Effects of physical activity on cognitive function in healthy older women: a systematic review and meta-analysis

Abstract

Age-related cognitive decline represents a major public health challenge, particularly among older women who face a disproportionately elevated risk of dementia. Physical activity has been proposed as a modifiable lifestyle factor with potential neuroprotective benefits; however, evidence specific to cognitively healthy older women remains limited. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, the Cochrane Library, Web of Science, and Embase were searched from database inception to 26 September 2026. Studies were eligible if they enrolled healthy women aged >60 years and compared physical activity interventions with control conditions. The primary outcome was global cognitive function assessed using the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). Secondary outcomes included brain-derived neurotrophic factor (BDNF) and body mass index (BMI). Pooled effect sizes were calculated using random-effects or fixed-effect models as appropriate. Subgroup analyses and meta-regression were performed to explore potential moderators. The certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Ten RCTs encompassing 446 participants were included. Physical activity was associated with higher global cognitive function scores (Hedges’ g = 0.63, 95% CI: 0.12–1.13, p = 0.02) and increased BDNF levels (MD = 2.43, 95% CI: 0.57–4.28, p = 0.01). No statistically significant effect on BMI was observed (MD = 0.63, 95% CI: −1.12–2.37, p = 0.48). Substantial between-study heterogeneity was observed for global cognitive function (I 2 = 77.82%). Formal tests for subgroup differences were not statistically significant for either intervention duration ( p = 0.82) or intervention frequency ( p = 0.12). The pooled evidence suggests potential beneficial effects of physical activity on global cognitive function and BDNF levels in healthy older women; however, the certainty of evidence was very low. No statistically significant effect on BMI was observed, and subgroup analyses did not provide sufficient evidence that intervention frequency significantly modified the effect on cognitive function. Further well-designed RCTs with larger samples and standardized outcome measures are needed to confirm these findings. PROSPERO under registration number CRD420251249052, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251249052 .