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Review

Which Specific Exercise Models Are Most Effective on Global Cognition in Patients with Cognitive Impairment? A Network Meta-Analysis

by
Junchao Yang
1,
Yunfeng Dong
1,
Shuting Yan
1,
Longyan Yi
2 and
Junqiang Qiu
1,3,*
1
School of Sport Science, Beijing Sport University, Beijing 100084, China
2
China Institute of Sports and Health, Beijing Sport University, Beijing 100084, China
3
Beijing Sports Nutrition Engineering Research Center, Beijing 100084, China
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2023, 20(4), 2790; https://doi.org/10.3390/ijerph20042790
Submission received: 28 November 2022 / Revised: 22 January 2023 / Accepted: 1 February 2023 / Published: 4 February 2023
(This article belongs to the Section Environmental Health)
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Abstract

:
(1) Introduction: Physical exercise interventions can impart significant cognitive benefits to older adults suffering from cognitive impairment (CI). However, the efficacy of these interventions can vary widely, depending on the type, intensity, duration and frequency of exercise. (2) Aim: To systematically review the efficacy of exercise therapy on global cognition in patients with CI using a network meta-analysis (NMA). (3) Methods: The PubMed, Embase, Sport Discus (EBSCO) and Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on exercise for patients with CI from inception to 7 August 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. The NMA was performed using the consistency model. (4) Results: A total of 29 RCTs comprising 2458 CI patients were included. The effects of different types of exercise on patients with CI were ranked as follows: multicomponent exercise (SMD = 0.84, 95% CI 0.31 to 1.36, p = 0.002), short duration (≤45 min) (SMD = 0.83, 95% CI 0.18 to 1.19, p = 0.001), vigorous intensity (SMD = 0.77, 95% CI 0.18 to 1.36, p = 0.011) and high frequency (5–7 times/week) (SMD = 1.28, 95% CI 0.41 to 2.14, p = 0.004). (5) Conclusion: These results suggested that multicomponent, short-duration, high-intensity, and high-frequency exercise may be the most effective type of exercise in improving global cognition in CI patients. However, more RCTs based on direct comparison of the effects of different exercise interventions are needed. (6) NMA registration identifier: CRD42022354978.

1. Introduction

Mild cognitive impairment (MCI) and dementia are the two most common cognitive impairments (CI) [1,2]. Globally, there are approximately 50 million dementia patients, and the number is projected to reach 74.7 million by 2030 [3]. Dementia is one of the leading causes of disability and dependence among elderly individuals. It is estimated that the annual cost of caring for dementia patients will reach US $2 trillion by 2030. This undoubtedly places a heavy burden on society, especially since 60% of dementia patients originate in low- and middle-income countries [3,4]. MCI is a transitional state between normal cognitive function and dementia, and is thus often labelled as incipient dementia [5]; 14.9% of MCI patients (≥65 years of age) are likely to develop dementia within 2 years [6], while 16% of patients with amnestic mild cognitive impairment (aMCI) develop Alzheimer’s disease [1]. Only a minority of patients with MCI (14 to 40%) remain stable or return to normal [7]. Currently, scientific evidence supporting the use of pharmaceutical agents or supplements for symptomatic relief in dementia and mild cognitive impairment is highly insufficient [8,9].
Exercise has been shown to confer significant benefits on cardiovascular and cerebrovascular function associated with dementia, but evidence of improved cognitive function is limited, especially in cognitively normal older adults [10]. Nonetheless, an increasing number of studies have proven that exercise can enhance cognitive function in people who suffer from cognitive impairment. Studies comparing the efficacy of exercise therapy in patients with cognitive impairment have focused on investigating and comparing the efficacy of the various types of physical activity. A meta-analysis by Panza and his colleagues [11], for example, postulated that aerobic exercise is more beneficial for Alzheimer’s patients. According to Northey et al. [12], tai chi is more effective for elderly individuals (over 50 years old) with dementia or severe mental illness. In another network meta-analysis (NMA), resistance exercise was found to be the most effective method for improving overall cognitive function in MCI patients [13]. Nevertheless, there is inadequate research on the relationships between intensity, duration, or frequency of exercise and cognitive boost. This study aims to conduct a network meta-analysis on the various exercise regimens, and thus contribute to filling that gap.
A network meta-analysis can compare not only the types of exercise that are more effective, but also the intensity, time, and frequency at which it is most effective. Therefore, randomized controlled trials (RCTs) of exercise intervention in patients with CI were the focus in this meta-analysis. It is our hope that this work will evaluate the effectiveness of exercise prescriptions in the literature, consequently providing scientific evidence to guide the prescription of exercise for patients with cognitive impairment.

2. Materials and Methods

The NMA was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [14].

2.1. Eligibility Criteria and Study Selection

This NMA included studies that met the following criteria: (i) Population: adults were over 50 years old. Since the original authors had differing criteria for diagnosing cognitive ability from study to study, the participants were diagnosed as having CI (e.g., MCI, dementia) as interpreted by the original authors [12]. (ii) Intervention: relevant interventions included either exercise alone or in combination with a control group. The specific exercises were classified as follows: (a) type: aerobic, resistance training, multicomponent training, or mind-body exercise; (b) intensity: light, moderate, or vigorous (c) time: short (≤45 min), medium (>45 to ≤60 min), or long (>60 min); and (d) frequency (number of exercise sessions per week): low (≤2), medium (3–4), or high (5–7). (iii) Control: comparators for non-exercise training treatments included true control, health education, or stretching. (iv) Outcome: global cognition measured by any validated neuropsychological test. (v) Type of study: randomized controlled trials. The following are the exclusion criteria: prospective or retrospective cohort studies, case reports, conference abstracts, and literature not written in English.

2.2. Search Strategy

A search was performed in PubMed, Embase, Sport Discus (EBSCO), and The Cochrane Library for work published before August 2022. The following keywords were chosen to screen studies: cognitive dysfunction, mild cognitive impairment, dementia, Alzheimer’s disease, mild cognitive disorder, aerobic, walking, high intensity interval, resistance, core stability, dance, breathing exercise, virtual reality exercise, whole-body vibration exercise, stretching, body-mind exercise, yoga, pilates, tai chi, taijiquan, health qigong, yijinjing, wuqinxi, liuzijue, baduanjin, and multicomponent exercise. The PubMed search strategy is presented in Table 1. The bibliographies of the selected studies and reviews were painstakingly reviewed to ensure that relevant literature was not missed.

2.3. Data Extraction

Two reviewers independently screened the abstracts and full-text articles of these selected works, extracted and cross-checked the data. In case of a disagreement, a third party was consulted to mediate it, and a consensus was reached. In the event that an article lacked key data, the corresponding author was contacted for clarification. During literature screening, the title and abstract were read first, and then the full text was read, to identify literature that would be eliminated and that which would be kept. The following data were extracted from the selected works: research title; name of corresponding author; publication journal and time; gender of study participants; type of cognitive impairment; sample size; intervention used; control measures; type, intensity, frequency, duration, and time of exercise therapy; follow-up time after intervention; tools for measurement of cognitive function; relevant patient outcomes; and risk of literature bias.

2.4. Risk of Bias of Individual Studies

Two reviewers assessed the risk of bias in the included studies according to the Cochrane Risk of Bias Tool (ROB-2) for RCTs. Funnel plots were also generated, and any asymmetry examined. As this study involved exercise interventions, it was not possible to blind patients to treatment allocation. Blinding of participants and personnel was thus deemed to be a high risk of bias in all studies and was not factored into the overall risk of bias assessment. The evaluation included six items on random sequence generation, allocation concealment, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias. Each item was rated as a “high risk”, “unclear risk”, or “low risk” of bias.

2.5. Data Analysis

STATA15.1 (StataCorp, College Station, TX, USA) was used to perform the statistical analysis within a frequentist framework. Standardized mean difference (SMD) was used as the summary statistic in studies that objectively measured global cognition outcomes using a variety of unit types. In this meta-analysis, the I2 statistic was used to rate heterogeneity into three categories: low (less than 25%), moderate (25% to 50%), or high (more than 50%). Consistency—meaning that the treatment effects estimated from direct comparisons agree with those estimated from indirect comparisons—was assessed by fitting both a consistency and an inconsistency NMA and examining the results from the Wald-type chi-squared test for inconsistency. Once the effectiveness of the interventions was compared, the interventions were ranked using the surface under the cumulative ranking curve (SUCRA). High odds in SUCRA provide better results for an intervention [15]. Thus, in a ranking table, we reported the pairwise effect size (ES) comparisons above the leading diagonal, and the ES estimated from NMA [16] below the leading diagonal.

3. Results

3.1. Literature Selection

A total of 6631 RCTs were initially identified. Following a review of the titles and abstracts, 89 studies were selected for full manuscript review. Of these, 60 were excluded because they did not fulfil our inclusion criteria. The remaining 29 studies [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45] were included in this review. The PRISMA chart is illustrated in Figure 1.

3.2. Characteristics of the Included RCTs

The characteristics of the included studies are presented in Table 2. The sample size ranged from 19 to 415 patients (mean age range, 55–85 years; two studies did not report age), and the study duration ranged from 8 to 48 weeks. Exercise training interventions included multicomponent exercise (studies: n = 9, patients: n = 483), resistance training (studies: n = 5, patients: n = 87), mind-body exercise (studies: n = 3, patients: n = 143), and aerobic exercise (studies: n = 14, patients: n = 559). The frequency of exercise ranged from 1 to 5 days each week, while each session of physical activity lasted for 15 to 90 min. The Mini-Mental State Examination was the most widely used cognitive measurement tool. Other tools noted were the Montreal Cognitive Assessment (MoCA), Alzheimer’s Disease Assessment Scale (ADAS-Cog), and Neurobehavioral Cognitive Status Examination (NCSE).
The risk of bias assessment for each individual study is presented in Figure 2. Overall, the studies tended to exhibit a low risk of random sequence generation (62%), allocation concealment (52%), blinding of outcome assessment (56%), incomplete outcome data (100%), and selective outcome reporting (48%), but not blinding of patients and personnel (0%) or other bias (0%).

3.3. Network Meta-Analysis

Four types of exercise therapy were included in this study, namely, multicomponent exercise, resistance training, mind-body exercise, and aerobic exercise. In addition to the direct comparison between multicomponent exercise and resistance training, there were direct comparisons between other exercise types, the most direct studies being conducted between the aerobic exercise and control groups (Figure 3a). Low-intensity exercise, medium-intensity exercise, and high-intensity exercise were also directly contrasted. There was no direct comparison between short, medium, and long periods of exercise (Figure 3b), with the most direct studies being between the short-duration and control periods (Figure 3c). There was no direct comparison between low-, medium-, and high-frequency exercise, with the most direct studies being between moderate and control exercise (Figure 3d). All pairwise comparisons in an NMA are included in the comparison league tables (Table 3).

3.3.1. Exercise Type

The results from the consistency NMA provided evidence that, when compared with the control, multicomponent exercise (p = 0.002), aerobic exercise (p = 0.001), and resistance training (p = 0.037) all resulted in greater improvements in global cognition following intervention. In contrast, the results from the consistency NMA did not provide evidence for a significant impact of mind-body exercise on global cognitive function. The results of the consistency model indicated that multicomponent exercise (SUCRA = 74.3%), aerobic (SUCRA = 63.9%) and resistance training (SUCRA = 61.0%) were among the best interventions for global cognition (Table 4).

3.3.2. Exercise Time

The results of the consistency NMA indicated that, as with the control, short (p < 0.001) and medium (p = 0.008) exercise duration resulted in enhanced global cognition following intervention. In contrast, the results from the consistency NMA did not provide evidence for a significant impact of prolonged exercise on global cognition. The results of the consistency model indicated that exercise of short (SUCRA = 77.3%) or medium (SUCRA = 62.9%) duration yielded the best results (Table 4).

3.3.3. Exercise Intensity

The results of the consistency NMA indicated that, as with the control, vigorous (p < 0.011) and moderate (p = 0.001) exercise intensity resulted in enhanced global cognition following intervention. In contrast, the results from the consistency NMA did not provide evidence for a significant impact of light exercise on global cognition. The results of the consistency model indicated that exercise of vigorous (SUCRA = 74.4%) or moderate (SUCRA = 71.8%) intensity yielded the best results (Table 4).

3.3.4. Exercise Frequency

The results from the consistency NMA provided evidence that, when compared with the control, high (p = 0.004), medium (p = 0.001), and moderate (p = 0.011) exercise frequencies all resulted in enhanced global cognition.
The results of the consistency model indicated that vigorous (SUCRA = 91.3%), medium (SUCRA = 64.0%), and moderate (SUCRA = 44.5%) exercise frequencies were among the best interventions for global cognition (Table 4).

3.4. Publication Bias

According to the funnel plot of this study, there was either publication bias or a small sample effect.

4. Discussion

This NMA confirmed that exercise can preserve global cognitive function in patients with cognitive impairment. The optimal type, intensity, duration, and frequency of exercise have also been established. It must be noted that the quality of the RCTs included in this analysis was relatively high. The following were other key merits of this analysis: a broad timeline of studies, highly international authorship, and exclusion of biased RCTs. Therefore, the results of this NMA can be considered relatively robust and of high clinical value.
According to this study, multicomponent, aerobic, resistance, and mind-body exercises all improve cognition in patients with CI (in descending order of efficacy). A subgroup analysis performed by Northey et al. [12] found that tai chi exercise is the most effective, followed by multimodal resistance exercise and aerobic exercise, but deemed hatha yoga as ineffective. The results of our study conflict with those from the aforementioned study, likely because we categorized yoga and tai chi as mind-body exercises [46] and excluded the cognitively “normal” population from our study. According to Northey and his colleagues [12], resistance exercise may be the most effective form of physical activity for MCI patients. In this study, aerobic dance was classified as mind-body exercise, and multimodal exercise was not included, which may explain the inconsistency with our study.
In our study, exercise of short duration (≤45 min) was 34.54 ± 8.65 min. It is interesting to note that the study conducted by Cancel et al. [26] had the shortest exercise (15 min), used a powerful bicycle, and suffered little resistance during their exercise. It was found in our study that vigorous intensity exercise was most effective, while the analysis by Northey et al. [12] showed that moderate and vigorous intensity exercise had similar success. This contrast can be primarily attributed to the fact that our meta-analysis involved only patients with cognitive impairments. The results of our study are corroborated by previous studies that have shown highfrequency exercise to be the most effective [12]. The conclusions on optimal exercise duration, frequency, and intensity made in this study are in line with the recommended ACSM physical activity guidelines [47]: 75–150 min of high-intensity aerobic exercise per week, with additional resistance exercise (≥2 times/week).
In spite of the many qualities of this NMA, a few limitations must be acknowledged: (1) Although the subjects and researchers in the reviewed RCTs could not be blinded, most of these studies blinded the outcome measures; this may result in a selective bias; (2) There is a large difference in the number of studies under each moderating variable; in particular, there is no direct comparative study on exercise intensity and frequency, manifesting inconsistencies in the results of future direct comparison studies; (3) The synergistic effects of exercise type, time, intensity, and frequency on cognitive function were not considered; (4) Publication bias in the meta-analysis (as only RCTs in English were used); (5) The number of RCTs included is arguably low (n = 29). The meta-analysis thus has low statistical power.

5. Conclusions

Exercise of a multicomponent, short-duration, high-intensity, and high-frequency nature may yield the best cognitive benefits for patients with cognitive impairment. In the future, more RCTs can be conducted based on direct comparison of the effects of different exercise interventions.

Author Contributions

J.Q., J.Y. and Y.D.: conceptualization. J.Y., Y.D. and S.Y.: methodology and investigation. J.Y.: NMA analysis and writing—original draft. J.Y., Y.D., S.Y. and L.Y.: resources and data curation. J.Y. and S.Y.: writing—review, editing, and visualization. J.Q.: supervision and funding acquisition. Contributions from all authors were reviewed and approved before publication. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by the National Key R&D Program of China (2018YFC2000600).

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Further inquiries should be directed to the corresponding author.

Conflicts of Interest

There were no commercial or financial relationships among the authors that could have been construed as potential conflict of interest in the research.

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Figure 1. PRISMA flow diagram of included studies.
Figure 1. PRISMA flow diagram of included studies.
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Figure 2. Risk of bias graph.
Figure 2. Risk of bias graph.
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Figure 3. NMA maps of the studies examining the efficacy of exercise in people living with CI on global cognition. (a) exercise type; (b) exercise time; (c) exercise intensity; (d) exercise frequency.
Figure 3. NMA maps of the studies examining the efficacy of exercise in people living with CI on global cognition. (a) exercise type; (b) exercise time; (c) exercise intensity; (d) exercise frequency.
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Table
Table 1. PubMed search strategy.
Table 1. PubMed search strategy.
Serial NumberContent
#1Cognitive Dysfunction [Mesh Terms] OR Dementia [Mesh Terms] OR Alzheimer Disease [Mesh Terms]
#2Mild Cognitive Impairment [Title/Abstract] OR Mild Cognitive Disorder [Title/Abstract] OR Mild Cognitive Dysfunction [Title/Abstract] OR Mild Cognitive Decline [Title/Abstract] OR Mild Neurocognitive Disorder [Title/Abstract]
#3#1 OR #2
#4Sports [Mesh Terms] OR Exercise [Mesh Terms] OR Exercise Movement Techniques [Mesh Terms] OR Resistance Training [Mesh Terms] OR Yoga [Mesh Terms] OR Dance Therapy [Mesh Terms] OR Virtual Reality Exposure Therapy [Mesh Terms] OR Breathing Exercises [Mesh Terms] OR Walking [Mesh Terms] OR High-Intensity Interval Training [Mesh Terms] OR Muscle Stretching Exercises [Mesh Terms] OR Tai Ji [Mesh Terms]
#5Core Stability [Title/Abstract] OR Whole Body Vibration Exercise [Title/Abstract] OR Body-Mind Exercise [Title/Abstract] OR Health Qigong [Title/Abstract] OR Yijinjing [Title/Abstract] OR Wuqinxi [Title/Abstract] OR Liuzijue [Title/Abstract] OR Baduanjin [Title/Abstract] OR Multicomponent Exercise [Title/Abstract]
#6#4 OR #5
#7#3 AND #6
Table
Table 2. Summary of studies included in the NMA.
Table 2. Summary of studies included in the NMA.
StudyAge (T/C)Sample (T/C)Intervention/ComparatorExercise Moderators Outcome
IntensityTime (Min)Frequency (Days/Week)Duration (Weeks)
Lam 2012 [17]77.20 ± 6.30/78.30 ± 6.6093/169Tai chi/stretchingmoderate30≥348①③
Suzuki 2013 [18]74.80 ± 7.40/75.80 ± 6.1047/45multicomponent exercise/educationmoderate90224①③
Yu 2021 [19]77.4 ± 6.6/77.5 ± 7.164/32cycling/stretchingmoderate40–60324①
Bisbe 2019 [20]72.88 ± 5.60/77.29 ± 5.1617/14aerobic dances/multicomponent exerciseModerate/moderate60NR12③
Lamb 2018 [21]≥65278/137aerobic dances/usual careNR60–90 12①
Yoon 2016 [22]NR23/7strength training/stretchingvigorous/moderate60212③
Langoni 2018 [23]72.60 ± 7.80/71.90 ± 7.9026/26multicomponent exercise/no exercisemoderate60224③
Wei 2014 [24]66.73 ± 5.48/65.27 ± 4.6330/30handball/recreational activitiesmoderate30524③
Hong 2017 [25]75.92 ± 4.81/77.89 ± 3.4010/12resistance exercise/maintain current lifestylemoderate60212④
Cancela 2016 [26]80.63 ± 8.32/82.90 ± 7.4273/113aerobic exercise/recreational activitiesmoderate15412③
Song 2019 [27]76.22 ± 5.76/75.33 ± 6.7860/60aerobic exercise/educationmoderate60216③
Huang 2019 [28]81.90 ± 6.00/81.90 ± 6.1036/38Tai Chi/usual caremoderate20340④
Kemoun 2010 [29]81.80 ± 5.3016/15multicomponent exercise/recreational activitiesmoderate60315②
Jurakic 2017 [30]70.40 ± 3.9314/14resistance exercise/Pilatesmoderate/moderate30–6038④
Law 2019 [31]77.94 ± 6.11/75.14 ± 8.5316/14multicomponent exercise/maintain current lifestylemoderate6028⑤
Shimada 2018 [32]70.10 ± 4.00/70.70 ± 4.7053/47golf/educationmoderate90–120112③
Bademli 2019 [33]72.24 ± 7.16/70.67 ± 8.3430/30multicomponent exercise/maintain current lifestylemoderate80320③
Holthoff 2015 [34]72.40 ± 4.34/70.67 ± 5.4113/12resistance exercise/maintain current lifestylemoderate30324③
Varela 2011 [35]77.88 ± 10.75/79.40 ± 6.7233/15cycling/recreational activitieslow30312③
Lazarou 2017 [36]67.92 ± 9.47/65.89 ± 10.7666/63international ballroom dancing/no exercisemoderate60240③④
Mavros 2017 [37]NR27/23resistance exercise/stretchingmoderate75224①
Hoffmann 2016 [38]69.80 ± 7.40/71.30 ± 7.30102/88aerobic exercise/maintain current lifestylevigorous60316③
Li 2021 [39]≥6042/42multicomponent exercise/stretchingNR30524③④
Tomoto 2021 [40]55–8017/20multicomponent exercise/stretchingvigorous30–403–448③
Aguiar 2014 [41]74.70 ± 7.40/78.60 ± 8.4017/17multicomponent exercise/usual caremoderate40224③
Venturelli 2011 [42]83 ± 6/85 ± 511/10walking program/usual caremoderate30324③
Yang 2015 [43]72.00 ± 6.69/71.92 ± 7.2825/25aerobic exercise/educationvigorous40312①
Silva 2019 [44]71.85 ± 5.69/78.20 ± 5.2612/7multicomponent exercise/maintain current lifestylemoderate60212③
Arcoverde 2014 [45]78.5 (64–81.2)/79 (74.7–82.2)10/10aerobic exercise/educationvigorous30216③
NR: not reported; T/C: intervention/comparator; ① ADAS-Cog; ② ERFC; ③ MMSE; ④ MoCA; ⑤ NCSE.
Table
Table 3. Ranking table of exercise moderators.
Table 3. Ranking table of exercise moderators.
ModeratorsEffect Size
exercise typemulticomponent exercise−0.05 (−1.68, 1.59)--−0.85 (−1.41, −0.28)
0.11 (−0.53, 0.75)aerobic exercise0.82 (−0.84, 2.48)-−0.72 (−1.55, 0.12)
0.03 (−0.89, 0.96)−0.08 (−0.94, 0.79)resistance training-−0.48 (−1.55, 0.59)
0.50 (−0.55, 1.55)0.39 (−0.61, 1.40)0.47 (−0.57, 1.50)mind-body exercise−0.72 (−1.17, −0.28)
0.84 (0.31, 1.36)0.73 (0.31, 1.15)0.80 (0.05, 1.56)0.34 (−0.58, 1.25)control
exercise time (min)short---
0.03 (−0.42, 0.47)medium--
0.27 (−0.29, 0.83)0.24 (−0.33, 0.82)long-
0.83 (0.53, 1.13)0.80 (0.48, 1.13)0.56 (0.09, 1.04)control
exercise intensityvigorous---
0.04 (−0.60, 0.69)moderate--
0.35 (−0.96, 1.65)0.30 (−0.87, 1.47)light-
0.77 (0.18, 1.36)0.72 (0.43, 1.02)0.42 (−0.75, 1.59)control
exercise frequency (days/week)high---
0.47 (−0.51, 1.46)medium--
0.69 (−0.29, 1.67)0.22 (−0.44, 0.87)low-
1.28 (0.41, 2.14)0.80 (0.33, 1.27)0.59 (0.14, 1.04)control
Table
Table 4. Results of the NMA and ranking.
Table 4. Results of the NMA and ranking.
Moderators Sample Size (Number of Studies)SMD (95% CI)p ValueRank (SUCRA)
exercise typemulticomponent exercise483 (9)0.84 (0.31, 1.36)0.0021 (74.3)
resistance training87 (5)0.80 (0.05, 1.56)0.0373 (61.0)
mind-body exercise143 (3)0.34 (−0.58, 1.25)0.4714 (44.4)
aerobic exercise559 (14)0.73 (0.31, 1.15)0.0012 (63.9)
exercise time (min)short (≤45)400 (12)0.83 (0.18, 1.19)<0.0011 (77.3)
medium (>45–≤60)378 (10)0.68 (0.48, 1.13)0.0082 (62.9)
long (>60)435 (5)0.65 (−0.04, 1.34)0.0673 (58.5)
exercise intensitylight17 (1)0.42 (−0.75, 1.59)0.4783 (45.9)
moderate681 (20)0.72 (0.43, 1.02)<0.0012 (71.8)
vigorous93 (5)0.77 (0.18, 1.36)0.0111 (74.4)
exercise frequency (days/week)low (≤2)629 (12)0.59 (0.14, 1.04)0.0113 (44.5)
medium (3–4)437 (12)0.80 (0.33, 1.27)0.0012 (64.0)
high (5–7)145 (3)1.28 (0.41, 2.14)0.0041 (91.3)
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Yang, J.; Dong, Y.; Yan, S.; Yi, L.; Qiu, J. Which Specific Exercise Models Are Most Effective on Global Cognition in Patients with Cognitive Impairment? A Network Meta-Analysis. Int. J. Environ. Res. Public Health 2023, 20, 2790. https://doi.org/10.3390/ijerph20042790

AMA Style

Yang J, Dong Y, Yan S, Yi L, Qiu J. Which Specific Exercise Models Are Most Effective on Global Cognition in Patients with Cognitive Impairment? A Network Meta-Analysis. International Journal of Environmental Research and Public Health. 2023; 20(4):2790. https://doi.org/10.3390/ijerph20042790

Chicago/Turabian Style

Yang, Junchao, Yunfeng Dong, Shuting Yan, Longyan Yi, and Junqiang Qiu. 2023. "Which Specific Exercise Models Are Most Effective on Global Cognition in Patients with Cognitive Impairment? A Network Meta-Analysis" International Journal of Environmental Research and Public Health 20, no. 4: 2790. https://doi.org/10.3390/ijerph20042790

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