effects of exercise and intensive vascular risk reduction on cognitive function in older adults

A study investigated whether exercise, intensive pharmacological reduction of blood pressure (BP) and serum low-density lipoprotein cholesterol (LDL-C), or the combination of these interventions could improve cognitive function in older adults with family history of dementia and/or self-reported subjective cognitive decline (1):

• randomized clinical trial of 513 participants, moderate to vigorous aerobic exercise training, intensive pharmacological lowering of BP and serum LDL-C, or both did not result in statistically significant differences in improvements in global cognitive function over 24 months
  • single-blind, multicenter randomized clinical trial with a 2 × 2 factorial design and duration of 24 months was conducted at 4 clinical sites in the US
  • participants were randomized with a 1:1:1:1 ratio to aerobic exercise training, IRVR (lowering of systolic blood pressure to <130 mm Hg and serum low-density lipoprotein cholesterol with atorvastatin), IRVR + exercise, and usual care
• findings did not provide evidence in support of exercise, intensive reduction of BP and serum LDL-C, or both for improving cognitive function in older adults with family history of dementia and/or self-reported subjective cognitive decline

However a network-meta analysis concluded (2):

• this network meta-analysis provides robust evidence that different exercise modalities yield domain-specific cognitive benefits in cognitively healthy older adults
  • `resistance training was identified as the most effective intervention for improving global cognitive function and inhibitory control, particularly when delivered as twice-weekly sessions of 45 min over 12 weeks
  • mind-body exercise demonstrated the greatest improvements in executive function, including task-switching ability and working memory, especially with high-frequency, moderate-duration protocols
  • aerobic exercise was most effective for enhancing memory function, with sustained benefits observed in mid- to long-term interventions

Reference:

1. Zhang R, Vidoni E, Vongpatanasin W, et al. Effects of Exercise and Intensive Vascular Risk Reduction on Cognitive Function in Older Adults: A Randomized Clinical Trial. JAMA Neurol. Published online March 23, 2026.
2. Han H et al. Optimal exercise interventions for enhancing cognitive function in older adults: a network meta-analysis. Front Aging Neurosci. 2025 Jul 11;17:1510773.