-intensity
group included exercises of 55–65% 1RM with 12–16 repetitions. Cognitive-task
performance (mental arithmetic and a computerized mirror drawing task) were
measured before and after the 12-week intervention. Both exercise groups showed
enhanced muscle strength and mood, whereas VO2max and cognitive performance
did not change significantly, suggesting that resistance training using different
intensities has limited influence on cognition.
However, some studies have reported contrasting results. Cassilhas et al. (2007)
also studied the effect of resistance-training intensity on cognition. Using a similar
experimental design, older participants were randomly assigned to a high-intensity
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(80% 1RM), moderate-intensity (50% 1RM), or control group for 24 weeks. Cogni-
tive assessments included the Wechsler Adult Intelligence Scale III (WAIS III) for
central, executive, and short-term memory; the Wechsler Memory Scale-Revised
(WSM-R) for the visual modality of short-term memory; Toulouse-Pieron’s con-
centration attention test for attention; and the Rey-Osterrieth Complex Figure Test
for long-term episodic memory. Cassilhas et al. found that both exercise groups
showed significant improvements in Longest Digit Span Forward (WAIS III),
Corsi’s Block-Tapping Backward and Similarities (WSM-R), and Rey-Osterrieth
Complex Figure Test immediate recall compared with the control group, while no
differences were found between exercise groups. The high-intensity group showed
additional better improvement on the Toulouse-Pieron concentration test than the
control group. Furthermore, plasma IGF-1 levels in both exercise groups were higher
than levels in the control group, suggesting that both resistance exercise intensities
benefited older adults, with IGF-1 being a potential biological mechanism.
Liu-Ambrose et al. (2010) further examined the dose-response relationship
of exercise frequency on executive function in older women. The older partici-
pants were randomly assigned to a once-weekly resistance-training, twice-weekly
resistance-training, or control group. Cognitive tasks included the Stroop Test to
assess selective attention and response inhibition, the TMT-A and TMT-B to assess
set shifting, and the Verbal Digit Span Forward and Backward Tests to assess
working memory at baseline, 6 months, and 12 months. In addition, magnetic reso-
nance imaging was used to assess whole-brain volume. Liu-Ambrose et al. (2010)
found that both exercise groups showed enhanced Stroop Test performance, which
increased by 12.6% and 10.9% in the once- and twice-weekly groups, respectively,
compared with the control group. In addition, both exercise groups had less whole-
brain volume than the control group. These results suggest that resistance exercise,
even once per week for 12 months, affects brain structure, as well as cognitive
function in terms of selective attention and conflict resolution in older women.
 Resistance Exercise and Cognition   509

In sum, although Tsutsumi et al. (1997) failed to find resistance-exercise effects

on cognition, both Cassilhas et al.’s (2007) and Liu-Ambrose et al.’s (2010) studies
proved differently. Cassilhas et al. further indicated a dose-response relationship
between exercise intensity and attention performance. The positive results might
be warranted in these particular circumstances because Cassilhas et al. and Liu-
Ambrose et al. used better design (single-blinded RCT in Liu-Ambrose et al.),
larger sample sizes, or longer exercise duration than Tsutsumi et al. Since only a
few studies have examined the dose-response relationship, additional research on
the issue should be encouraged.

Potential Mechanism Linking Resistance Exercise

and Cognition
Many molecular mechanisms have been proposed to link exercise and cognition,
including insulin-like growth factor (IGF-I), brain-derived neurotrophic factor,
fibroblast growth factor 2, and vascular endothelial growth factor (VEGF; Cotman
& Berchtold, 2002; Kramer & Erickson, 2007). Among them, IGF-1 has been
recognized as a candidate factor that specifically connects resistance-exercise
training and cognition.
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IGF-1 is one of the most important hormones for growth and development in
humans (Sonntag, Ramsey, & Carter, 2005) and is associated with aging in the brain
(Ramsey, Weiner, Moore, Carter, & Sonntag, 2004; Sonntag et al., 2000). Thornton,
Ingram, and Sonntag (2000) indicated that IGF-1 replacement enhanced learning
and memory in aged rats. The mechanism included IGF-1-mediated increases in
neurogenesis, vascular density, glucose utilization, and regulation of N-methyl-D-
aspartic acid receptors in the brain (Lichtenwalner et al., 2001; Sonntag et al., 2000).
IGF-1 was shown to prevent the loss of brain tissue and increase concentrations
of BDNF (Cotman & Berchtold, 2002) and VEGF, a molecule related to vessel
growth (Lopez-Lopez, LeRoith, & Torres-Aleman, 2004). BDNF is found in the
central nervous system and functions in areas associated with cognitive processes,
such as the prefrontal cortex, striatum, hippocampus, cortex, septum neurons,
cerebellum, and motor neurons. In addition, studies have indicated that IGF-1
enhances synaptic plasticity and neuronal survival, which would, in turn, improve
cognitive performance (Adlard, Perreau, & Cotman, 2005; Cotman & Berchtold,
2002; Vaynman, Ying, Yin, & Gomez-Pinilla, 2006).
In rodents, studies have found that circulating levels and brain uptake levels
of IGF-1were elevated with increased exercise (Carro, Trejo, Busiguina, & Torres-
Aleman, 2001), and IGF-1 could mediate exercise-induced neurogenesis in the
hippocampus (Trejo, Carro, & Torres-Aleman, 2001). These results linking IGF-1
and resistance exercise have been extended to humans. Borst et al. (2001) assigned
participants to either of two resistance programs or a control group to examine
the effects of different numbers of sets of resistance training on IGF-1 levels. The
exercise programs included one or three sets, 3 days/week for 25 weeks. Results
indicated that although the three-set group increased 1RM compared with the
one-set and control groups, both the one- and three-set groups showed significant
increases in IGF-I levels. In addition, IGF-1 increased by 20% after the first 13
weeks, and the levels were maintained from 13 to 25 weeks. Resistance training’s
 510  Chang et al.

positive association with IGF-I has also been proposed by other studies (Adamo
& Farrar, 2006; Hameed et al., 2004).
Alternatively, Cassilhas et al. (2007) indicated that blood viscosity, or resis-
tance of blood to flow, might explain how resistance-exercise training enhances
cognition, particularly in the older population. Studies have indicated that blood
viscosity is negatively associated with cognitive performance, with lower blood
viscosity reducing transportation of nutrients and oxygen to the central nervous
system. Resistance exercise increased blood flow (Umpierre & Stein, 2007), which,
in turn, was associated with cognitive performance (Cassilhas et al., 2007).
In addition to molecular and physiological mechanisms, Ozkaya et al. (2005)
applied ERP to investigate the potential mechanism between strength training,
endurance training, and cognitive neuroelectronic activity. They indicated that both
exercises could positively influence ERP components reflecting stimulus-classi-
fication speed and levels of attentional resource allocation compared with control
groups. In addition, strength training might have better effects than endurance
training, where some ERP components reveal additional positive neuroelectronic
activities (see the section on Multiple Exercises Comparison for detail).

General Discussion and Future Direction

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The effects of resistance-exercise training on cognition have only recently been

studied. Although studies have reported conflicting findings on the role of resis-
tance-exercise training in preventing cognitive decline with age, many studies have
demonstrated a beneficial effect of such training on specific cognitive measures. In
comparing resistance-exercise training with other types of exercise training such
as flexibility, tone, relaxation, calisthenics, and even endurance exercises (Brown
et al., 2009; Cancela Carral & Ayan Perez, 2007; Ozkaya et al., 2005), some stud-
ies have shown that resistance training produces equivalent or increased specific
cognitive performances. These beneficial effects were supported by both behavioral
and neuroelectric cognitive functions (Ozkaya et al., 2005). However, it should be
noted that although all the studies included in the current review applied an RCT
design, studies of higher quality (e.g., single-blinded RCT, larger sample sizes, etc.)
yielded inconsistent findings. In addition, some of these results were revealed only
concerning within-group differences; we cannot know whether the improvements
were based on resistance exercise per se or other confounders (e.g., learning or
practice effects). Interpretation of the relationship between resistance exercise and
cognition, therefore, should be approached cautiously.
Nonetheless, among these studies, we propose that designs including loads
from 60% to 80% 1RM, approximately seven movements in two sets with 2 min
rest between sets at least twice per week for 2–12 months (usually 6 months), might
positively affect cognition in older adults. The efficiency of the design is also based
on the dose-response studies; Cassilhas et al. (2007) indicated that compared with
50% 1RM, 80% 1RM was more beneficial for a variety of cognitive performances,
although Liu-Ambrose et al. (2010) showed that resistance exercise once or twice
a week for 12 months was beneficial.
Although Komulainen et al. (2010) found that increased VO2max in resistance
training was linked to immediate memory, some studies did not show that resistance-­
 Resistance Exercise and Cognition   511

exercise training affects cognition (Kimura et al., 2010; Komulainen et al., 2010;
Tsutsumi et al., 1997). Differences in the intensity level and length of the interven-
tions might help explain this ambiguity. According to Borst et al. (2001), 25 weeks
of intervention with an initial intensity set at 70% 1RM for chest/leg and 60% 1RM
for other movements that increased to 1.8–2.7 kg after adaptation would enhance
IGF-1 levels. In contrast, Kimura et al. and Komulainen et al. only used 60% 1RM.
In addition, although Tsutsumi et al. applied 55–85% 1RM, the intervention was
short (12 weeks). Therefore, the intensity and length chosen by these studies might
be insufficient to elicit an increase in IGF-1 levels and cognition.
Several possible directions need to be further addressed with respect to resis-
tance-exercise training and cognition. First, many studies applied a combination
of exercise routines, such as balance or aquatic exercises, in which the effect of
resistance-exercise training alone on cognition could not be elucidated, and some
studies that examined resistance exercise alone provided insufficient descriptions of
their experimental design (Brown et al., 2009; Perrig-Chiello et al., 1998). Second,
to establish the optimal exercise prescription for older adults, findings of the dose-
response relationship need to be confirmed. Currently, only issues of intensity
and frequency have been addressed; that is, length, progression, set, and volume
have not been thoroughly examined. Unfortunately, inconsistent results have been
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found thus far. In addition, a dose-response study conducted by Liu-Ambrose et al.

(2010) focused primarily on senior women. Because Colcombe and Kramer (2003)
indicated that gender might be a potential modulator of exercise and cognition, the
dose-response relationship between genders should be studied further.
Third, previous studies examined the effects of resistance exercise on cognition
using a variety of cognitive tasks, and these tasks might explain the inconsistent
findings between studies. Colcombe and Kramer (2003) indicated that long-term
exercise intervention increased cognitive function, but disproportionally. Specifi-
cally, they proposed that chronic exercise is most effective at increasing executive
functions, which are forms of high-level cognition, followed by controlled, spatial,
and speed-related cognitive functions. However, we found inconsistent results on
the effects of resistance-exercise training. For example, some studies found that
resistance training increased scores on the Stroop Test, a type of executive-function
task (Liu-Ambrose et al., 2008; Liu-Ambrose et al., 2010), but other groups have
shown limited effects (Brown et al., 2009). In addition, studies have found that
resistance exercise has minimal effects on other types of executive-function-related
tasks, including the TMT-B, the digits backward test, the Controlled Oral Word
Association Test, and verbal fluency (Brown et al., 2009; Komulainen et al., 2010;
Liu-Ambrose et al., 2008). These results raise two questions: First, is the effect
of aerobic exercise the same as that of resistance exercise on cognition? Second,
are there any differences in the influence of exercise based on the types of cogni-
tive tasks or executive-function-related tasks? To answer the first question, further
studies comparing aerobic exercise and resistance exercise are needed. A recent
meta-analysis by Smith et al. (2010) focused on the second question. In contrast to
Colcombe and Kramer, Smith et al. found a similar, but modest, aerobic-exercise
effect in various cognitive tasks—for example, attention and processing speed (g =
0.158), executive functions (g = 0.123), and memory (g = 0.128)—suggesting that
the effects of exercise on different types of cognition were similar. However, because
a variety of tasks have been used to address the relationship between exercise and
 512  Chang et al.

cognition, it is difficult to compare findings. To address this concern, Etnier and

Chang (2009) identified the most commonly reported executive-function tasks
recognized in the neuropsychological field and recommended further research to
apply these specific tasks, which have been commonly used to measure executive
function. If this approach is taken, future comparisons between studies might be
attainable.
Another direction is to determine the time course of resistance-exercise-training
effects on cognitive function. For example, most studies that assessed cognitive
performance were conducted before and after the intervention. Only Perrig-Chiello
et al. (1998) examined both the short-term and long-term follow-up effects of
resistance training, and they found a sustained effect 1 year after the intervention
in the delayed-recall performance task. Further research addressing these issues is
encouraged. Regarding quality of design, although most studies have applied an
RCT design, only three were single-blinded. Results from insufficient RCT design
might overestimate the effects and lower the cause–effect relationships. Therefore,
quality of design should be considered for future studies. Furthermore, only Cas-
silhas et al. (2007) investigated the mechanisms and relationship between IGF-1
and blood viscosity and found that only IGF-1 played a role in cognition. Because
IGF-I is associated with many neuronal factors (e.g., BDNF, VEGF, neurogenesis)
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and the effects of aerobic exercise on cognition have been examined, future research
on the involvement of IGF-1, as well as other neuronal factors, is recommended.
Last but not least, studies related to exercise and cognitive functions can be
categorized into chronic exercise and acute exercise (Tomporowski, 2003). Kesani-
emi et al. (2001) suggested that both chronic and acute exercise should be equally
valued, because frequent repetition of acute exercises might induce changes that
are more lasting. In addition, the mechanisms, phenomena, theories, and clinical
applications of the two forms of exercises might be different. Based on our search,
relatively few studies have examined how acute exercise influences cognitive per-
formance (Chang & Etnier, 2009a, 2009b; Pontifex, Hillman, Fernhall, Thompson,
& Valentini, 2009), and none have focused on the older population. However, some
of these studies demonstrated benefits of acute resistance exercise on cognition in
both younger and middle-aged adults (Chang & Etnier, 2009a, 2009b), suggest-
ing that these types of exercise studies should be further directed to older adults.

Conclusions
Cognitive decline is one of the characteristics of aging for older adults. Extensive
research has shown the positive effects of aerobic exercise on cognition in older
adults, with a recent focus on resistance exercise. Our review seeks to reiterate that
resistance-exercise training might be potentially strategic to facilitating cognitive
functions in older adults with cognition intact, where some studies have found a
positive effect of resistance-exercise training on specific cognitive performances
in either resistance-exercise training alone or in combination with other exercise
regimens and in examination of the dose-response relationships focusing on inten-
sity and frequency of exercise. Specifically, we found that intervention designs in
loads of 60–80% 1RM with approximately seven movements in two sets separated
by 2 min of rest at least twice per week for 2–12 months (usually 6 months) could
positively affect cognition, including information-processing speed, attention,
 Resistance Exercise and Cognition   513

memory formation, and specific types of executive function. These benefits might
be influenced by the biological mechanisms (e.g., IGF-1) induced by resistance-
exercise training.
Further studies are needed to address the relationship between resistance exer-
cise and cognition in terms of design of resistance-exercise-training regimens, dose-
response relationships, types of cognition, time courses, quality of experimental
design, mechanisms, and issues of acute resistance exercise. We therefore believe
that additional research focusing on resistance-exercise training and cognition is
necessary before making further claims along these lines.

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