J Med Internet Res. 2026 Aug 18;28:e92764. doi: 10.2196/92764.
ABSTRACT
BACKGROUND: Cognitive decline in older adults imposes a major global burden, with physical inactivity a leading modifiable risk factor for dementia. Digital physical exercise interventions offer scalable alternatives to traditional programs, but comparative effectiveness across cognitive domains remains unclear.
OBJECTIVE: The aim of the study is to compare and rank 4 digital physical exercise interventions-immersive virtual reality exercise (IVR_E), nonimmersive exergame (NI_ExG), remote exercise (RE), and virtual reality exercise combined with cognitive training (VR_EC)-against routine intervention (RI) or nonintervention (NI) on global cognition, executive function, and memory function in older adults aged ≥60 years.
METHODS: Eligible studies were English-language randomized controlled trials evaluating digital physical exercise on any untrained cognitive outcome in older adults. In total, 6 databases (PubMed, Embase, Web of Science, CENTRAL, PsycINFO, and CINAHL) and 2 trial registries were searched from January 2010 to April 2026; reference lists were screened. Screening, data extraction, and risk-of-bias assessment were conducted independently in duplicate using the Cochrane tool. Bayesian network meta-analyses were performed in R, reporting standardized mean differences (SMDs) with 95% CIs and prediction intervals (PIs); surface under the cumulative ranking curve (SUCRA) ranked interventions, and CINeMA (Confidence in Network Meta-Analysis) assessed certainty of evidence, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analyses).
RESULTS: In total, 51 randomized controlled trials (3673 participants) were included. NI_ExG significantly outperformed both NI (SMD 0.51, 95% CI 0.26-0.78; PI -0.03 to 1.07) and RI (SMD 0.32, 95% CI 0.12-0.53; PI -0.20 to 0.86) for global cognition (30 studies); IVR_E also outperformed NI (SMD 0.74, 95% CI 0.11-1.36; PI -0.04 to 1.53) and ranked highest by SUCRA. For executive function (33 studies), only NI_ExG versus NI was significant (SMD 0.39, 95% CI 0.04-0.76; PI -0.48 to 1.29). For memory function (20 studies), RE was significantly superior to both NI (SMD 1.30, 95% CI 0.15-2.44; PI -0.05 to 2.70) and RI (SMD 1.22, 95% CI 0.15-2.28; PI 0.07-2.56), with its PI also excluding the null; VR_EC was significantly inferior to RE (SMD -1.54, 95% CI -2.89 to -0.24; PI -3.09 to -0.07). Cumulative training ≥1000 minutes was associated with more stable memory benefit. Certainty was very low for most comparisons, downgraded for unclear allocation concealment, heterogeneity, and suspected reporting bias in executive function.
CONCLUSIONS: This Bayesian network meta-analysis compares 4 digital physical exercise categories against active and passive controls across 3 cognitive domains. Comparative effectiveness was domain-specific: NI_ExG most consistently benefited global cognition and executive function; RE produced the only statistically robust memory improvement; and IVR_E achieved the highest rankings but requires confirmatory trials. The scalability of RE and NI_ExG makes them practical for older adults in rural and resource-limited settings, providing an evidence base to inform clinical guidelines and digital health investment.
PMID:42612199 | DOI:10.2196/92764
