Aging Clinical and Experimental Research (2024) 36:47

https://doi.org/10.1007/s40520-024-02700-2

REVIEW

Multidomain interventions for sarcopenia and cognitive flexibility

in older adults for promoting healthy aging: a systematic review
and meta‑analysis of randomized controlled trials
A. M. García‑Llorente1 · A. J. Casimiro‑Andújar1,2,3 · D. G. Linhares4 · R. G. De Souza Vale3,4,5 ·
P. J. Marcos‑Pardo1,2,3

Received: 2 November 2023 / Accepted: 8 January 2024

© The Author(s) 2024

Abstract
The global population is undergoing rapid aging, making physical activity a crucial element in preventing mortality and
lowering the risk of Alzheimer's disease. Age-related declines in muscle mass and cognitive abilities significantly contribute
to frailty and dependency. Thus, this study focuses on a meticulous analysis of the protective effects of multidomain
interventions, an emerging resource combating age-related declines. It seeks to underscore their profound impact on cognitive
flexibility and sarcopenia, highlighting their pivotal role in mitigating the adverse effects of aging. To identify relevant
randomized controlled trials up to November 2023, we reviewed eight online academic databases, following PERSiST
guidelines, PRISMA reporting system, and PICOs criteria. Meta-analyses on selected functional outcomes utilized a random-
effects model, including the Timed Up and Go Test, Sit to Stand Test, Victoria Stroop Test, and Trail Making Test. Out of
2082 scrutinized articles, 17 were included in the systematic review, and 8 in the meta-analysis. Positive effects (p = 0.05,
I2 = 57%; 95% CI – 0.63 to – 0.05) were observed in cognitive flexibility for certain interventions. Similarly, interventions
addressing muscle strength demonstrated improvements in the Sit to Stand Test for the exercise group compared to the
control group (p = 0.02, I2 = 0%; 95% CI – 0.63 to – 0.05). These findings underscore the importance of incorporating
physical activity as a primary component of public health interventions for promoting healthy aging and reducing the burden
of age-related diseases. Future interventions may explore more homogeneous approaches and evaluate the impact of thrice
multidomain weekly sessions.

Keywords Aging · Multidomain · Sarcopenia · Cognitive flexibility · Meta-analysis

3
* A. M. García‑Llorente Active Aging, Exercise and Health/HEALTHY‑AGE
amgll1991@gmail.com Network, Consejo Superior de Deportes (CSD), Ministry
of Culture and Sport of Spain, 28040 Madrid, Spain
* P. J. Marcos‑Pardo
4
pjmarcos@ual.es Universidade do Estado de Rio de Janeiro, Rio de Janeiro,
BR, Brazil
1
Present Address: SPORT Research Group (CTS‑1024), 5
Laboratorio de Ejercicio y Deporte, Instituto de Educación
Department of Education, CIBIS (Centro de Investigación
Física y Deportes, Universidad del Estado de Rio de Janeiro,
Para el Bienestar y la Inclusión Social) Research Center,
Rio de Janeiro 20550‑900, Brazil
Area of Physical Education and Sport, University
of Almería, Office 0.22, Building CITE III, Almería, Spain
2
Department of Education, Faculty of Education Sciences,
University of Almeria, 04120 Almeria, Spain

Vol.:(0123456789)
 47 Page 2 of 11 Aging Clinical and Experimental Research (2024) 36:47

Introduction cognitive decline, and more specifically cognitive

flexibility. The global situation of an aging population
Rationale necessitates comprehensive strategies to effectively
enhance the well-being and quality of life of older adults.
The global aging population poses both challenges and Over the last decade, there has been increased interest
opportunities for societies worldwide. With increasing in the influence of exercise on broad executive functions
life expectancies and declining birth rates, the proportion [11]. However, there is limited information about how
of older adults in the global population is growing at multidomain interventions may influence both cognitive
an unprecedented rate. According to the World Health flexibility and sarcopenia. While Xiong and colleagues
Organization (WHO), it is projected that by 2050, the recently studied the influence of different types of
number of people aged 60 years and above will reach exercise on executive functions [11], they did not reflect
2 billion, constituting approximately 22% of the global on sarcopenia, which we consider essential in the aging
population [1]. Additionally, the burden of physical process. The primary objective of this meta-analysis is to
inactivity exacerbates this situation [2]. This demographic scrutinize the existing evidence available for interventions
shift and the attitude toward physical activity necessitate addressing sarcopenia and cognitive flexibility. This novel
a comprehensive understanding of the factors influencing approach endeavors to formulate an effective strategy
healthy aging to effectively address the associated aimed at enhancing the quality of life for the elderly
challenges. population, with a particular emphasis on mitigating
A critical aspect of healthy aging is frailty, representing factors that may lead to dependency.
a complex state of vulnerability that increases the Given the multifaceted dynamics inherent in healthy
risk of adverse health outcomes in older adults [3, 4]. aging, interventions concurrently addressing multiple
Frailty encompasses various dimensions, including domains have garnered significant attention. Multidomain
physical, psychological, and social aspects. Determinants interventions integrate strategies targeting physical activity,
influencing frailty, notably sarcopenia and cognitive cognitive stimulation, social participation, etc. [12, 13].
decline, are pivotal elements in the distressing trajectory Notably, multidomain interventions incorporating dual tasks
leading to dependency. Sarcopenia, the age-related loss for both physical and cognitive training, show promise in
of muscle mass and strength, significantly contributes to fostering healthy aging and averting frailty-related adverse
the development toward dependency. Emerging evidence outcomes [14, 15]. In the context of this study, a dual task
suggests the importance of regular physical activity, will be considered as the simultaneous training of physical
resistance training, adequate diet, and sleep in preventing and cognitive aspects, with a particular exercise, involving
and managing sarcopenia [5, 6]. Strategies aimed at one or more tasks within the multidomain intervention.
maintaining muscle health, particularly resistance training, Consequently, multidomain interventions including strength
should be incorporated into interventions targeting healthy training, cardiorespiratory training, cognitive stimulation,
aging. Furthermore, sarcopenia is strongly associated with and social engagement may enable stakeholders to address
cognitive impairment in older adults [7]. the various factors influencing healthy aging, thereby
Cognitive decline, which includes impairments in improving the overall well-being for older adults.
memory, attention, and executive functions, is another In relation to this meta-analysis, the duration cut-off
critical aspect affecting healthy aging. Cognitive flexibility, was 8 weeks. According to the position statement from the
the ability to adapt cognitive processes in response to national strength and conditioning association (NSCA) for
changing circumstances, plays a vital role in maintaining older adults, effective strengthening sessions should be of a
cognitive function and overall well-being in older adults duration no less than 6 weeks [16]. However, they have been
[8]. Enhancing cognitive flexibility through cognitive deemed insufficient to produce a reduction in inflammation
training and engaging in intellectually stimulating measured with C‐reactive protein and TNF-α.
physical activities, such as dual-task physical–cognitive
training, may mitigate cognitive decline. Physical activity
interventions have also been shown to be effective in
preventing one-third of Alzheimer's and dementia clinical Methods
cases [9]. Additionally, cognitive flexibility is strongly
associated with mild cognitive diseases (MCD) and the This study was conducted in line with the PERSiST
cognitive decline of the population [10]. guidelines for systematic reviews [17], a sports and exercise
Promoting healthy aging requires a multidimensional medicine alignment of the 27 PRISMA statement [18].
approach that addresses frailty, sarcopenia prevention, It was also prospectively registered in the international
database for reviews from the National Institute for Health
Aging Clinical and Experimental Research (2024) 36:47 Page 3 of 11 47

Research (NIHR), Prospero, under the reference number Selection process

(CRD42023400224).
The literature search strategy for this study followed the
PRISMA guidelines, which provide a standardized approach
Eligibility criteria for reporting systematic reviews and meta-analyses. These
guidelines ensure that all essential elements are included in
Inclusion criteria 1.Complete original study; 2.Clear the report. Additionally, the search strategy incorporated the
intervention; 3.Randomized Controlled Trials (RCT); Problem/Population, Intervention, Comparison, Outcome,
4.≥ 65 years old physically independent; 5.The intervention and Study (PICOs) framework. The PICOs framework helps
addressed both sarcopenic/strength training and cognitive formulate key questions that guide the search for high-
flexibility outcome measures. Any studies that examined quality evidence effectively.
other chronic effects, alternative training methods, or disease Population: Older adults aged > 65 living independently;
specific studies were not included. Intervention: Multidomain, multicomponent or dual-task
Exclusion criteria 1.Insufficient length of the intervention training of at least 8 weeks; Comparator: Passive control
(< 8 weeks); 2.Not written in English, Spanish, Portuguese group (absence of cognitive or physical training); Outcome
or French; 3.Absence of a passive control group; measures: Sarcopenia and cognitive flexibility. Including
4.Institutionalized patients (care homes, hospitals, etc.); Timed Up and Go (TUG), Sit to Stand Test (STS), Trail
5.Studies including nutritional supplementation. Making Test (TMT), and Victoria Stroop Test (VST); Study:
Randomized control trials.
Considering the high degree of heterogeneity in reporting
Information sources the results from the study selection, we decided to exclude
some articles from further analysis and the reasons can be
A systematic literature search was conducted by two found below. However, they were still included in Tables 1,
independent investigators between April and November 2, and 3 (Annex B, C, and D).
2023. The search was carried out using the following online
databases to identify relevant articles: PubMed, Scopus, Data collection
Cochrane, Science Direct, PEDro, Web of Science, EBSCO,
and Nature. Furthermore, the reference lists of all included The search for relevant studies on a specific topic was
studies were scrutinized to find other eligible papers, which conducted by two independent authors. The screening
resulted in the inclusion of gray literature. process consisted of four stages: First, the reviewers
evaluated the titles of the studies to determine their
suitability for inclusion in our meta-analysis. Second, the
Search strategy abstracts of the selected titles were assessed to ensure
that the study topics met the predetermined inclusion
We conducted a search using specific terms related to the and exclusion criteria. Third, the full-text articles were
intervention. These terms were combined with Mesh terms thoroughly examined using relevant keywords, and the
to enhance the accuracy of our results. Our search criteria articles deemed relevant were then uploaded to Mendeley.
were as follows: we included terms such as ("Executive Lastly, the references of the included studies were carefully
Function" OR "Cognitive Flexibility") AND (Multidomain reviewed, and studies that did not provide the necessary
OR Multi-domain OR Multicomponent OR "Dual task") information, such as outcome measures, were excluded.
AND (Sarcopenia OR Strength* OR "Resistance training"). In cases where there were disagreements regarding the
To ensure comprehensive coverage, we adapted these search inclusion or exclusion of certain RCTs, resolution was
terms for other bibliographic databases, using database- achieved through discussion or involvement of a third party
specific filters for controlled trials when available (Annex when consensus could not be reached.
A). In addition to the database searches, we reviewed the
authors' files and examined the reference lists of each Data items
included article. Prior to conducting the final analysis, we
repeated the searches and identified additional studies for The study items were divided in three sections: 1.Study
potential inclusion. There was a time criterion for the last 10 characteristics: including the author's name, country
years set from December 2012 until the end of the screening where the intervention took place, sample size (expressed
period, November 2023. Titles and abstracts that did not in mean and standard deviation), and the percentage of
meet the predetermined inclusion criteria were subsequently female participants in both the experimental group and
excluded from the list. control group. In instances where studies featured multiple
 47 Page 4 of 11 Aging Clinical and Experimental Research (2024) 36:47

experimental groups, the data were documented when the measures of variability for all reported outcome measures;
relevant outcome measures were observed in the post- 10.monitoring of activities in control groups; 11.the relative
evaluation. 2.Additionally, study intervention encompassed intensity of constant physical exercise; and 12.characteristics
details such as the type of intervention, total duration of of exercise volume and energy expenditure.
the session, training volume (comprising session duration,
session frequency, and total number of sessions during the Effect measures
intervention), dose/intensity (encompassing intensity level
and measurement methodology for each training type), According to the European consensus on the definition
and supplementary information that could have potentially and diagnosis of Sarcopenia [6], the parameters for
impacted the study results. 3.Finally, the relevant outcome defining sarcopenia are best characterized by muscle
measures were identified, and the post-evaluation results strength assessments, such as the STS test, muscle quality
were reported using either mean and standard deviation evaluations, and physical performance measures like the
values or confidence intervals (CI), along with their TUG. Furthermore, recent research indicates that muscle
corresponding levels of significance. Only the outcomes strength serves as a more reliable indicator of poor cognitive
related to the study were included in the Table of results. function compared to other markers such as lean mass [21].
In the context of measuring cognitive flexibility, a
Risk of bias assessment commonly used tests in the older population include TMT.
However, it is worth noting that the level of education among
To assess the risk of bias (ROB), the researchers used the participants may have an influence on the test results [22],
RoB 2 [19], a framework that serves as a guide for evaluating thus warranting further investigations to account for this
the potential for bias in the results of randomized trials. It potential confounding factor.
focuses on assessing the relative effect of two interventions
or intervention strategies on a specific outcome in a single Reporting bias assessment
trial. These interventions are referred to as the experimental
intervention and comparator intervention, though the In the assessment of reporting bias, three articles were
comparison may sometimes involve two active interventions. excluded due to bias risk or methodological reasons: The
The framework consists of five domains, which were articles [23–25], were excluded from the selection process
determined based on both empirical evidence and theoretical due to a substantial risk of bias. This decision was made to
considerations, that identify how bias may be introduced ensure the reliability and validity of the study's findings.
into the result. The five domains are: 1.bias arising from Similarly, an additional manuscript [26] was ruled out due
the randomization process; 2.bias due to deviations from to methodological reasons, specifically the high volume
intended interventions; 3.bias due to missing outcome of dropouts observed in the control group, based on the
data; 4.bias in measurement of the outcome; and 5. bias in TESTEX methodological risk (Annex E). By excluding this
selection of the reported result. study, the researchers aimed to maintain the integrity of the
control group and minimize potential confounding factors,
Assessment of methodological quality resulting the selection in 17 articles for the systematic
review [12, 27–42].
To assess the methodological quality of the study, the
researchers used the Tool for the Evaluation of the Quality Meta‑analysis
of Study and Report in Exercise (TESTEX) [20], which is
specifically designed for physical exercise studies. TESTEX The Review Manager 5.4.1 program (RevMan version
consists of a scale that includes criteria for evaluating 5.4.1; The Cochrane Collaboration, Oxford, UK, available
internal validity and the statistical analysis presented in at (http://​tech.​cochr​ane.​org/​revman) was used to analyze
experimental studies. Each indicator defined in the scale muscle power (STS), functional strength (TUG), cognitive
is assigned one point, and zero points are given in the function (VST), and cognitive flexibility (TMT). Meta-
absence of these indicators. The criteria in the scale include: analyses were performed when two or more studies could be
1.specification of inclusion criteria; 2.random allocation; pooled based on similar interventions and the same outcome
3.allocation secrecy; 4.similarity of groups in the initial variables assessed with the same tests. Each standardized
or baseline phase; 5.blinding (for at least one key outcome mean difference (SMD) was weighted according to the
assessed); 6.measure of at least one primary completion inverse variance method. The SMD values in each study
in 85% of the allocated subjects (up to three points); were pooled with a random, if heterogeneity was significant
7.intention-to-treat analysis; 8.comparison between groups model, or fixed effect if heterogeneity was by chance.
of at least one primary dropout (up to two points); 9.report Such model is used when heterogeneity is low (I2 < 0.50).
Aging Clinical and Experimental Research (2024) 36:47 Page 5 of 11 47

However, when there is a moderate or high degree of and/or cognitive flexibility were not included in other
heterogeneity (I2 ≥ 0.50) between studies, the random effect studies, so a meta-analysis could not be performed.
model should be considered. SMD values were interpreted
as: < 0.2: weak; 0.2–0.79: moderate; ≥ 0.8: strong [43]. A
Study characteristics
statistically significant effect was indicated by p < 0.05.
Table 1 displays the characteristics of the studies included
Evidence‑level assessment
in this review. The selection process encompassed a global
representation, resulting in 17 studies (10 from Asia, 4
Two authors independently assessed the certainty of evidence
from Europe, 2 from Australia, and 1 from South America.
using the Grading of Recommendations Assessment,
All studies had female participants, with the experimental
Development and Evaluation (GRADE) approach with
groups comprising at least 41.3% females, except for the
the GRADE PRO website, available at https://​g rade​pro.​
study conducted by Wang and collaborators [41]. The sample
org. GRADE specifies four categories: “high,” “moderate,”
sizes of the studies varied, ranging from 19 participants [33]
“low,” and “very low,” applied to a body of evidence.
to 309 participants [35], resulting in a total sample size of
RCTs begin with high-quality evidence. Five aspects can
1036 participants across all studies. The studies selected
decrease the quality of evidence: methodological limitations,
focused on older adults with average ages surpassing 70
inconsistency, indirect evidence, inaccuracy, and publication
years old, with the exceptions being the studies by Coelho
bias. On the other hand, three aspects can increase the
and collaborators [32], Iuliano and colleagues [36], and Kim
quality of the evidence: effect size, dose–response gradient,
and colleagues [38]. Notably, none of the included studies
and confounding factor [44]. Heterogeneity between studies
reported any adverse events associated with the interventions
was analyzed using I2 statistics. I2 values are interpreted
or interventions' outcomes.
as low heterogeneity (0–50%), moderate heterogeneity
(50–74%), and high heterogeneity (≥ 75%) [45, 46] (Annex
F). Meta‑analysis results

Figure 2 presents the results of the meta-analysis of the

Results studies that investigated the variables of muscle power,
functional strength, cognitive function, and cognitive
Search results flexibility. The effect size was calculated by SMD with a
CI of 95%. When calculating the effect size, the negative
The initial search yielded a total of 1982 studies, of sign means greater effects for the exercise group (EG)
which 783 duplicates were eliminated. Moreover, 24 when compared to the control group (CG). The diamond
studies from alternative sources were added. After careful represents the average effect size of the included studies and
consideration, 1151 records were excluded for distinct should be interpreted equally.
reasons. Subsequently, 71 studies underwent thorough full- Figure 2A presents the results of the meta-analysis of
text review, and 21 RCTs proceeded to the assessment stage studies that used the TUG in the assessment of functional
for bias evaluation. Ultimately, a total of 17 articles were strength. There was no significant improvement; however,
included in the systematic review, and among them, 8 were the presented p-value is close to results that indicate a trend
used for the meta-analysis [12, 27–30, 32, 37, 39] (Fig. 1). toward improvement in this variable (functional strength)
(95% CI – 0.51 to 0.01) in favor of EG participants with
Study selection inconsistency I2 = 34% and p = 0.06.
Figure 2B shows the results of the meta-analysis of
Once the duplicates were removed, two researchers studies that used the TMT to assess cognitive flexibility.
individually reviewed the selected titles. In the event of There was no significant difference in TMT (95% CI – 0.75
a disagreement, a third researcher would help to reach to 0.00) in between participants in the EG and CG groups
consensus. Additionally, to take into consideration gray with I 2 inconsistency = 57% and p = 0.05. The results
literature, the reference lists of primary selected studies and indicate a trend toward improvement in this variable in favor
related systematic reviews and meta-analysis were reviewed. of EG.
The following studies were included in the systematic Figure 2C shows the results of the meta-analysis of
review but not in the Meta-analysis for the reasons below: studies that used the STS to assess lower limb power. There
(A) The studies contained mean differences between pre- was a significant difference in Sit to Stand (95% CI – 0.63
tests and post-tests but no information about post-test results to – 0.05) in favor of EG participants with inconsistency
[35, 39]; (B) The relevant outcome measures for sarcopenia I2 = 0% and p = 0.02.
 47 Page 6 of 11 Aging Clinical and Experimental Research (2024) 36:47

Fig. 1  Flow diagram of the studies´ selection process

Figure 2D shows the results of the meta-analysis of improvement in functional strength (TUG test) [27–29, 32,
studies that used the VST to assess cognitive parameters. 33, 38], with values approaching statistical significance
There was no significant difference (95% CI – 0.27 to 0.30) (p = 0.06). Caution is warranted in interpreting these results
between participants in the EG and CG groups with I 2 due to the limited number of meta-analyzed studies per
inconsistency = 18% and p = 0.91. variable and the low heterogeneity.
Eight of the 17 studies were meta-analyzed, with
Hiyamizu, Nishiguchi, Adocock, and collaborators [12,
27, 28] showing a strong tendency for improvement in Discussion
the TMT variable (p = 0.05). The VST variable did not
exhibit differences (p = 0.92). The STS variable indicated The primary aim of this meta-analysis was to assess the
increased muscle strength in the exercise group compared to impact of multidomain exercises on sarcopenia and cognitive
the control group (p = 0.02) [28–30]. There was a potential flexibility in older individuals. The VST test was utilized
Aging Clinical and Experimental Research (2024) 36:47 Page 7 of 11 47

(A) Functional strength assessment (TUG)

(B) Trail making test (TMT)

(C) Assessment of muscle power of lower limbs (Sit to Stand)

(D) Assessment of cognitive parameters (VST)

Fig. 2  Forest plot TUG (A), TMT (B), Sit to Stand (C), and VST (D). A Functional strength assessment (TUG). B Trail making test (TMT). C
Assessment of muscle power of lower limbs (Sit to Stand). D Assessment of cognitive parameters (VST)

for cognitive analysis, with interventions ranging from interventions. These results are consistent with those of the
resistance training to multidomain exercises, exergame, and Framingham study [48], emphasizing the cognitive benefits
aerobics. Notably, some studies demonstrated a significant of exercise, particularly in Alzheimer's patients [49].
improvement in cognition (p < 0.05) [12, 36, 37, 42]. These However, when examining cognitive flexibility through
findings align with Chaparro et al.'s cross-sectional study the TMT test [12, 27–29, 36], no significant improvements
[47], which indicated improved cognition with specific were observed despite interventions involving exergame
 47 Page 8 of 11 Aging Clinical and Experimental Research (2024) 36:47

and multidomain exercises. Imaoka et al.'s study [50] also Limitations

found no differences in cognitive flexibility (p > 0.05) in
older individuals undergoing multidomain exercise. The The limitations of the present study were as follows:
insufficient duration and intensity of the interventions First, the small number of studies included in the meta-
might explain these outcomes, underscoring the analysis per variable. Second, it may be advisable for future
importance of adhering to WHO recommendations for studies to explore the retention of cognitive and physical
physical activity [1]. improvements over time. It is unknown whether the positive
Muscle strength, evaluated through the Sit to Stand Test effects multidomain interventions have on older individuals
(STS) [27–30, 32] and HGS-R test [29, 50], showed varied are retained over time. Finally, future interventions may
results. While some studies reported increased muscle benefit from using the Latin American Group for Maturity
strength (p < 0.05), others, such as those by Calisaya et al. battery (GDLAM) [54] which offers improved property
and Hiyamizu et al., did not observe significant changes in determining the risk of sarcopenia as opposed to SPPB
(p > 0.05). Divergent outcomes may be attributed to based on the European Working Group on Sarcopenia in
differences in training volume, intensity, frequency, and Older People guidelines (EWGSOP19) [6].
load control.
Functional strength, assessed by the TUG test
[27–29, 31, 32, 36, 37], exhibited improvements in some Conclusions
studies (p < 0.05), suggesting that multidomain exercise
prescriptions can enhance the functional strength of older Multidomain interventions that encompass both cognitive
individuals, contributing to fall prevention and increased and physical training for at least 8 weeks within a training
independence. Corroborating these findings, Sadjapong plan have been shown to be effective in improving both
and collaborators [51] used multidomain exercises in 2 muscle strength and cognitive flexibility among older
groups (multidomain x usual activities), with a frequency adults. In addition, multi-dominance training also has
of 2 × week for a total period of 24 weeks in 64 older people the potential to improve muscle function and balance.
with a mean age of 78 years. In this sense, Sanders, and Consequently, multidomain training may contribute to the
colleagues [52] analyzed 69 older people comparing 2 prevention and treatment of age-related diseases, including
groups of exercises at different intensities with a frequency cognitive diseases such as Alzheimer's disease. Based on
of 3 × week for 24 weeks (low intensity x high intensity this novel information, policy makers, health professionals,
exercises). The authors did not find improvements (p > 0.05) and researchers can develop and implement effective non-
in muscle strength. The divergent results reported may be pharmacological intervention strategies with multidomain
due to the intensity of training, weekly frequency, and load interventions to promote healthy aging and ensure societies
control. successfully adapt to the challenges and opportunities
Cardiorespiratory fitness, measured through the walking presented by a rapidly aging world.
test (WT) [28, 30, 31], demonstrated increased capacity
in most studies (p < 0.05), with variations attributed to Supplementary Information The online version contains
supplementary material available at https:// ​ d oi. ​ o rg/ ​ 1 0. ​ 1 007/​
differences in intervention types. The SPPB battery revealed s40520-​024-​02700-2.
mixed results [36, 37], emphasizing the potential influence
of exercise intensity on functional fitness. Acknowledgements Thanks to the University of Almeria and the
Body composition assessments (% Fat and MM) [37, Sports Service for their support to the project "Psycho-physiological
effects of multidomain training in adults and older people (ACTIVA-
38] showed varied outcomes. Kim et al.'s study reported an Senior)" with ethics committee UALBIO2022/011. This article is part
increase in MM, while Park et al.'s study [53] demonstrated of the doctoral thesis of AMGL.
improvements in body composition (% fat and BMI). The
impact of exercise intensity on physiological adaptations Author contributions PJMP, RGSV, and AJCA designed the research.
AMGL and DGL performed the data extraction. The meta-analysis
was evident. was performed by DGL and RGSV. Additionally, AMGL and PJMP
Noteworthy is the reduced number of weekly training drafted the manuscript. Finally, PJMP, RGSV, AJCA, and DGL revised
sessions in some studies [28, 29], potentially influencing and edited. All authors approved the manuscript and definitive version
results in functional strength assessment (TUG test). of the article.
Increased weekly sessions may generate positive effects on Funding Funding for open access publishing: Universidad de Almería/
physical fitness due to chronic physiological adaptations CBUA. No financial assistance from governmental, corporate, or non-
[16]. It is recommended to consider variables such as weekly profit entities was used to conduct the study described in the manuscript
nor to assist in its preparation.
frequency, session duration, intensity, volume, exercise type,
and total intervention period for effective exercise program Availability of data and materials Annex A in appendices shows where
prescriptions for older individuals. the information can be found.
Aging Clinical and Experimental Research (2024) 36:47 Page 9 of 11 47

Pre-register of the study: the study was uploaded to Prospero with flexibility. Aging Ment Health 24:1028–1045. https://​doi.​org/​10.​
the ID number (CRD42023400224). 1080/​13607​863.​2019.​15847​85
11. Xiong J, Ye M, Wang L et al (2021) Effects of physical exercise
Declarations on executive function in cognitively healthy older adults: A
systematic review and meta-analysis of randomized controlled
Conflict of interest The authors declare that they have no competing trials: Physical exercise for executive function. Int J Nurs Stud.
interests. https://​doi.​org/​10.​1016/j.​ijnur​stu.​2020.​103810
12. Adcock M, Fankhauser M, Post J et al (2020) Effects of an
Open Access This article is licensed under a Creative Commons in-home multicomponent exergame training on physical functions,
Attribution 4.0 International License, which permits use, sharing, cognition, and brain volume of older adults: a randomized
adaptation, distribution and reproduction in any medium or format, controlled trial. Front Med (Lausanne) 6:321. https://​doi.​org/​10.​
as long as you give appropriate credit to the original author(s) and the 3389/​FMED.​2019.​00321/​BIBTEX
source, provide a link to the Creative Commons licence, and indicate 13. Fragala MS, Cadore EL, Dorgo S et al (2019) Resistance training
if changes were made. The images or other third party material in this for older adults: position statement from the national strength and
article are included in the article's Creative Commons licence, unless conditioning association. J Strength Condit Res. https://​doi.​org/​
indicated otherwise in a credit line to the material. If material is not 10.​1519/​JSC.​00000​00000​003230
included in the article's Creative Commons licence and your intended 14. Rosenberg A, Ngandu T, Rusanen M et al (2018) Multidomain
use is not permitted by statutory regulation or exceeds the permitted lifestyle intervention benefits a large elderly population at
use, you will need to obtain permission directly from the copyright risk for cognitive decline and dementia regardless of baseline
holder. To view a copy of this licence, visit http://​creat​iveco​mmons.​ characteristics: the FINGER trial. Alzheimer’s Dementia 14:263–
org/​licen​ses/​by/4.​0/. 270. https://​doi.​org/​10.​1016/J.​JALZ.​2017.​09.​006
15. Etnier JL, Chang YK (2019) Exercise, cognitive function, and the
brain: advancing our understanding of complex relationships. J
Sport Health Sci 8:299–300. https://​doi.​org/​10.​1016/j.​jshs.​2019.​
03.​008
References 16. Marques DL, Neiva HP, Marinho DA et al (2023) Manipulating
the resistance training volume in middle-aged and older adults:
1. Kim D, Ko Y, Jung A (2022) Longitudinal effects of exercise a systematic review with meta-analysis of the effects on muscle
according to the World Health Organization guidelines on strength and size, muscle quality, and functional capacity. Sports
cognitive function in middle-aged and older adults. Front Public Med 53:503–518. https://​doi.​org/​10.​1007/​s40279-​022-​01769-x
Health 10:3947. https://​doi.​org/​10.​3389/​FPUBH.​2022.​10097​75/​ 17. Ardern CL, Büttner F, Andrade R et al (2022) Implementing
BIBTEX the 27 PRISMA 2020 Statement items for systematic reviews in
2. Dillon K, Morava A, Prapavessis H et al (2022) Total sedentary the sport and exercise medicine, musculoskeletal rehabilitation
time and cognitive function in middle-aged and older adults: a and sports science fields: the PERSiST (implementing Prisma
systematic review and meta-analysis. Sports Med Open. https://​ in Exercise, Rehabilitation, Sport medicine and SporTs science)
doi.​org/​10.​1186/​s40798-​022-​00507-x guidance. Br J Sports Med 56:175–195. https://​doi.​org/​10.​1136/​
3. Fried LP, Tangen CM, Walston J, et al (2001) Frailty in older bjspo​rts-​2021-​103987
adults: evidence for a phenotype. Vol 56. https://​acade​mic.​oup.​ 18. Page MJ, Mckenzie JE, Bossuyt PM et al (2020) The PRISMA
com/​biome​dgero​ntolo​gy/​artic​le/​56/3/​M146/​545770. Accessed 1 2020 statement: an updated guideline for reporting systematic
May 2023 reviews. BMJ. https://​doi.​org/​10.​1136/​bmj.​n71
4. Morley JE, Vellas B, Abellan van Kan G et al (2013) Frailty 19. Sterne JAC, Savović J, Page MJ et al (2019) RoB 2: a revised tool
consensus: a call to action. J Am Med Dir Assoc 14:392–397. for assessing risk of bias in randomised trials. BMJ. https://​doi.​
https://​doi.​org/​10.​1016/j.​jamda.​2013.​03.​022 org/​10.​1136/​bmj.​l4898
5. Landi F, Cesari M, Calvani R et al (2017) The “Sarcopenia and 20. Smart NA, Waldron M, Ismail H et al (2015) Validation of a new
Physical fRailty IN older people: multi-componenT Treatment tool for the assessment of study quality and reporting in exercise
strategies” (SPRINTT) randomized controlled trial: design and training studies: TESTEX. Int J Evid Based Healthc 13:9–18.
methods. Aging Clin Exp Res 29:89–100. https://d​ oi.o​ rg/1​ 0.1​ 007/​ https://​doi.​org/​10.​1097/​XEB.​00000​00000​000020
S40520-​016-​0715-2/​TABLES/2 21. Sui SX, Holloway-Kew KL, Hyde NK et al (2020) Muscle
6. Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised strength and gait speed rather than lean mass are better indicators
European consensus on definition and diagnosis. Age Ageing for poor cognitive function in older men. Sci Rep. https://​doi.​org/​
48:16–31. https://​doi.​org/​10.​1093/​ageing/​afy169 10.​1038/​s41598-​020-​67251-8
7. CabettCipolli G, Sanches Yassuda M, Aprahamian I (2019) 22. Fällman K, Lundgren L, Wressle E et al (2020) Normative data
Sarcopenia is associated with cognitive impairment in older for the oldest old: trail making test A, symbol digit modalities test,
adults: a systematic review and meta-analysis. J Nutr Health victoria stroop test and parallel serial mental operations. Aging
Aging 23:525–531. https://​doi.​org/​10.​1007/​s12603-​019-​1188-8 Neuropsychol Cogn 27:567–580. https://​doi.​org/​10.​1080/​13825​
8. Hull R, Martin RC, Beier ME et al (2008) Executive function 585.​2019.​16487​47
in older adults: a structural equation modeling approach. 23. Ansai JH, Rebelatto JR (2015) Effect of two physical exercise
Neuropsychology 22:508–522. https://​doi.​org/​10.​1037/​0894-​ protocols on cognition and depressive symptoms in oldest-
4105.​22.4.​508 old people: a randomized controlled trial. Geriatr Gerontol Int
9. De la Rosa A, Olaso-Gonzalez G, Arc-Chagnaud C et al (2020) 15:1127–1134. https://​doi.​org/​10.​1111/​GGI.​12411
Physical exercise in the prevention and treatment of Alzheimer’s 24. Ansai JH, De Andrade LP, De Souza Buto MS et al (2017) Effects
disease. J Sport Health Sci 9:394–404. https://​doi.​org/​10.​1016/j.​ of the addition of a dual task to a supervised physical exercise
jshs.​2020.​01.​004 program on older adults’ cognitive performance. J Aging Phys
10. Guarino A, Forte G, Giovannoli J et al (2020) Executive functions Act 25:234–239. https://​doi.​org/​10.​1123/​japa.​2016-​0094
in the elderly with mild cognitive impairment: a systematic review 25. Thaiyanto J, Sittichoke C, Phirom K et al (2021) Effects of
on motor and cognitive inhibition, conflict control, and cognitive multicomponent exercise on cognitive performance and fall risk in
 47 Page 10 of 11 Aging Clinical and Experimental Research (2024) 36:47

older women with mild cognitive impairment. J Nutr Health Aging cluster-randomized trial. Arch Gerontol Geriatr 95:104392. https://​
25:160–164. https://​doi.​org/​10.​1007/​s12603-​020-​1458-5 doi.​org/​10.​1016/J.​ARCHG​ER.​2021.​104392
26. de Smolarek AC, Boiko Ferreira LH, Gomes Mascarenhas LP et al 40. Rosado H, Bravo J, Raimundo A et al (2021) Effects of two 24-week
(2016) The effects of strength training on cognitive performance in multimodal exercise programs on reaction time, mobility, and dual-
elderly women. Clin Interv Aging 11:749–754. https://​doi.​org/​10.​ task performance in community-dwelling older adults at risk of
2147/​CIA.​S1021​26 falling: a randomized controlled trial. BMC Public Health. https://​
27. Hiyamizu M, Morioka S, Shomoto K et al (2012) Effects of dual doi.​org/​10.​1186/​s12889-​021-​10448-x
task balance training on dual task performance in elderly people: a 41. Wang RY, Wang YL, Cheng FY et al (2018) Effects of a
randomized controlled trial. Clin Rehabil 26:58–67. https://​doi.​org/​ multicomponent exercise on dual-task performance and executive
10.​1177/​02692​15510​394222 function among older adults. Int J Gerontol 12:133–138. https://​doi.​
28. Nishiguchi S, Yamada M, Tanigawa T et al (2015) A 12-week org/​10.​1016/J.​IJGE.​2018.​01.​004
physical and cognitive exercise program can improve cognitive 42. Wollesen B, Mattes K, Schulz S et al (2017) Effects of dual-task
function and neural efficiency in community-dwelling older adults: management and resistance training on gait performance in older
a randomized controlled trial. J Am Geriatr Soc 63:1355–1363. individuals: a randomized controlled trial. Front Aging Neurosci.
https://​doi.​org/​10.​1111/​JGS.​13481 https://​doi.​org/​10.​3389/​fnagi.​2017.​00415
29. Park H, Park JH, Na HR et al (2019) Combined intervention 43. Cohen J (1992) A power primer. Psychol Bull 112(1):155–159.
of physical activity, aerobic exercise, and cognitive exercise https://​doi.​org/​10.​1037//​0033-​2909.​112.1.​155
intervention to prevent cognitive decline for patients with mild 44. Guyatt GH, Oxman AD, Vist G et al (2011) GRADE guidelines: 4.
cognitive impairment: a randomized controlled clinical study. J Clin Rating the quality of evidence – Study limitations (risk of bias). J
Med 8:940. https://​doi.​org/​10.​3390/​JCM80​70940 Clin Epidemiol 64:407–415. https://​doi.​org/​10.​1016/j.​jclin​epi.​2010.​
30. Callisaya ML, Jayakody O, Vaidya A et al (2021) A novel cognitive- 07.​017
motor exercise program delivered via a tablet to improve mobility 45. Higgins JPT, Altman DG, Gøtzsche PC et al (2011) The Cochrane
in older people with cognitive impairment—standingTall Cognition Collaboration’s tool for assessing risk of bias in randomised trials.
and Mobility. Exp Gerontol 152:111434. https://​doi.​org/​10.​1016/J.​ BMJ (Online). https://​doi.​org/​10.​1136/​bmj.​d5928
EXGER.​2021.​111434 46. Melsen WG, Bootsma MCJ, Rovers MM et al (2014) The effects
31. Bae S, Lee S, Lee S et al (2019) The effect of a multicomponent of clinical and statistical heterogeneity on the predictive values
intervention to promote community activity on cognitive function of results from meta-analyses. Clin Microbiol Infect 20:123–129.
in older adults with mild cognitive impairment: a randomized https://​doi.​org/​10.​1111/​1469-​0691.​12494
controlled trial. Complement Ther Med 42:164–169. https://​doi.​ 47. Chaparro GN, Sosnoff JJ, Hernandez ME (2020) Effects of aerobic
org/​10.​1016/j.​ctim.​2018.​11.​011 fitness on cognitive motor interference during self-paced treadmill
32. Coelho-Júnior HJ, Uchida MC (2021) Effects of low-speed and walking in older adults. Aging Clin Exp Res 32:2539–2547. https://​
high-speed resistance training programs on frailty status, physical doi.​org/​10.​1007/​s40520-​020-​01479-2
performance, cognitive function, and blood pressure in prefrail and 48. Spartano NL, Demissie S, Himali JJ et al (2019) Accelerometer-
frail older adults. Front Med (Lausanne) 8:1115. https://​doi.​org/​10.​ determined physical activity and cognitive function in middle-aged
3389/​FMED.​2021.​702436/​BIBTEX and older adults from two generations of the Framingham Heart
33. de Oliveira SF, Ferreira JV, Plácido J et al (2019) Three months of Study. Alzheimer’s Dementia Transl Res Clin Interv 5:618–626.
multimodal training contributes to mobility and executive function https://​doi.​org/​10.​1016/J.​TRCI.​2019.​08.​007
in elderly individuals with mild cognitive impairment, but not in 49. Lv S, Wang Q, Liu W et al (2023) Comparison of various exercise
those with Alzheimer’s disease: a randomized controlled trial. interventions on cognitive function in Alzheimer’s patients: a
Maturitas 126:28–33. https://​doi.​org/​10.​1016/J.​MATUR​ITAS.​2019.​ network meta-analysis. Arch Gerontol Geriatr. https://​doi.​org/​10.​
04.​217 1016/j.​archg​er.​2023.​105113
34. Hong SG, Kim JH, Jun TW (2018) Effects of 12-week resistance 50. Imaoka M, Nakao H, Nakamura M et al (2019) Effect of
exercise on electroencephalogram patterns and cognitive function in multicomponent exercise and nutrition support on the cognitive
the elderly with mild cognitive impairment: a randomized controlled function of older adults: a randomized controlled trial. Clin Interv
trial. Clin J Sport Med 28:500–508. https://​doi.​org/​10.​1097/​JSM.​ Aging 14:2145–2153. https://​doi.​org/​10.​2147/​CIA.​S2290​34
00000​00000​000476 51. Sadjapong U, Yodkeeree S, Sungkarat S et al (2020) Multicomponent
35. Huang CH, Umegaki H, Makino T et al (2021) Effect of various exercise program reduces frailty and inflammatory biomarkers and
exercises on intrinsic capacity in older adults with subjective improves physical performance in community-dwelling older adults:
cognitive concerns. J Am Med Dir Assoc 22:780-786.e2. https://​ a randomized controlled trial. Int J Environ Res Public Health.
doi.​org/​10.​1016/j.​jamda.​2020.​06.​048 https://​doi.​org/​10.​3390/​ijerp​h1711​3760
36. Iuliano E, di Cagno A, Aquino G et al (2015) Effects of different 52. Sanders LMJ, Hortobágyi T, Karssemeijer EGA et al (2020) Effects
types of physical activity on the cognitive functions and attention in of low- And high-intensity physical exercise on physical and
older people: a randomized controlled study. Exp Gerontol 70:105– cognitive function in older persons with dementia: a randomized
110. https://​doi.​org/​10.​1016/j.​exger.​2015.​07.​008 controlled trial. Alzheimers Res Ther. https://​doi.​org/​10.​1186/​
37. Kang D, Kim H, Yoon D et al (2014) Effects of 12 weeks high-speed s13195-​020-​00597-3
elastic band training on cognitive function, physical performance and 53. Park W, Jung WS, Hong K et al (2020) Effects of moderate
muscle strength in older women with mild cognitive impairment: a combined resistance-and aerobic-exercise for 12 weeks on body
randomized controlled trial. Korean J Health Promot 14:26. https://​ composition, cardiometabolic risk factors, blood pressure, arterial
doi.​org/​10.​15384/​kjhp.​2014.​14.1.​26 stiffness, and physical functions, among obese older men: a pilot
38. Kim DR, Song S, Kim GM et al (2021) Effects of ICT-based study. Int J Environ Res Public Health 17:1–12. https://​doi.​org/​10.​
multicomponent program on body composition and cognitive 3390/​ijerp​h1719​7233
function in older adults: a randomized controlled clinical study. Clin 54. Marcos-Pardo PJ, González-Gálvez N, Carbonell-Baeza A et al
Interv Aging 16:1161–1171. https://​doi.​org/​10.​2147/​CIA.​S3068​94 (2023) GDLAM and SPPB batteries for screening sarcopenia in
39. Liang CK, Lee WJ, Hwang AC et al (2021) Efficacy of multidomain community-dwelling Spanish older adults: healthy-age network
intervention against physio-cognitive decline syndrome: a study. Exp Gerontol. https://​doi.​org/​10.​1016/j.​exger.​2022.​112044
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