Neurobiological mechanisms, modalities, and clinical implications of exercise interventions for cognitive health in older adults: A narrative review

Abstract

Objective: This narrative review synthesizes evidence from the last five years on the effects of physical exercise—categorized as aerobic, resistance, and multicomponent—on cognitive function in older adults, including those with MCI. Results: Meta‐analyses and randomized controlled trials (RCTs) demonstrate that structured aerobic programs yield small‐to‐moderate improvements in episodic memory and processing speed, while resistance training enhances executive function and working memory. Multicomponent interventions outperform single‐modality protocols, producing moderate gains in global cognition and verbal, visual memory, and executive domains in MCI populations. Mechanistically, exercise elevates neurotrophic factors, promotes hippocampal neurogenesis, improves cerebral perfusion, reduces inflammation and oxidative stress, and induces synaptic‐plasticity–related epigenetic modifications, culminating in functional reorganization of brain networks. However, there are still research gaps to be addressed. Future research should employ standardized, multicenter trials with personalized exercise prescriptions, integrated biomarkers, and long‐term follow‐up, and explore multidisciplinary combinations with cognitive training and nutritional support. Conclusion: Collectively, these findings underscore physical exercise as a safe, accessible, and cost-effective strategy to preserve cognitive health and delay neurodegenerative progression in aging populations.