Resistance training improved working memory and flexibility in cognitively healthy older adults, but not against other exercise

Design

Systematic review and meta-analysis of 17 randomised trials (22 in the review)

Population

Community-dwelling adults aged 60 or older without cognitive impairment

Primary outcome

Executive function: inhibitory control, working memory, cognitive flexibility

Effect

Working memory SMD 0.30 (95% CI 0.02 to 0.59); cognitive flexibility SMD -0.50 (-0.88 to -0.12); no difference versus other exercise

This systematic review and meta-analysis searched for randomised trials of resistance exercise in community-dwelling adults aged 60 or older without cognitive impairment. Twenty-two trials met inclusion criteria, and 17 contributed to the meta-analysis. The outcomes were inhibitory control, working memory and cognitive flexibility.

Compared with control conditions, resistance training improved working memory (standardised mean difference 0.30, 95% CI 0.02 to 0.59) and cognitive flexibility (SMD -0.50, -0.88 to -0.12), with no significant effect on inhibitory control. When resistance training was compared with other exercise, there were no significant differences in any domain.

Certainty of evidence was low, and protocols and risk of bias varied. The working memory interval only just excludes zero. Resistance training is worth recommending for strength, function and falls prevention; the cognitive gain is a possible bonus, and the review does not show that it outperforms aerobic or mixed exercise.

• Recommend resistance training to older adults for strength and function first; cognitive benefit is a possible extra.
• Do not promise cognitive gains; the evidence was low certainty.
• Any regular exercise looked similar to resistance training for cognition in head-to-head comparisons.
• Start with supervised, progressive loading and check for cardiovascular and joint problems first.

Why it matters

It shifts the question from whether exercise helps thinking to whether resistance training has any distinct advantage, and the answer so far is that it does not.

Don't overread it

Low-certainty evidence from heterogeneous trials with high risk of bias does not show that resistance training prevents cognitive decline or dementia.

The statistics, in plain English

A standardised mean difference of 0.30 is a small to moderate effect, and its interval (0.02 to 0.59) barely excludes zero. Comparisons with other exercise showed no clear difference, so the effect may be of exercise generally rather than of resistance work specifically.

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