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Background <p>Physical activity (PA) is associated with improved cognitive outcomes in older adults, yet the biological and psychosocial mechanisms through which PA exerts these benefits remain inadequately understood. Previous research has often lacked systematic rigor or has focused narrowly on experimental designs, limiting generalizability.</p> Objectives <p>To systematically evaluate and synthesize the evidence on mediating and moderating mechanisms that explain how PA influences cognitive function in individuals aged 60 and older.</p> Methods <p>This study was conducted as a systematic review without quantitative synthesis, following PRISMA 2020 guidelines. PubMed and Scopus were searched from inception to April 2025. Studies were eligible if they included quantitative assessments of PA, examined cognitive outcomes, and analyzed mediation and/or moderation. Eligible designs included randomized controlled trials, longitudinal, cross-sectional, and experimental studies. Data were extracted independently by two reviewers, and study quality was assessed using seven established methodological criteria. Due to substantial heterogeneity in study designs, measurements, and reported outcomes, a best-evidence synthesis approach was applied within a systematic review framework, rather than conducting a meta-analysis.</p> Results <p>Fifty-six studies met inclusion criteria; 44 focused on mediation, 10 on moderation, and two addressed both. Key mediators included depression (very strong evidence), sleep (very strong), and neurocognitive and physiological factors (limited to moderate evidence). Moderators such as genetic profiles (e.g., APOE), age, comorbidities, and psychosocial contexts showed mixed or limited evidence. Most studies (93%) were rated high quality.</p> Conclusions <p>PA influences cognitive function in older adults through diverse and interrelated pathways. Depression and sleep quality are particularly robust mediators. Future research should adopt integrative, longitudinal approaches to refine causal models and guide personalized interventions for cognitive health in aging populations.</p>

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A systematic review employing a best-evidence synthesis approach of mechanistic pathways linking physical activity and cognitive function in older adults

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月26日

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  • Konstantinos Baliotis,
  • Zoe Konstanti,
  • Nektaria Zagorianakou,
  • Aneta Toti,
  • Elena Dragioti,
  • Fotios Tatsis,
  • Stefanos Mantzoukas,
  • Mary Gouva,
  • Michael Kourakos

摘要

Background

Physical activity (PA) is associated with improved cognitive outcomes in older adults, yet the biological and psychosocial mechanisms through which PA exerts these benefits remain inadequately understood. Previous research has often lacked systematic rigor or has focused narrowly on experimental designs, limiting generalizability.

Objectives

To systematically evaluate and synthesize the evidence on mediating and moderating mechanisms that explain how PA influences cognitive function in individuals aged 60 and older.

Methods

This study was conducted as a systematic review without quantitative synthesis, following PRISMA 2020 guidelines. PubMed and Scopus were searched from inception to April 2025. Studies were eligible if they included quantitative assessments of PA, examined cognitive outcomes, and analyzed mediation and/or moderation. Eligible designs included randomized controlled trials, longitudinal, cross-sectional, and experimental studies. Data were extracted independently by two reviewers, and study quality was assessed using seven established methodological criteria. Due to substantial heterogeneity in study designs, measurements, and reported outcomes, a best-evidence synthesis approach was applied within a systematic review framework, rather than conducting a meta-analysis.

Results

Fifty-six studies met inclusion criteria; 44 focused on mediation, 10 on moderation, and two addressed both. Key mediators included depression (very strong evidence), sleep (very strong), and neurocognitive and physiological factors (limited to moderate evidence). Moderators such as genetic profiles (e.g., APOE), age, comorbidities, and psychosocial contexts showed mixed or limited evidence. Most studies (93%) were rated high quality.

Conclusions

PA influences cognitive function in older adults through diverse and interrelated pathways. Depression and sleep quality are particularly robust mediators. Future research should adopt integrative, longitudinal approaches to refine causal models and guide personalized interventions for cognitive health in aging populations.