Exercise training improved thinking skills in adults over 60 across 227 trials

Exercise is often promoted as a way to keep the mind sharp with age, and many trials have tested it. What has been less settled is how large the benefits are, and whether exercise works better when it is combined with other activities such as brain training.

A review in the British Journal of Sports Medicine pooled randomized trials in adults over 60 without dementia. Exercise on its own improved memory, processing speed and planning skills compared with control groups. Combining exercise with other activities, most often cognitive training, did better than exercise alone for some skills but not for memory.

What was known about exercise and the aging brain

The National Institute on Aging notes that several studies have supported a connection between physical activity and brain health. It lists physical activity alongside blood pressure control, diet and social connection as factors that may help cognitive health.

How strong the trial evidence is has been debated. A 2023 umbrella review in Nature Human Behaviour pooled the trials behind 24 earlier meta-analyses in healthy people of all ages. It found small benefits from exercise that became substantially smaller after accounting for key moderators, such as whether the comparison group did some other activity. After correcting for publication bias, the tendency for positive results to be published more often, the benefit was close to zero, and its authors urged caution about claims linking exercise to better thinking.

Multidomain trials have tested exercise as part of a package. In the FINGER trial (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability), 1,260 people aged 60 to 77 at raised risk of dementia were assigned to two years of diet, exercise, cognitive training and vascular risk monitoring, or to general health advice. Its authors concluded that a multidomain intervention could improve or maintain cognitive functioning in at-risk older people. The US POINTER trial (US Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk), published in JAMA in 2025 with 2,111 participants, found a structured program had a greater benefit on global cognition than a self-guided version, although both groups improved.

How the exercise and cognition review worked

The researchers searched four databases up to March 2026 for randomized trials of exercise training in adults over 60 living without dementia. They compared exercise alone, which they called Exercise-Only, and exercise combined with other lifestyle changes, called Exercise-Plus, with control groups and with each other.

They included 227 studies in their main comparisons: 178 of exercise alone and 67 of combined programs. A subset of 105 studies went into a network meta-analysis, a method that compares several approaches across many trials at once, including pairs never tested head-to-head. Cognitive training and cognitively engaging activities were the most common additions to exercise.

The outcomes were three kinds of thinking skill. Memory is the familiar one. Processing speed means how quickly the brain takes in and responds to information. Executive functions are the mental skills used to plan, focus and switch between tasks.

What exercise did for memory and thinking speed

Exercise on its own produced improvements across all three cognitive domains compared with control groups. The differences were unlikely to be explained by chance alone, but that on its own says nothing about how big they were.

The combined programs gave a mixed picture. Compared with control groups, Exercise-Plus was clearly better only for memory. Compared with exercise alone, it was better for executive functions and processing speed but not for memory. Those results come from different sets of trials and different analyses, which may be why they do not line up neatly.

The authors write that they recommend the promotion of exercise training to improve cognitive outcomes of older adults, and that further research is needed on the added benefit of combined programs.

Why the size of the exercise benefit matters

A clear result across hundreds of trials can still be a small one. The 2023 umbrella review is the reminder: its pooled benefit, already small, shrank once differences between groups at the start and active comparison groups were taken into account, and nearly vanished after the correction for publication bias.

The new review looked only at older adults, while the umbrella review covered healthy people of all ages, so the two do not directly contradict each other. Read together, they suggest that any effect of exercise on thinking skills in people without dementia is likely to be modest.

What the exercise and cognition review cannot tell us

The trials measured performance on thinking tests, mostly over months. They were not designed to show whether exercise prevents dementia, which develops over years and would need much larger and longer studies to detect. People in exercise trials know they are exercising, and comparison groups ranged from doing nothing to doing other activities, which changes how large a benefit looks.

The review also pools many kinds of exercise program and many kinds of addition. It cannot say which program works best, how much exercise is needed, or how long any benefit lasts after a program ends.

What this adds to exercise for brain health

The review adds weight to the evidence that exercise training can improve some thinking skills in people over 60 without dementia. It also suggests that adding cognitively engaging activities may bring further gains in planning and processing speed.

How large those gains are, and whether they add up to a lower risk of dementia, remain open questions.