Combined exercise and cognitive interventions are superior to exercise alone but comparable with cognitive interventions alone for persons with cognitive decline.
Exercise and cognitive interventions are beneficial for adults with preclinical and clinical dementia, but it is unclear whether the combination of these two components could generate synergistic benefits and what intervention designs would optimize this effect.
Twenty-nine randomized controlled trials involving 2910 participants were included. The results of pairwise meta-analyses indicated that combined interventions were superior to exercise in improving response inhibition, working memory, and delayed recall, but were not superior to cognitive interventions in all outcomes. Combined interventions were superior to active/passive controls in improving global cognition, response inhibition, immediate recall, delayed recall, category fluency, processing speed, and visuospatial ability. Influences of the clinical severity of dementia (mild cognitive impairment vs dementia), combination format (sequential vs simultaneous combination), mode of delivery (group-based vs individual-based vs mixed), training duration (short: ≤ 12 weeks vs medium: 13–24 weeks vs long: > 24 weeks), and types of control (active vs passive control) were not detected. The network meta-analysis results indicated that the optimal intervention components varied across different outcomes, with multimodal exercise combining cognitive training demonstrated the greatest effects among all other combined or single component interventions in improving global cognition.
The effects of combined exercise and cognitive interventions are not influenced by the clinical severity of dementia, combination format, mode of intervention delivery, training duration, and types of control.
It is unclear whether “the more the better” phenomenon applies in persons with cognitive decline by combining exercise and cognitive interventions, and what intervention designs would optimize the effects
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