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  • Systematic Review
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25 November 2023

The Relationship between Physical Fitness and Cognitive Functions in Older People: A Systematic Review

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1
Coordination of Physical Education and Sport, Federal Institute of Science and Technology Education of Amazonas, Manaus 69020-120, Brazil
2
Department of Physical Education, Federal University of Vale do São Francisco, Petrolina 56304-917, Brazil
3
Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, 1495-751 Lisbon, Portugal
4
Instituto de Saúde Ambiental (ISAMB), Faculty of Medicine, University of Lisbon, 1649-020 Lisbon, Portugal
Sustainability2023, 15(23), 16314;https://doi.org/10.3390/su152316314
This article belongs to the Special Issue Enhancing the Sustainability of Healthy Ageing and Long-Term Care through Innovations
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Abstract

The ageing process is associated with vulnerabilities, such as cognitive decline. Physical activity and exercise are key for preserving cognitive health in older age. This systematic review aims to analyse the effects of physical fitness programs on healthy older adults’ cognitive functions. An electronic search was performed in the PubMed, Web of Science, and Scopus databases. It included observational and experimental studies published between February 2017 and March 2023. Of the 1922 studies identified, 38 met the inclusion criteria. The findings show the positive effects of physical training on cognitive function in older adults. The most examined cognitive domains were executive function, memory function, and global cognition. Aerobic training prevailed, followed by resistance strength training and exergames. There was high variability in the characteristics of the protocols. The average length of interventions was 3–6 months; the frequency varied in the range of 1–4-times a week and 30–90 min sessions. The findings of this systematic review emphasise that physical fitness programs positively improve the specific domains of cognitive function in healthy older adults. These results can contribute to planning future interventions to improve the mental health of the older population and strengthen the development of policies for healthy ageing.

1. Introduction

The ageing process is associated with vulnerabilities, such as cognitive decline [1,2] and increased non-communicable diseases [3]. The association between cognitive decline and comorbidities increases the chances of older individuals experiencing barriers to adapting to the environment and an increased risk of death [4,5]. Review studies and meta-analyses have shown that, at an advanced age, regular physical activity (PA) is a strategy capable of mitigating changes in cognitive function (CF) [6,7]. PA can trigger positive cognitive stress reflexes [8], which in turn generate brain changes (neural plasticity), resulting in a better activation of neurons and facilitating new demands and behavioural adaptations [9].
PA’s role in the CFs of older individuals underlies the improvement in their physical fitness (PF). Regular PA practice can substantially increase PF levels or one of its components, namely, cardiorespiratory fitness, muscular strength, endurance, balance, flexibility, speed, agility, coordination, and body composition [10]. In turn, an increase in cardiorespiratory fitness can stimulate the processes underlying neurogenesis in older adults [11], promoting neuroplasticity in the hippocampus [12], which consequently benefits executive functions (EFs) [13]. Thus, when older adults practice regular PA, spatial learning induced by activities improves their memory performance [14]. Furthermore, in later life, which is considered as the period that generally begins at retirement age, around 60 or 70 years old, and extends to the end of people’s lives, maintaining sufficient levels of muscle strength is crucial for performing daily activities [15]. Therefore, it is advisable for older adults to engage in weekly resistance training sessions, potentially leading to improvements in their cognitive function [16]. However, the combination of resistance training and an aerobic intervention creates additional benefits for CF compared to aerobic training alone [17]. A current study has shown that this conclusion requires investigations that compare the effects of low- and high-intensity types of exercises on the neuroplasticity of the older adult population [18].
With the improvement in PF components through PA, neurogenesis is triggered at the structural level, resulting from cell proliferation and dendritic branching [14]. Another CF potentiating factor that PA can release is the neurotrophic action of the brain-derived neurotrophic factor (BDNF), a mechanism known to act in the structural alteration of the central nervous system (CNS) [19]. The BDNF can benefit peripheral systems, favouring the health of older adults, as it reduces food intake and increases the glucose oxidation rate and insulin sensitivity [20].
Over the years, several investigations have been conducted to test, identify, and determine the effects of PA or PF on improving CFs in older adults. Thus, different protocols were tested, such as aerobic exercises [12,21], resistance training [22,23], and multicomponent training that combines both strength training and aerobic exercises with other training modalities [24]. However, it remains inconclusive which CF domains are most responsive to PF programs, which types of training are the most effective in generating neuroplasticity, and what the ideal weekly frequency and total duration of a program should be [6,25]. Consequently, it is necessary to summarise the different guidelines on the type, frequency, and intensity of PF that should be prescribed to benefit older adults’ CFs [16]. Therefore, we conduct a systematic review of both observational and experimental studies to examine the influence of physical fitness programs on healthy older adults’ cognitive functions. Our specific objectives are as follows: (i) to ascertain the most commonly employed types of PF training and their effects on different CF domains; (ii) to identify the specific cognitive functions assessed, along with the instruments or tasks used for the evaluation; and (iii) to provide a comprehensive overview of the training or tasks performed during the interventions, including frequency, duration, and session duration.

2. Methods

2.1. Study Design

The present study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines [26]. Figure 1 illustrates the PRISMA checklist. This review was registered in Prospero, whose registration number is CRD42022314794.
Figure 1. Flowchart of the study selection.

2.2. Search Strategy

The lead author conducted a comprehensive search across three electronic databases (PubMed, Web of Science, and Scopus) in March 2023. We limited our inclusion criteria to articles exploring the impact of PF programs on CFs in elderly individuals, specifically focusing on peer-reviewed scientific journals published between February 2017 and March 2023. The choice to consider articles from 2017 onwards was influenced by the existence of a similar review published in that year [6].
The manuscripts included in the present review met the following criteria: (1) population—healthy older adults (≥60 years old) without any associated disease; (2) intervention—PF programs; (3) comparator—studies with and without comparison/control groups; (4) outcome—cognitive function; and (5) studies—observational and experimental. The exclusion criteria were: (1) studies that presented a sample with an associated disease because there are certain conditions, medications, or other comorbidities that could affect cognition, and this could influence the results regarding the impact of physical fitness programs on cognitive function; (2) articles published before 2017; and (3) articles published in languages other than English. The following terms were searched for in the title and abstract: (“Cognitive function” OR “Cognitive dysfunction” OR “Cognitive behavio*” OR “Cognitive decline” OR “Cognitive domains” OR Dement*) AND (“Physical activity” OR Exercise OR Sport OR Fitness OR Functional OR Movement) AND (Healthy OR “Active ageing”) AND (“Older adults” OR Senior OR Elder* OR “Older people”). The search terms were defined based on the previous systematic review [6] and after agreement among the authors (Table 1).
Table 1. Search terms and keywords used in each database.

2.3. Screening Strategy and Study Selection

Once the search was completed, all returned studies were combined and exported into a reference manager software (EndNote X20, Thomson Reuters, Philadelphia, PA, USA) for further evaluation. Duplicates were automatically removed and manually checked. Three authors (M.A.T., F.S., and S.M.) independently checked the title and abstract for eligibility. The inclusion and exclusion decisions were determined by consensus among the same authors after they had read all the eligible records.

2.4. Data Extraction and Harmonisation

Table 2 contains the primary information of the studies included in this systematic review. The data extraction and harmonisation were performed by the three authors (M.A.T., F.S., and S.M.), who grouped all the relevant information, summarising the sample characteristics (sample number and mean age), the purpose of the study, the setting and country where it was applied, the type of physical training applied, the weekly frequency and duration, the primary outcomes and the instruments used to assess the cognitive domains, and the main results.
Table 2. Characteristics and main results of the studies included in the systematic review.

2.5. Study Quality and Risk of Bias

The Quality Assessment Tool for Quantitative Studies of the Effective Public Health Practice Project (EPHP) Field [64] was used to assess the study quality and risk of bias. This instrument assesses six components, which are (1) selection of bias; (2) study design; (3) confounders parameter that evaluates the differences that exist between the groups before the intervention; (4) the “blindness” of the outcome assessors and the participants regarding the awareness of the intervention exposure status and research question, respectively; (5) methods/instruments used to collect the data; and (6) the withdrawal report. Subsequently, each study achieved a final score according to the instrument rules. This information is presented in Table 3 and was independently assessed by the three authors (M.A.T., F.S., and S.M.). Any differences were analysed and were resolved in agreement.
Table 3. Study methodological quality assessment using the EPHPP.

3. Results

The flowchart is presented in Figure 1. In the identification phase, 1922 articles were found in the database search. Of these articles, 375 were duplicates, and after their elimination, 1547 were recorded for the title and abstract screening process. In this phase, 1418 articles were removed because they did not meet the eligibility criteria. Thus, 129 remained for a full review. Ninety-one articles were deleted for reasons related to (1) the intervention type, such as not having a physical fitness program, not being an observational or experimental study, or presenting other types of outcomes (n = 57); (2) the population, when the sample had some type of disease and/or was younger than 60 years old (n = 25); (3) not being able to find the articles (n = 5); (4) being written in another language (n = 1); and (5) articles that only presented the intervention protocol but not the final results (n = 3). Therefore, 38 studies were considered as relevant for inclusion.

3.1. Study Quality and Risk of Bias

Due to the methodological quality analysis performed on the articles included (Table 3), fourteen studies were classified as strong [21,28,31,35,36,37,44,46,48,50,54,59,60,61], sixteen moderate [27,28,30,32,38,39,40,41,45,49,51,53,57,58,62,63], and eight weak [33,34,42,43,47,52,55,56]. Regarding the individual parameters analysed, the following actions were performed. (1) In the selection of bias, twelve studies were classified as good [29,36,38,40,41,44,48,49,50,59,61,63], because the sample was very likely to be representative of the target population and have a rate equal to or higher than 80% in terms of participation. (2) In the study design, a good score was assigned when the articles were randomised controlled [21,27,28,29,31,35,36,37,39,44,46,48,50,54,57,60,61,63] or controlled trials [32,33,41,43,45,51,52,53,55,56,58,59,62] and fair [30,34,38,40,42,47,49,60] when they presented another type of design. (3) Regarding the confounder parameter, which evaluated the differences between the analysed groups, thirty four studies were rated as strong, since they had no difference between the groups or were controlled for a least 80% of the relevant confounders. Studies that only analysed one group (n = 4) [38,42,47,49] were not classified. (4) In the blinding process, if the assessor was not aware of the intervention status of participants and the study participants were not aware of the research question, the study was classified as good (n = 5) [29,31,35,39,59]; when studies met only one of the abovementioned conditions, they were classified as fair (n = 13) [21,36,37,44,46,48,50,53,54,57,58,60,61], and when they did not meet any, they were considered poor (n = 20) [27,28,30,32,33,34,38,40,41,42,43,45,47,49,51,52,55,56,62,63]. (5) In terms of the data collection methods, all the studies presented collection tools that were valid and reliable, so were classified as strong. (6) The last points assessed were the withdrawals and drop-outs; studies with a follow-up rate ≥ 80% were classified as good (n = 29) [27,28,30,31,32,33,35,37,38,41,42,43,45,47,48,50,51,53,54,55,57,58,59,60,61,62,63,65], between 60% and 79% were fair (n = 6) [21,36,40,44,46,49], and less than 60% were poor (n = 3) [34,52,56].

3.2. Intervention Characteristics

The pertinent information of all the included studies is systematised in Table 2. Regarding the main characteristics of the interventions, the present review presented a total of 2389 older adults analysed. Most participants were female (n = 1515). In terms of age, the studies covered an average age between 60 and 84 years old. Two studies [30,34] contained groups that had mild cognitive impairments, but such groups were not considered. Only healthy groups from those two studies were analysed.
The type of intervention program most observed was aerobic training sessions (n = 19) [21,27,28,30,33,34,36,38,41,42,48,50,52,53,56,58,60,61,63]. Dance was the most used methodology in this type of intervention (n = 9) [28,33,34,36,42,50,52,61,63], but other forms of training physical capacity were also used, such as walking on the treadmill (n = 7) [28,30,33,38,41,50,53] or stationary cycling (n = 8) [21,36,48,52,53,56,58,60]. Still considering these aerobic training studies, for eleven of them [21,28,33,36,41,50,52,53,56,60,61], the difference between aerobic training and another type of training (i.e., stretching, strength, balance, etc.) was analysed across various intervention groups. Other studies (n = 9) adopted resistance, strength, or functional training sessions performed with or without using exercise machines or other accessories [32,35,37,39,43,44,45,47,57]. In addition, ten studies [29,31,40,46,49,51,54,55,59,62] adopted a mixed methodology, performing aerobic, strength, flexibility, or balance training sessions in a combined way. Innovative methodologies were also used for the performance of physical exercise based on exergames (n = 4) [37,46,55,63].
Most of the interventions had a duration of three months (n = 19) [21,27,30,31,36,37,39,40,41,43,44,46,47,48,49,54,58,61,63] and only ten had a longer duration [28,29,32,33,34,38,51,52,56,60], highlighting the studies of Muller, Rehfeld, Schmicker, Hokelmann, Dordevic, Lessmann, Brigadski, Kaufmann, and Muller [52] which lasted one year, and Morita, Yokoyama, Imai, Takeda, Ota, Kawai, Suzuki, and Okazaki [51] that had a duration of 2 years. The intervention with the shortest period was only four weeks [57].
In terms of weekly frequency training, twice and three times a week were the most common. Only the studies by Morita, Yokoyama, Imai, Takeda, Ota, Kawai, Suzuki, and Okazaki [51], and Murata, Ono, Yasuda, Tanemura, Kido, and Kowa [54] had sessions once a week; on the other hand, the study by Ji, Pearlson, Zhang, Steffens, Ji, Guo, and Wang [42] had a frequency of 4 times a week. One study did not have this feature of weekly frequency clarified, as the participants were encouraged to perform training sessions at home [39].

3.3. Main Results

Table 4 summarises the main results of each study, including information related to the CF (instruments/tasks, outcomes evaluated, and the effects of the interventions). The main outcomes were organised into three main categories: the first two were EF and memory function (MF) domains, as presented in the review by de Asteasu, Martinez-Velilla, Zambom-Ferraresi, Casas-Herrero, and Izquierdo [6], and the third one was global performance (GP). The EF subdomains were working memory, attention, verbal fluency, reasoning, and processing speed. On the other hand, the MF subdomains were recognition, immediate recall, delayed recall, facial name recall, and paired associations. The GP category included studies that used a cognitive assessment instrument that produced a final score, such as the Montreal Cognitive Assessment (MoCA), COGTEL, or the Mini-Mental State Examination (MMSE).
Table 4. Cognitive tasks assessing outcomes and main effects of interventions on cognitive function.
Regarding the main impact of the interventions, most studies (n = 34) showed a positive effect, at least in one CF domain. In terms of the results, considering the three categories of the cognitive domains presented above, it was verified that (1) the majority of the studies included variables that belonged to the EF and MF domains (n = 16) [30,31,32,34,38,40,42,45,47,48,51,52,56,57,58,63]. Six of these showed improvements in the outcomes related to both domains [30,31,34,38,40,52], seven showed improvements in one of the two domains [32,42,45,47,56,57,63], and only three did not report post-intervention improvements [48,51,58]. In one of these previous three studies [51], although they did not see significant improvements, the participants in the intervention group maintained the scores in almost all the main outcomes in a 2-year intervention period and the control group did not. (2) Ten studies analysed only EF domain outcomes [21,28,35,41,43,55,59,60,61,62], with a significant improvement in the one least assessed outcome. (3) Three only focused on GP [27,33,49] since they used an instrument that generated a final score, and just one did not report significant improvements [27]. (4) The remaining combined outcomes of EF and GP (n = 4) [36,39,50,53] or EF, MF, and GP (= 5) [29,37,44,46,54] were achieved. The interventions of Inoue, Kobayashi, Mori, Sakagawa, Xiao, Moritani, Sakane and Nagai [39], Liao, Chen, Hsu, Tseng, and Wang [46], and Kujawski, Kujawska, Kozakiewicz, Jakovljevic, Stankiewicz, Newton, Kędziora-Kornatowska, and Zalewski [44] showed improvements in all primary outcomes (Table 4).

4. Discussion

The main purpose of this study was to conduct a systematic review of observational and experimental studies examining the impact of PF programs on CF in elderly individuals. A total of thirty-eight articles involving 2389 participants (with 63% being female) were included in this review. Among them, thirty-four reported positive effects of physical training on at least one cognitive domain, including executive function, memory function, and general processing, following an intervention. Therefore, it is evident that older adults are able to enhance their CF domains through consistent participation in structured PF programs.

4.1. Cognitive Functions and Subdomains

We identified three primary categories of cognitive domains, with EF and MF being the predominant ones, followed by GP. Our findings align with the previous research, supporting the notion that physical exercise has a positive impact on the CFs of older adults [14,66]. Within the EF category, cardiorespiratory and muscle strength programs were observed to particularly benefit subdomains, such as working memory, attention, verbal fluency, reasoning, and processing speed. In the MF category, studies reported improvements in subdomains, including recognition, immediate recall, delayed recall, facial name recall, and paired associations. As for the GP category, enhancements were observed in immediate, short-term, and long-term memory parameters. It is worth noting that the studies included in this systematic review did not employ imaging tests to assess structural and functional changes in the brain following physical interventions. Nevertheless, our findings align with the review and meta-analysis studies [16,18], which support the connection between PF and neuroplasticity in old age.
We observed in the studies the combined use of specific instruments for the performances of EFs and MF, and we assumed this occurred because dysfunctions in EFs often preceded the decline in MF [67]. This can occur both in normal ageing and cases of preclinical dementia [68], consequently making it difficult to differentiate between the cognitive changes related to ageing and neurodegenerative diseases. EFs are recognised as higher cognitive processes linked to the prefrontal cortex of the brain; therefore, proper functioning favours goal-directed action [69], essential for self-control or self-regulation [70]. All of these are fundamental in older age for the planning and execution of instrumental activities of daily living [71,72]. Eleven studies reported a positive effect of the physical training program on MF, which suggested a relationship between PF and functional and structural changes in the hippocampus. Episodic memory processes are subordinate to the hippocampus’s anterior and posterior neocortical regions [73].
Nine studies indicated significant effects of physical training on GP. The finding corroborates recent reviews [74,75], attesting that PE-based training can create improvements to specific and global CFs. The screening identified three instruments to detect global cognitive changes: COGTEL, MMSE, and MoCA. All could provide aggregated information for cognitive performance. COGTEL had the advantage of being able to be applied in face-to-face and telephone interviews [76]. MoCA and MMSE were cognitive tests proposed for the early screening of cognitive impairments and dementia with an extensive use in older-adult investigations [77,78]. They are simple to understand, require little time to administer, and are easy to interpret.

4.2. Intervention Program Types

Cardiorespiratory training was prevalent in 19 studies. On a smaller scale, the use of walking on a treadmill and an ergometric bicycle was verified, while dancing was the most frequently used methodology. Of these, only Douka, Zilidou, Lilou, and Tsolaki [34] used a traditional style (traditional Greek dance), while the other studies adopted dance under the fitness methodology. A possible explanation for the greater use of dance aerobics was the ease this methodology offered to maintain and control the intensity of aerobic training. Comparatively, in traditional dance sections, the teaching methodology requires many pauses to explain and correct steps and gestures, often making it difficult to maintain a heart rate when shifting from moderate to vigorous intensities [79].
Review studies with meta-analyses pointed to dance as skilful training to promote cognitive improvements in older adults [80,81]. In addition to being attractive to this age group, rhythmic activities have the potential to associate with underlying mechanisms capable of inducing neural plasticity [79]. During a dance, there is an activation of the cardiac system, favouring the release of BDNF and insulin-like growth factor 1 (IGF-1), physiological mechanisms that are determinants for causing structural and functional alterations in the brain [6]. Moreover, a dance requires a constant adjustment of movements, often asynchronous between the legs, arms, head, and trunk in space following different rhythms [82]. Consequently, connectivity is strengthening that occurs between the two cerebral hemispheres [83]. Experimental studies on healthy older adults showed that dance training increased grey matter volume [52] and white matter [84]. It is worth mentioning that, although all nine included studies showed positive effects of dance in one of the three domains of cognition, we observed that in the majority, the intensity of the tasks needed to be more clearly detailed in the protocols.
The second most common PF program in this review was muscle strength. However, we observed a significant variability in the magnitude of procedures and results. Riegle van West, Stinear and Buck [57], Ladawan, Sungkamanee, Maharan, Amput, Srithawong, and Burtscher [45], and Macaulay, Pa, Kutch, Lane, Duncan, Yan, and Schroeder [47] observed improvement in EFs. The first two studies adopted meditative training (Poi, Tai Chi, and 4-movement Qigong), and the last used a machine-based exercise. We considered meditative training in the muscle strength category because of its relationship to strength development [85,86]. Improvements in CFs were verified in the study by Inoue, Kobayashi, Mori, Sakagawa, Xiao, Moritani, Sakane, and Nagai [39], who used a resistance program combining latex bands, squats, and Tai Chi. The other studies that used strength programs adopted different methodologies in two intervention groups to understand their effects on the cognitive domain. Gouveia É, Smailagic, Ihle, Marques, Gouveia, Cameirão, Sousa, Kliegel, and Siewiorek [37] verified the impacts of functional exercise and exergames fitness programs and training based only on functional exercise on short-term and long-term memory. However, the effects at the follow-up session (after four weeks) were observed only for the combined training group. Eckardt, Braun, and Kibele [35] also pointed out the variability in the outcomes. According to the authors, resistance training for instability improved working memory, processing speed, and response inhibition. On the other hand, stable machine-based and stable machine-based adductor/abductor training did not generate improvements in EF. Kujawski, Kujawska, Kozakiewicz, Jakovljevic, Stankiewicz, Newton, Kędziora-Kornatowska, and Zalewski [44] analysed the influence of sitting callisthenic balance training versus resistance training, and the two programs positively influenced multiple cognitive domains. Finally, Castano, de Lima, Barbieri, de Lucena, Gaspari, Arai, Teixeira, Coelho, and Uchida [32] compared the effects of traditional resistance training versus resistance training combined with cognitive tasks, and the results showed only improvements in the resistance and cognitive training group.
Although these studies have shown positive effects of resistance and functional training for different domains of cognition, the results can be more consistent, suggesting a greater analysis of the protocols. The differences between the results were also observed in ten other studies [13,29,31,40,46,49,51,54,55,59] that adopted mixed methodologies (i.e., a combination of aerobic training, strength, flexibility, or balance).
Finally, four investigations used new technologies or exergames in their interventions. This methodology has been frequently used to improve the FPs and CFs of the older adult population [87]. However, the results of its real effectiveness for PFs are inconclusive due to the difficulty of controlling the intensity of the physical task [88]. On the other hand, this methodology has been shown to be superior to simple task training [89]. This training is also widely used in preventing falls, as it simultaneously requires several motor skills in accordance with cognition domains [87]. Our analysis observed in Ordnung, Hoff, Kaminski, Villringer, and Ragert [55], and Zhao, Zhao, Li, Zhao, Wang, Guo, Zhang, Sun, Ye, and Zhu [63] that the practice of exercise through exergames showed significant improvements in one or more EF domains. Liao, Chen, Hsu, Tseng, and Wang [46] found GP and EF improvements for older adults submitted to exergames and multicomponent training. However, only members of the exergame group improved their verbal and working memory at the end of the intervention. In Gouveia É et al.’s (2020) [37] study, exergames improved the patients’ short- and long-term memory performances.

4.3. Length of Interventions, Frequency, and Time of Sessions

A high variability outcome was observed for the length of training programs (6 weeks–2 years), with three months prevailing. Only one study reported a two-year longitudinal design [51]. Regarding the training frequency, most activities occurred 2–3 times a week. Only one study was performed four times a week [42]. High heterogeneity was verified for the time of the training sessions, which varied from 30 to 90 min. When it came to guaranteeing the effect of physical exercise on CFs, it was fundamental that the training prescriptions considered aspects, such as frequency, intensity, type of exercise, session time, and length of intervention [90]. Frequency is an essential moderator for creating the stimuli necessary for neural plasticity [91]. A review study showed that comparatively moderate-frequency exercises (performed 3 to 4 times) had greater neural benefits than low-frequency exercises (performed 1 to 2 times) [92]. On the other hand, very intense training or overtraining could induce an increase in inflammatory cytokines and markers of oxidative stress, reducing the level of BDNF and impairing neural plasticity [93].
The possible explanations for the presented findings include the notion that regular exercise or training programs stimulate protective factors against age-related cognitive decline [16,94]. Exercise intensity plays a crucial role, as moderate to vigorous activities have demonstrated an increase in the levels of critical neurochemicals, such as the brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1) [6,95]. Both factors promote synaptic plasticity and neuronal survival, which are vital for counteracting the decline in neural mass [96]. Our findings align with the previous research, including a previous meta-analysis that indicated structural changes in the hippocampal volume resulting from aerobic training [12]. Additionally, review studies and meta-analyses have highlighted the potential of resistance exercise training to induce structural and functional alterations in the brains of healthy, older adults [97,98].

4.4. Clinical Implications

The findings of this review demonstrate the potential for exercise-based interventions to mitigate cognitive decline in healthy, older adults, which is recognised as a significant measure of public health [99]. Notably, the effects of PF programs on the CF domains depend on each individual’s biological, psychological, functional, and cognitive characteristics. Thus, issues, such as the length of the intervention, type of exercise, frequency, and duration of sessions, are fundamental [100,101]. Therefore, we suggest that future training protocols apply aerobic activities and resistance exercises with or without machines. Furthermore, we advise that training occurs 2–3 times a week (at a moderate PA level), in 60 min sessions. We also suggest that the interventions focus on developing strategies to promote the recruitment of men to ensure greater homogeneity in the analysis.

4.5. Strengths and Limitations

This study possesses notable strengths, particularly in its comprehensive coverage of current information from observational and experimental interventions utilising PF programs to potentially enhance the CFs of healthy, older individuals. Furthermore, our findings offer a valuable synthesis of information related to exercise frequency, exercise type, session duration, and intervention duration. However, there were certain limitations to our findings. Firstly, among the selected studies, there was an uneven distribution in terms of total participant numbers and gender and heterogeneity in the instruments employed for assessing cognitive performance. These disparities may have introduced biases to our results and conclusions. Secondly, we did not evaluate the intensity of the physical exercises applied, which was a crucial factor in stimulating neuroplasticity [16], due to the absence of this information in several included studies. Therefore, we recommend that future reviews focus on determining the optimal moderate- or high-intensity levels for promoting CF in the older, healthy population. Additionally, it is conceivable that the specific terms used to identify the relevant studies may have excluded certain articles, particularly those where the predefined terms were not present in the title and abstract. This potential limitation should be acknowledged.

5. Conclusions

The findings of this study consistently underscored the beneficial effects of involving older people in physical fitness interventions focusing on CF. Specifically, the cognitive domains expected to benefit more from a physical fitness program were EF, MF, and GP. Importantly for professionals who work with older people, it is crucial to remember that, among the various types of physical training employed, aerobic exercises were the most prevalent, emphasising activities, such as dancing, treadmill walking, and stationary cycling. Resistance training, using both machines and free weights and exergames, was also suggested as a common approach with an increased benefit. In order to keep an intervention based on the evidence, the revised studies typically spanned a duration of 3 to 6 months, with a frequency of two to three sessions per week, each lasting approximately 60 min. It is suggested that future studies may focus the analyses on the quality of the interventions, i.e., which new skill development/newer learning methods are the most beneficial for cognitive decline. The insights gleaned from this review can serve as valuable guidance for designing future interventions and contribute to formulating robust health policies aimed at promoting healthy ageing.

Author Contributions

M.A.T. and M.d.M.N. wrote the first draft of the manuscript. M.A.T. conducted the database searches. M.A.T., F.S. and S.M. conducted the data extraction. Methodological assessments were conducted by the same three authors. A.M., É.R.G. and A.I. wrote and reviewed the original article. All authors have read and agreed to the published version of the manuscript.

Funding

Swiss National Centre of Competence in Research LIVES—Overcoming vulnerability: life course perspectives, which was funded by the Swiss National Science Foundation (grant number: 51NF40-185901). Moreover, A.I. acknowledges the support received from the Swiss National Science Foundation (grant number: 10001C_189407). We also acknowledge support from the Portuguese Recovery and Resilience Program (PRR), IAPMEI/ANI/FCT, under Agenda C645022399-00000057 (eGamesLab).

Institutional Review Board Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflict of interest.

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