{"publication_id":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","content_hash":"sha256:1b754341eb7e22a632bd50a1e2e44084747f00d2ad469eabc6689269bcc78921","nodes":[{"id":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","type":"publication","title":"Adjacent Evidence Brief: Physical Exercise Effects — full paper"},{"id":"claim_1","type":"claim","text":"This paper synthesizes evidence on physical exercise effects across 55 accepted source papers and 2160 high-confidence extracted claims. The evidence profile contains 11 direct clinical sources, 44 adjacent, review, or context sources, and no sources classified primarily as mechanistic or model-system evidence, with a high-density pairwise disagreement map across the evidence base. Positive study-level signals are summarized in the safety and comorbidity, deficiency prevalence, contextual adjacent evidence outcome classes, null signals in the contextual adjacent evidence, cognitive and muscle function outcome classes, and negative signals in the contextual adjacent evidence outcome class. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect. The conclusion is that physical exercise effects remains a bounded geroscience case: the retained direct, adjacent, and context evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified anti-aging claim. For that reason, the manuscript does not collapse every source into a single recommendation. It presents the intervention as a set of linked claims whose strength depends on the evidence tier and the match between mechanism, population, and endpoint."},{"id":"claim_2","type":"claim","text":"This paper synthesizes evidence on physical exercise effects across 55 accepted source papers and 2160 high-confidence extracted claims."},{"id":"claim_3","type":"claim","text":"The evidence profile contains 11 direct clinical sources, 44 adjacent, review, or context sources, and no sources classified primarily as mechanistic or model-system evidence, with a high-density pairwise disagreement map across the evidence base."},{"id":"claim_4","type":"claim","text":"Positive study-level signals are summarized in the safety and comorbidity, deficiency prevalence, contextual adjacent evidence outcome classes, null signals in the contextual adjacent evidence, cognitive and muscle function outcome classes, and negative signals in the contextual adjacent evidence outcome class. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect."},{"id":"claim_5","type":"claim","text":"The conclusion is that physical exercise effects remains a bounded geroscience case: the retained direct, adjacent, and context evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified anti-aging claim."},{"id":"claim_6","type":"claim","text":"For that reason, the manuscript does not collapse every source into a single recommendation. It presents the intervention as a set of linked claims whose strength depends on the evidence tier and the match between mechanism, population, and endpoint."},{"id":"claim_7","type":"claim","text":"This synthesis evaluates evidence on physical exercise effects across 55 included source papers and 2160 high-confidence extracted claims. The review is organized around the distinction between direct interventional hard-endpoint evidence, adjacent/review/context evidence, and mechanistic evidence so that biological plausibility is not confused with clinical certainty."},{"id":"claim_8","type":"claim","text":"The corpus contains 11 direct clinical sources, 44 adjacent, review, or context sources, and no sources classified primarily as mechanistic or model-system evidence. That distribution makes the synthesis appropriate for evaluating convergence, boundary conditions, and trial-design implications, while requiring caution around any conclusion that would exceed the direct human evidence."},{"id":"claim_9","type":"claim","text":"The introductory frame therefore treats the corpus as a set of evidence roles rather than a single directional verdict. Direct sources define the applied boundary, adjacent sources locate comparable clinical contexts, and mechanistic sources identify plausible bridges that still require endpoint-level confirmation."},{"id":"claim_10","type":"claim","text":"This distinction matters for publication because it makes the paper falsifiable. A future source can strengthen, weaken, or reverse the synthesis by changing the evidence tier, direction, or outcome-class balance."},{"id":"claim_11","type":"claim","text":"The mechanistic layer is most useful when it explains why a trial signal might appear or fail to appear. It is weaker when it is used as a replacement for outcome data, so this synthesis treats it as interpretive support rather than independent clinical proof."},{"id":"claim_12","type":"claim","text":"Null findings have a specific role in this evidence model. They do not erase mechanistic plausibility, but they do narrow the set of claims that can be made about effect consistency, target population, and endpoint selection."},{"id":"claim_13","type":"claim","text":"Adverse or negative signals are likewise retained in the main interpretation. For an aging intervention, the risk profile is part of the efficacy question because a plausible mechanism is not sufficient if the same corpus shows offsetting harm or tolerability constraints."},{"id":"claim_14","type":"claim","text":"The evidence base also distinguishes breadth from certainty. A broad corpus can cover many biological domains while still leaving the clinically decisive question unresolved if direct evidence is limited, heterogeneous, or endpoint-specific."},{"id":"claim_15","type":"claim","text":"The research value of the synthesis lies in making these boundaries explicit. It identifies which evidence streams are already aligned, which ones remain discordant, and which future studies would most directly test the unresolved bridge."},{"id":"claim_16","type":"claim","text":"The background evidence for physical exercise effects is heterogeneous rather than uniformly confirmatory. Direct clinical sources such as Suikkanen 2025, Arici 2025, Adnan 2026 are interpreted separately from mechanistic studies such as the retained evidence base, because these evidence roles answer different questions about aging biology and clinical translation."},{"id":"claim_17","type":"claim","text":"The direct evidence establishes what has been observed in human or adjacent clinical settings. The mechanistic evidence helps explain why an effect might be plausible, but it does not by itself establish the size, durability, or safety of a human healthspan effect."},{"id":"claim_18","type":"claim","text":"Across the retained sources, positive signals cluster around the safety and comorbidity, deficiency prevalence, contextual adjacent evidence outcome classes; null signals around the contextual adjacent evidence, cognitive and muscle function outcome classes; and negative or adverse signals around the contextual adjacent evidence outcome class. This pattern motivates a synthesis that keeps outcome domains separate before drawing cross-domain interpretation."},{"id":"claim_19","type":"claim","text":"The study-level structure also prevents selective emphasis. Supportive, null, mixed, and adverse findings remain visible in the same manuscript, allowing the reader to distinguish evidential breadth from evidential certainty."},{"id":"claim_20","type":"claim","text":"The resulting paper is therefore a calibrated synthesis: it can identify plausible mechanisms, observed direct signals when present, unresolved tensions, and trial-design priorities without converting them into claims stronger than the retained corpus can support."},{"id":"claim_21","type":"claim","text":"The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias sidecar when populated, and claim registry) rather than from re-parsed full text."},{"id":"claim_22","type":"claim","text":"Risk-of-bias framework assignment follows study design (RoB-2 for RCTs, ROBINS-I for non-randomised studies, AMSTAR-2 for systematic reviews / meta-analyses). Public appraisal claims are limited to populated `risk_of_bias.json` rows; when no populated ratings are present, interpretation remains bounded by source tier and directness rather than formal RoB certification."},{"id":"claim_23","type":"claim","text":"Evidence-tension synthesis: claims grouped by outcome class (cardiometabolic, cognitive, contextual adjacent evidence, deficiency prevalence, dosing and pharmacokinetics, frailty, muscle function, safety and comorbidity, skeletal, fracture, and bone); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates."},{"id":"claim_24","type":"claim","text":"Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary `manifest.json`. Final eligibility and interpretation decisions are author-verified."},{"id":"claim_25","type":"claim","text":"Outcome-class note:** Contextual Adjacent Evidence denotes background, boundary-condition, or adjacent-outcome sources. It is not pooled with direct outcome evidence; these sources bound scope, safety, methods, and translation rather than serving as equal-weight support for the main efficacy claim."},{"id":"claim_26","type":"claim","text":"| Evidence domain | Corpus slice | Strongest signal | Directness | Main limitation |"},{"id":"claim_27","type":"claim","text":"| Physical Exercise Effects / Contextual Adjacent Evidence | n=35; claims=1431 | significant source statistic in 25/35 sources; receipt-level direction coded unclear | 3 direct; 11 indirect; 1 protocol; 20 review | limited corpus depth in this outcome class |"},{"id":"claim_28","type":"claim","text":"| Physical Exercise Effects / Frailty | n=1; claims=105 | significant source statistic in 1/1 sources; receipt-level direction coded null | 1 review | single-source slice; hypothesis-generating |"},{"id":"claim_29","type":"claim","text":"Contextual Adjacent Evidence: n=35; claims=1431; mixed signal in 20/35 sources | directness: 3 direct; 11 indirect; 20 review; 1 protocol; main limitation: directionally heterogeneous."},{"id":"claim_30","type":"claim","text":"The cardiometabolic evidence base for physical exercise effects spans three principal sources, each anchored in different study designs and populations. Pela 2025 reported on a randomized control trial conducted in frail, sarcopenic older subjects aged 70 years or older, evaluating a two-year adapted physical exercise program combined with nutritional counselling on cardio-sarcopenia syndrome, with multiple endpoints reaching statistical significance (P = 0.004, P = 0.037, P = 0.034, P < 0.001, P = 0.012, P < 0.05, P = 0.038, P < 0.005, P = 0.003). Ancin-Oses 2025 contributed a systematic review with meta-analysis of randomized controlled trials examining physical exercise on metabolic syndrome in psychotic disorders, pooling across enrolled trials. Kazeminasab 2024 provided a systematic review and meta-analysis of clinical studies evaluating intermittent fasting combined with physical exercise on cardiometabolic outcomes. Together these sources define a cardiometabolic outcome class whose evidence strength depends on population, intervention pairing, and endpoint specificity."},{"id":"source_1","type":"source","study":"Effects of physical exercise on the lipid profile of perimenopausal and postmenopausal women: a systematic review and meta-analysis","year":2025,"doi":"10.1590/1414-431X2025e14194","url":"https://doi.org/10.1590/1414-431X2025e14194","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Bernal 2025","excerpt":"During the climacteric period, the decline in ovarian hormones leads to changes in the lipid profile. Physical exercise is the main non-pharmacological recommendation for controlling lipid levels. However, the effects on the lipid profile in perimenopausal and postmenopausal women are incipient and inconclusive. In this context, we searched the Embase, PubMed, Scopus, and Web of Science databases for randomized clinical trials on the effects of exercise on the lipid profile of these women. We excluded studies that did not specify criteria for classifying the climacteric phase, that involved women undergoing hormone replacement therapy, or that examined combined treatments or acute effects of physical exercise. The meta-analysis indicated that general physical exercise increased high-density lipoprotein cholesterol (HDL-C) levels (mean difference [MD]=4.89; 95% confidence interval [95%CI]=0.97 to 8.81) in perimenopausal women. For obese postmenopausal women, 16 weeks of aerobic training increased HDL-C levels (MD=3.88; 95%CI=0.56 to 7.20) and reduced total cholesterol (MD=-22.36; 95%CI=-29.67 to -15.05) and low-density lipoprotein cholesterol (LDL-C) levels (MD=-17.86; 95%CI=-25."},{"id":"source_2","type":"source","study":"EFFECT OF PHYSICAL EXERCISE ON THE HEALTH-RELATED QUALITY OF LIFE ASSESSED BY CLDQ OF LIVER CIRRHOSIS PATIENTS: SYSTEMATIC REVIEW WITH META-ANALYSIS","year":2025,"doi":"10.1590/S0004-2803.24612025-024","url":"https://doi.org/10.1590/S0004-2803.24612025-024","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"CORREA 2025","excerpt":"OBJECTIVE: To verify the effect of physical exercise on the quality of life of patients with liver cirrhosis (LC). METHODS: the sample included controlled and randomized experimental studies of individuals with LC, at any stage of the disease, over 18 years of age, of both sexes, who performed any type of physical exercise compared to any other intervention or no intervention, with quality of life as the outcome assessed by the Chronic Liver Disease Questionnaire (CLDQ). The search for articles was conducted in 11 databases. The descriptors considered for the search were physical exercise, quality of life, liver cirrhosis, and their synonyms. The methodological quality and study bias were assessed using the Jadad scale and the RoB 2 scale, respectively. Review Manager 5.4 was used for the meta-analysis of the data. Quality of life was considered a continuous variable. The mean difference was considered as the effect measure. The analysis model was fixed-effect. The confidence level adopted was .05. The level of evidence for the meta-analysis results was assessed using the GRADE tool."},{"id":"source_3","type":"source","study":"Effects of different physical exercise programs on blood pressure in overweight children and adolescents: systematic review and meta-analysis","year":2025,"doi":"10.1186/s12887-025-05575-y","url":"https://doi.org/10.1186/s12887-025-05575-y","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Tozo 2025","excerpt":"AIMS: The purpose of this meta-analysis was to systematically review studies in the literature that evaluated the effect of different exercise programs on blood pressure in overweight children and adolescents. DATA SOURCES: In September 2024, studies were searched in six electronic databases (PubMed, Web of Science, Scopus, Sportdiscus, Lilacs, and Scielo) and in reference lists. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Randomized and non-randomized controlled trials with interventions involving physical exercise programs and assessment of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in children and adolescents with overweight and/or obesity were considered for synthesis. STUDY APPRAISAL AND SYNTHESIS METHODS: The quality of studies was assessed using the PEDro scale for studies with randomized clinical trials. Meta-analysis was conducted using a random model in the Review Manager Software. RESULTS: Seventeen studies were selected that involved 1,125 children and adolescents. The risk of bias score was considered moderate (five to eight points out of 11)."},{"id":"source_4","type":"source","study":"Effects of physical exercise in patients undergoing haematopoietic stem cell transplantation: systematic review and meta-analysis","year":2025,"doi":"10.1007/s00520-025-10194-5","url":"https://doi.org/10.1007/s00520-025-10194-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Martin-Sanchez 2025","excerpt":"PURPOSE: To evaluate the effects of physical exercise on key clinical outcomes (such as quality of life (QoL), aerobic capacity, fatigue, and muscle strength) in patients undergoing haematopoietic stem cell transplantation. METHODS: PRISMA systematic review and meta-analysis from inception to April 2025. PubMed, Embase, Cochrane Library, Web of Science and Scopus databases were searched for eligible studies. Methodological quality and risk of bias were evaluated with the Pedro scale and the Risk-Of-Bias Tool for randomized trials (ROB2.0) respectively. RESULTS: An initial search retrieved 5217 articles. Finally, 20 studies were included in the qualitative synthesis and 7 in the meta-analysis. Exercise showed a small, non-significant effect on QoL (SMD = 0.23; p = 0.072), and a significant moderate effect on functional capacity (SMD = 0.43; p = 0.002). No significant effects were found on fatigue (SMD = - 0.05; p = 0.819) or handgrip strength (SMD = 0.21; p = 0.201), although a large and significant effect was observed for lower limb strength (SMD = 1.48; p < 0.001)."},{"id":"source_5","type":"source","study":"The role of physical exercise in enhancing Health, quality of life and joy among older adults","year":2025,"doi":"10.1038/s41598-025-26683-w","url":"https://doi.org/10.1038/s41598-025-26683-w","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Cabo 2025","excerpt":"Physical exercise (PE) plays a vital role in promoting health, quality of life (QoL), and well-being in older adults. It helps prevent chronic diseases, improves strength, balance, and cognitive function, and reduces fall risk. Enjoyment and psychological engagement are also essential for long-term adherence. This randomized controlled trial (RCT) study aimed to examine the effects of a 24-week structured sensorimotor training program on physical activity (PA) levels, body composition, quality of life, and enjoyment in older adults. A total of 124 participants (65-80 years old) were allocated to an experimental group (EG, n = 46) or control group (CG, n = 78). The EG engaged in a 24-week supervised sensorimotor training program, while the CG maintained their usual lifestyle. PA levels were assessed using the International Physical Activity Questionnaire - Short Form (IPAQ-SF); enjoyment of PA was evaluated using the Physical Activity Enjoyment Scale (PACES); and QoL was measured with the SF-36 questionnaire. Body composition, PA, and QoL were evaluated at baseline and post-intervention. Both groups showed small reductions in body composition measures."},{"id":"source_6","type":"source","study":"Residual Effects of Physical Exercise After Periods of Training Cessation in Older Adults: A Systematic Review With Meta‐Analysis and Meta‐Regression","year":2025,"doi":"10.1111/sms.70010","url":"https://doi.org/10.1111/sms.70010","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"BuendiaRomero 2025","excerpt":"We aimed to determine the persisting effects of various exercise modalities and intensities on functional capacity after periods of training cessation in older adults. A comprehensive search was conducted across the Cochrane Library, PubMed/MEDLINE, Scopus, and Web of Science Core Collection up to March 2024 for randomized controlled trials examining residual effects of physical exercise on functional capacity in older adults ≥ 60 years. The analysis encompassed 15 studies and 21 intervention arms, involving 787 participants. The exercise and training cessation periods ranged from 8 to 43 weeks and 4 to 36 weeks, respectively. Meta-analyses were performed using change scores from before the physical exercise to after the training cessation. The effect sizes (ES) were calculated as the standardized mean differences between the intervention and control groups' change scores."},{"id":"source_7","type":"source","study":"Effects of two-year adapted physical exercise program and nutritional counselling on cardio-sarcopenia syndrome in older adults with low muscle function","year":2025,"doi":"10.1186/s11556-025-00377-8","url":"https://doi.org/10.1186/s11556-025-00377-8","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Pela 2025","excerpt":"BACKGROUND: Frail, sarcopenic older individuals have high risk of cardiovascular events and require multidomain interventions. The cross-talk between cardiac and skeletal muscle mass is crucial to maintain physical independence in this specific population. The aim of the study was to evaluate, in a selected sample of frail, sarcopenic older adults, the influence of a two-year multimodal intervention, composed by exercise program and nutritional counseling, compared to a lifestyle education program, on echocardiographic parameters and the relationship between left ventricular mass and skeletal muscle. METHODS: One-hundred subjects, among those enrolled in the SPRINTT trial at Frailty Clinic of the University-Hospital of Parma, underwent cardiac examination as part of the ancillary protocol CARDIOSPRINTT. Eighty-two participants completed the protocol and attended the final visit after approximately 25 months from enrolment. RESULTS: We did not find significant changes in the intervention group compared with the control one."},{"id":"source_8","type":"source","study":"The Effects of Exercise Intervention in Older Adults With and Without Sarcopenia: A Systematic Review","year":2025,"doi":"10.3390/sports13050152","url":"https://doi.org/10.3390/sports13050152","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Cabrolier-Molina 2025","excerpt":"This systematic review, conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42024619693), aimed to evaluate the effects of physical exercise interventions on muscle function and fall risk in older adults with and without sarcopenia. Methods : A comprehensive search of PubMed and Web of Science databases identified 11 randomized controlled trials (RCTs) published between 2015 and 2025. A total of 792 participants (mean age 75.13 ± 4.71 years; 65.53% women, 34.47% men) were included. Interventions varied in type-strength, balance, aerobic, and multi-component programs-with a minimum duration of 8 weeks. Results : The reviewed studies showed that physical exercise interventions significantly improved neuromuscular function, physical performance, and postural control in older adults. Positive effects were observed in gait speed, stair-climbing ability, grip strength, muscle mass, and bone density."},{"id":"source_9","type":"source","study":"Benefits of physical activity on cognitive function in patients with neurocognitive disorders: A systematic review","year":2025,"doi":"10.1016/j.tjfa.2025.100069","url":"https://doi.org/10.1016/j.tjfa.2025.100069","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Decaix 2025","excerpt":"Neurocognitive disorders, particularly in older adults, significantly affect functional abilities and global health. Physical activity has emerged as a potential non-pharmacological intervention to improve cognitive performance in patients with neurodegenerative diseases. This review specifically addressed the issue of tailored physical activity interventions for individuals with various neurocognitive disorders. This literature review analyzed studies investigating the effects of physical activity on cognitive function in patients with Alzheimer's disease (AD), vascular cognitive impairment, Parkinson's disease, and Lewy body dementia. The studies were evaluated for methodological rigor, participant characteristics, types of physical activities, and cognitive outcomes. Of the 21 studies reviewed, 14 reported beneficial effects of physical exercise on cognitive function, particularly with aerobic activities. While most studies observed improvements in cognitive performance and physical functional capacity, results were inconsistent, and effect sizes were modest."},{"id":"source_10","type":"source","study":"Is Adapted Physical Exercise an Innovative Adjuvant Approach to Combine with Low-Protein Diet in Chronic Kidney Disease?","year":2026,"doi":"10.3390/nu18101557","url":"https://doi.org/10.3390/nu18101557","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Murri 2026","excerpt":"Background: In chronic kidney disease (CKD) treatment, a holistic approach, which involves not only nephrologists but also nutritionists, sports physicians, and kinesiologists, is becoming increasingly important, characterized as including not only pharmacological therapy but also integrative treatments, i.e., nutritional therapies (like low protein diet-LPD) and adapted physical exercise (APE) programs. The aim of this study was to evaluate the potential adjuvant therapeutic role of an integrated APE + LPD program on CKD comorbidities, comparing its additional beneficial effects with those induced by the LPD alone. Methods: This clinical study is a randomized controlled trial, where 40 CKD patients (stage G3b-G5) were enrolled and divided into two homogeneous groups: an APE + LPD group, which performed an online APE protocol combined with LPD; and an LPD group, which received only LPD. All enrolled patients were evaluated at baseline (T 0 ) and after 12 weeks (T 1 ) for clinical and body composition parameters and for functional assessment and health-related quality of life (HRQoL). Results: Both groups showed a significant reduction in lipid and glucose metabolism parameters."},{"id":"source_11","type":"source","study":"Feasibility of a Pre-Operative Morphofunctional Assessment and the Effect of an Intervention Program with Oral Nutritional Supplements and Physical Exercise","year":2025,"doi":"10.3390/nu17091509","url":"https://doi.org/10.3390/nu17091509","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Mudarra-Garcia 2025","excerpt":"Background: Surgical patients often experience nutritional imbalances due to their underlying condition and the forthcoming surgical procedure. These imbalances can increase the risk of post-operative complications. To mitigate such risks, a comprehensive nutritional assessment-also known as morphofunctional assessment-should be conducted. This includes evaluating body composition (muscle and fat mass), muscle strength, and functional capacity. Methods: We conducted an observational, prospective, pre-post interventional study involving 138 patients undergoing major elective surgery. Each patient received a morphofunctional assessment and an individualized prehabilitation program, including nutritional supplementation, physical exercise, and comorbidity optimization for 21 days before surgery and one month afterward. Outcomes were assessed through bioimpedance (muscle mass), muscle ultrasound (QRF thickness), dynamometry (strength), and visceral fat ultrasound (fat reduction)."},{"id":"source_12","type":"source","study":"Long-term home-based physical exercise, pain, and use of pain medication over a year after hip fracture – A secondary analysis of a randomised controlled trial","year":2025,"doi":"10.1177/02692155251389435","url":"https://doi.org/10.1177/02692155251389435","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Suikkanen 2025","excerpt":"ObjectiveTo study the effects of a year-long, supervised home-based exercise training on perceived pain, pain interference, and use of pain medication over 12 months after hip fracture.DesignRandomised clinical trial, secondary analysisSettingHomeParticipantsParticipants ( n = 121) had surgical repair of a hip fracture, were ≥60 years old, and community-living.InterventionParticipants were allocated into 12-month home-based Physical Exercise ( n = 61) or Usual Care ( n = 60). Exercise sessions (60 minutes/twice a week) at participants' home under physiotherapist supervision including strength, balance, and functional exercises.Main measuresPain intensity, interference, and locations, and information of the pain medication were queried at baseline, 3, 6 and 12 months.ResultsThe mean age was 81 (SD 7) years, 91 (75%) were women, and 74 (61%) had fractured femoral neck. At baseline, in Physical Exercise 46 (75%) and in Usual Care 43 (72%) reported some sort of pain. After discharge, 118 (98%) used pain medication: 116 (96%) paracetamol and 41 (34%) opioids."},{"id":"source_13","type":"source","study":"Benefits of physical exercises in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials","year":2026,"doi":"10.1080/0886022X.2026.2654288","url":"https://doi.org/10.1080/0886022X.2026.2654288","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Chen 2026a","excerpt":"Physical exercise has been proven to be beneficial for chronic kidney disease (CKD) patients; however, there is a lack of a comprehensive summary of existing literature, especially the results from randomized controlled trials (RCTs). We had conducted a systematic review and meta-analysis to evaluate the benefits of physical exercise in chronic kidney disease. Outcomes were classified into all-cause mortality, cardiovascular, pulmonary, and renal outcomes, inflammatory indices, laboratory tests, and physical indices. The risk of bias was assessed using the Cochrane criteria. Relative risk ratios with 95% confidence intervals (CIs) for categorical variables, and weighted mean difference or standardized mean differences with 95% CIs for continuous variables were pooled using a random-effects model. Publication bias was assessed using Funnel plot analysis and Egger's Test. At last, 82 studies were included, and the results of the meta-analysis show that the physical exercises can significantly reduce all-cause mortality, particularly in dialysis dependent patients."},{"id":"source_14","type":"source","study":"Comparing Aerobic Interval Training with Other Forms of Physical Exercise for Brachial Artery Endothelial Function Improvement: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials","year":2025,"doi":"10.1186/s40798-025-00929-3","url":"https://doi.org/10.1186/s40798-025-00929-3","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Paravlic 2025","excerpt":"BACKGROUND: Brachial artery endothelial function, measured by the flow-mediated dilatation (FMD) technique, serves as a surrogate for coronary endothelial function and is recognized as an independent predictor of cardiovascular disease risk. Despite the known benefits of physical exercise interventions (PEI) in improving endothelial function, limited evidence exists to guide practitioners on the most effective form of PEI for enhancing endothelial function. The aim of this article is to investigate the effects of different PEI modalities on brachial artery FMD, and to establish the most effective PEI through a systematic review and network meta-analysis (NMA). METHODS: PubMed, WoS, CINAHL, EMBASE, CENTRAL and EBSCOhost search was conducted from inception to February 20th, 2025. Randomized controlled studies investigating the effects of PEI on brachial artery FMD in adults were included. Both pairwise and Bayesian NMA were conducted using random-effects model to compare different PEI modalities within primary (aerobic training, resistance training and combined training) and secondary (continuous aerobic training vs. interval aerobic training vs. dynamic resistance training vs."},{"id":"source_15","type":"source","study":"Feasibility and effectiveness of physical exercise for older adults delivered remotely via videoconferencing—systematic review and meta analysis","year":2025,"doi":"10.1093/ageing/afaf171","url":"https://doi.org/10.1093/ageing/afaf171","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Toledano-Shubi 2025","excerpt":"BACKGROUND: Physical activity promotes healthy ageing. Videoconferencing enables delivery of accessible exercise therapy, supporting older adults in engaging in structured physical activity. OBJECTIVES: To investigate the feasibility and effectiveness of remotely supervised videoconferencing exercise therapy for adults over 65. DATA SOURCES: Nine databases were searched, with manual search completed in March 2025. STUDY SELECTION: Randomised controlled trials assessing remote exercise effectiveness or feasibility, delivered via videoconference with professional real-time interaction. DATA EXTRACTION AND SYNTHESIS: Two authors independently screened studies, extracted data, and assessed methodological quality. Meta-analysis used random effects models, with primary conclusions based on high methodological quality studies. RESULTS: Twenty-eight studies (n = 2086) were analysed. Results are given for the 18 high-quality studies, including 7 low and 11 moderate risks of bias studies. Average attendance and completion rates were 79.7% and 92.8%, respectively. In videoconference exercise, the number of adverse events was comparable to control groups."},{"id":"source_16","type":"source","study":"Effects of physical exercise on aggressive behavior in children and adolescents: a systematic review and meta-analysis","year":2025,"doi":"10.1186/s12889-025-25267-7","url":"https://doi.org/10.1186/s12889-025-25267-7","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Zhao 2025","excerpt":"BACKGROUND: Physical exercise is recognized as a cost-effective intervention for mitigating aggressive behavior; however, its impact on aggression in children and adolescents remains inconclusive. The aim of this study was to investigate the effects of physical exercise on aggressive behavior in this population and to perform subgroup analyses to examine potential moderating factors. METHODS: We searched five databases (PubMed, Web of Science, Scopus, EBSCOhost, and China National Knowledge Infrastructure (CNKI)) for studies published up to December 25, 2024, that tested physical activity programs for reducing aggression in children and teenagers. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. The standardized mean difference (SMD) was calculated as the outcome indicator, which was based on the mean and standard deviation (SD) of the aggression scores before and after the physical exercise intervention. The data were analyzed with RevMan 5.4 and Stata 15 software using a random effects model. RESULTS: Eighteen studies involving 2,479 participants were included."},{"id":"source_17","type":"source","study":"Personalized Diet With or Without Physical Exercise Improves Nutritional Status, Muscle Strength, Physical Performance, and Quality of Life in Malnourished Older Adults: A Prospective Randomized Controlled Study","year":2025,"doi":"10.3390/nu17040675","url":"https://doi.org/10.3390/nu17040675","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Arici 2025","excerpt":"Objectives: Malnutrition (MN) is prevalent in older adults and closely related to sarcopenia, frailty, morbidity, mortality, and decreased quality of life. In this study, we aimed to evaluate the effects of a personalized diet combined with planned physical exercise on nutritional status, physical performance, and quality of life (QoL) in malnourished older adult patients. Methods: In this prospective study, 20 older adults with MN risk according to the Mini Nutritional Assessment-Short Form (MNA-SF) were randomized into (i) personalized diet (PD) and (ii) personalized diet with physical exercise (PDE) groups, and followed up with for 12 weeks. The physical exercise included warm-up, strengthening, balance, and cooldown phases, with a frequency of 3-4 days per week. Anthropometric measurements, physical performance, and quality of life were assessed using standardized tools at baseline and at the 4th, 8th, and 12th weeks. QoL was measured using the EQ-5D index and EQ-5D visual analog scale (VAS) scores. Results: A total of 20 patients (55% male) participated in the study."},{"id":"source_18","type":"source","study":"The Chain Mediation Role of Self-Efficacy, Health Literacy, and Physical Exercise in the Relationship Between Internet Use and Older Adults’ Health: Cross-Sectional Questionnaire Study","year":2025,"doi":"10.2196/73242","url":"https://doi.org/10.2196/73242","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Liao 2025","excerpt":"BACKGROUND: With the widespread use of the internet, the number of older internet users is rapidly increasing. However, the role of individual factors such as self-efficacy, health literacy, and physical exercise in the chain of influence between internet use and the health of older adults is unclear. OBJECTIVE: On the basis of the media effects theory and the health belief model, we aimed to explore the relationship between internet use and self-rated health among Chinese older adults. We also analyzed the mediating roles of self-efficacy, health literacy, and physical exercise and examined how these mediating effects varied by sex, residence, and per capita monthly household income groups. In addition, we investigated the moderating effect of education level. METHODS: We included 1147 participants aged ≥60 years from the 2021 Psychology and Behavior Investigation of Chinese Residents project in this study. Using a combination of multiple linear regression and bootstrap testing, we constructed a chain mediation model and a moderated chain mediation model to examine how internet use affects older adults' health through self-efficacy, health literacy, and physical exercise."},{"id":"source_19","type":"source","study":"Physical Activity Improves Quality of Life in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta‐Analysis","year":2026,"doi":"10.1002/jcsm.70206","url":"https://doi.org/10.1002/jcsm.70206","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kasznar 2026","excerpt":"BACKGROUND: Patients with inflammatory bowel disease (IBD) are often less active physically and experience impaired bone mineral density (BMD) as well as sarcopenia, which are associated with a higher risk of poor disease outcomes. Physical exercise can improve BMD and sarcopenia and may also play a role in controlling inflammation via anti-inflammatory myokines. This study aimed to evaluate the effects of structured physical exercise on the disease activity and quality of life of patients with IBD by conducting a before-and-after analysis. METHODS: We conducted a systematic search on 16 November 2023. Studies with structured exercise interventions in patients with IBD focusing on quality of life, disease activity, body composition, muscle strength, inflammatory markers, aerobic fitness and sedentary time were included. The mean difference (MD) or the standardized MD (SMD) of the differences between the before and after values was used to measure the effect size with a 95% confidence interval (CI). Risk of bias was assessed using the MINORS tool. RESULTS: Twenty-one studies involving 498 patients with IBD were included. Quality of life improved significantly: SMD 0.55 (CI, 0.30-0."},{"id":"source_20","type":"source","study":"The Effects of Various Types of Physical Exercise on Health Outcomes in Older Adults with Depression: A Systematic Review and Meta-Analysis of Controlled Trials","year":2024,"doi":"10.1155/2024/9363464","url":"https://doi.org/10.1155/2024/9363464","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Alowaydhah 2024","excerpt":"METHODS: An electronic search of five databases was used to retrieve controlled studies investigating health-related outcomes associated with any type of PE, in adults over 65 years with depression. Where possible, data were analyzed in meta-analyses or else reported narratively. Results and Discussion . Fifteen studies were included in the review. All 15 studies had data available for meta-analysis, yet heterogeneity in exercise types and outcome measures limited synthesis. When data for all types of exercise were pooled together, significant improvements were found in depression (SMD = 0.52; CI = 0.07, 0.97; p = 0.02), physical health and function (SMD = 0.44, CI = 0.14, 0.74; p = 0.004), anxiety (SMD = 0.23; CI = 0.04, 0.42; p = 0.02), and self-efficacy (SMD = 0.97; CI = 0.32, 1.61; p = 0.003). When data were pooled according to exercise type, positive effects were demonstrated for aerobic exercise on depression (SMD = 0.49; CI = -0.16, 0.8; p = 0.003), tai chi/qigong on depression (SMD = 0.89; CI = -0.14, 1.63; p = 0.02), and self-efficacy (SMD = 6.70; CI = -0.90, 12.50; p = 0.02) and multicomponent exercise demonstrated positive effects on physical function (SMD = 0."},{"id":"source_21","type":"source","study":"Effects of High-Dose Vitamin D Supplementation and Physical Exercise on Vitamin D Metabolites in Professional Football Players: A Pilot Study","year":2026,"doi":"10.3390/nu18010175","url":"https://doi.org/10.3390/nu18010175","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Ksiazek 2026","excerpt":"Results : Physical exercise during the football match significantly increased serum concentrations of 25-(OH)D 3 , 24,25-(OH) 2 D 3 , and 3- epi -25-(OH)D 3 (by up to 25%, p < 0.001). The method has satisfactory sensitivity at a limit of quantification (LOQ) of 0.1 ng/mL and appropriate analytical parameters (varying between analytes) including linearity (R2 greater than 0.995) recovery (95-98%), precision (less than 5%) and accuracy (relative bias less than 10%)."},{"id":"source_22","type":"source","study":"E-based physical exercise in patients with multiple sclerosis and comorbidity (COMPACT): feasibility study and protocol for a randomized controlled trial","year":2026,"doi":"10.3389/fimmu.2026.1625017","url":"https://doi.org/10.3389/fimmu.2026.1625017","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Adnan 2026","excerpt":"BACKGROUND: Comorbidity is prevalent among people with multiple sclerosis (pwMS) and may contribute to disease progression. Physical exercise (PE) reduces symptoms in pwMS and also benefits comorbidities. Digital (e)-based PE has been proposed as a tool to support the integration of PE. AIMS: To describe a protocol for a randomized controlled trial (RCT) based on a structured approach and the results from a controlled feasibility study of an e-based PE intervention in pwMS with and without comorbidities. METHOD: In a RCT following a feasibility study (n=50), patients will be randomly assigned in a 1:1 ratio to receive either usual care (n=150) or usual care plus an e-based PE program at home (n=150). The exercise program consists of resistance training with resistance bands targeting the lower extremities. The sessions will enable participants to engage in group exercises from their homes, supervised online by physiotherapists, two 60-minute sessions per week for 6 months (24 weeks and 48 sessions). The primary endpoint is change of walking capacity using the 6-minutes' walk test."},{"id":"source_23","type":"source","study":"The Effects of Physical Exercise on the Social Adaptation of Older Adults—With Reference to the Mediating Effect of Aging Identity","year":2025,"doi":"10.3390/bs15111491","url":"https://doi.org/10.3390/bs15111491","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Zhang 2025","excerpt":"Maintaining social adaptation in later life has become a key challenge amid China's rapidly aging population. Using nationally representative data from the China Longitudinal Aging Social Survey (CLASS 2023), this study examined the relationship between physical exercise and social adaptation among 8913 older adults. Ordinary least squares regression and the Karlson-Holm-Breen decomposition method were applied to test both direct and mediating effects. The results showed that physical exercise significantly improved social adaptation (β = 0.452, p < 0.001), while aging identity played a partial mediating role, accounting for approximately 11.0% of the total effect. The association was stronger among those aged 80 and above, with lower education and income, without chronic diseases, and covered by social security. These findings suggest that physical exercise enhances social adaptation not only through physical benefits but also by strengthening psychological resilience and fostering a positive sense of aging, providing valuable evidence for developing inclusive aging policies and targeted exercise interventions."},{"id":"source_24","type":"source","study":"Effects of physical exercise on metabolic syndrome in psychotic disorders: A systematic review with meta-analysis of randomized controlled trials","year":2025,"doi":"10.1192/j.eurpsy.2025.10064","url":"https://doi.org/10.1192/j.eurpsy.2025.10064","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ancin-Oses 2025","excerpt":"BACKGROUND: Physical exercise improves mental and physical health of individuals with severe mental illness (SMI); however, its impact on metabolic syndrome remains unclear. AIMS: To evaluate the effects of exercise interventions on metabolic syndrome components in individuals with SMI and explore interactions between exercise and antipsychotic medications on metabolic outcomes. METHODS: Following PRISMA guidelines, we systematically searched PubMed, CINAHL, Web of Science, and APA PsycINFO through October 10, 2023, for randomized controlled trials (RCTs) assessing the effects of exercise on waist circumference, blood pressure, glucose, triglycerides, and HDL cholesterol in SMI. Risk of bias was evaluated using the Cochrane RoB-2 tool. Data were pooled using random-effects models in Comprehensive Meta-Analysis and JASP. RESULTS: Ten RCTs ( N = 773; mean age 39.9 ± 7.36 years; 38.7% female; 71.5% schizophrenia spectrum disorders) met inclusion criteria. Pooled analyses revealed no significant effects of exercise on waist circumference (SMD = 0.206, 95% CI [-0.118, 0.530], p = 0.171), systolic blood pressure (SMD = 0.194, 95% CI [-0.115, 0.504], p = 0."},{"id":"source_25","type":"source","study":"Impact of physical exercise on health and social interaction in older adults: a meta-analysis","year":2025,"doi":"10.3389/fpubh.2025.1634313","url":"https://doi.org/10.3389/fpubh.2025.1634313","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Tao 2025","excerpt":"BACKGROUND: This study aimed to evaluate the effect of physical exercise on the physical and mental health of older adults using meta-analysis and to analyze the moderating variables influencing this relationship. The goal was to provide a scientific basis for identifying effective exercise methods to enhance the physical and mental health of the older adults. METHODS: A literature search was conducted in databases such as PubMed, Web of Science, Cochrane Library, and Google Scholar. Data were processed using Review Manager 5.4 and Stata 18.0 statistical software. Meta-analysis was performed using the random effects model, and relevant moderating variables were tested. RESULTS: The study findings indicated that physical activity significantly improves the physical and mental health of older adults across various dimensions. Specifically, it showed a large effect size for enhancing social interactions (standardized mean difference (SMD) = 0.78, 95% confidence interval (CI) [0.14, 0.69], P = 0.0002), a medium effect size for improving physical health (SMD = 0.42, 95% CI [0.20, 0.48], P = 0.003), and a small effect size for improving mental health (SMD=0.34, 95% CI [0.37, 1."},{"id":"source_26","type":"source","study":"Cognitive and physical exercise to improve outcomes after surgery (COPE-iOS) study: protocol for a randomised, controlled trial in the USA examining the efficacy of a combined cognitive and physical exercise programme performed before and after major surgery in improving cognitive and functional out","year":2026,"doi":"10.1136/bmjopen-2025-110435","url":"https://doi.org/10.1136/bmjopen-2025-110435","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Rengel 2026","excerpt":"INTRODUCTION: Surgery and its resulting hospitalisation are associated with subsequent cognitive and functional decline. Interventions to reduce this decline have exhibited limited success. Prehabilitation is the process of enhancing capacity and reserve before an acute stressor to improve tolerance of the acute physiologic insult. Older adults requiring major surgery are an ideal population for prehabilitation. Prehabilitation exercise studies have mostly focused on physical training to improve physical outcomes after specific surgery types, and data on cognitive outcomes and in broader surgical populations are needed. Computerised cognitive training (CCT) has been shown to enhance memory, processing speed, attention and multitasking. Combining CCT with a physical exercise may be most effective in reducing cognitive and functional decline in older patients undergoing major surgery, but has yet to be evaluated."},{"id":"source_27","type":"source","study":"The correlation between physical exercise and cognitive function in older adults with cognitive impairment mediated by inhibitory control and possible cognitive processing mechanisms","year":2026,"doi":"10.3389/fpubh.2026.1818047","url":"https://doi.org/10.3389/fpubh.2026.1818047","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Xie 2026","excerpt":"PURPOSE: Cognitive impairment is currently a prominent age-related challenge among older adults. This study examined the relationships between inhibitory control, cognitive function, EEG indicators, and physical exercise in older adults with cognitive impairment, and explored the mediating roles of EEG indicators and inhibitory control in the association between physical exercise and cognitive function. PATIENTS AND METHODS: A total of 239 older adults were recruited, of whom 209 were included in the final analysis. Cognitive function and physical exercise were assessed using the Montreal Cognitive Assessment (MoCA) and Physical Activity Rating Scale-3 (PARS-3), respectively. Inhibitory control was evaluated using the Stroop task and 5 min of resting-state EEG signals were recorded. RESULTS: Cognitive function was significantly associated with inhibitory control in older adults with cognitive impairment. θ (FP1 + FP2) power emerged as a specific EEG indicator correlated with both cognitive function and inhibitory control. A significant negative correlation was observed between physical exercise volume and resting-state θ (FP1 + FP2) power ( r = -0.288, p < 0.05)."},{"id":"source_28","type":"source","study":"Physical Exercise or Cognitive Behavioral Therapy for Takotsubo Cardiomyopathy: A Randomized Controlled Trial","year":2025,"doi":"10.1161/CIRCHEARTFAILURE.125.013229","url":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.013229","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Gamble 2025","excerpt":"BACKGROUND: Takotsubo cardiomyopathy is an acute cardiac emergency presenting with severe left ventricular dysfunction. Physical exercise training or cognitive behavioral therapy may enhance myocardial recovery after takotsubo cardiomyopathy. METHODS: In a prospective multicenter clinical trial conducted between February 2020 and August 2023, patients with acute takotsubo cardiomyopathy were randomized 1:1:1 to physical exercise training, cognitive behavioral therapy, or standard care for 12 weeks after index presentation. The primary end point was resting phosphocreatine/gamma-ATP ratio assessed by 31 P-magnetic resonance spectroscopy. Secondary end points were the rate of oxygen consumption at peak exercise on cardiopulmonary exercise testing, 6-minute walk distance, left ventricular global longitudinal strain, and the Minnesota Living With Heart Failure Questionnaire. Twelve-week changes in outcome were compared between allocated trial interventions. RESULTS: Seventy-six participants were recruited: the median age was 66 years, and 91% were women."},{"id":"source_29","type":"source","study":"Impact of exercise type, duration, and intensity on depressive symptoms in older adults: a systematic review and meta-analysis","year":2024,"doi":"10.3389/fpsyg.2024.1484172","url":"https://doi.org/10.3389/fpsyg.2024.1484172","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Li 2024a","excerpt":"OBJECTIVE: This systematic review and meta-analysis assessed the effects of three types of physical exercise (resistance exercise, aerobic exercise, and group exercise), different exercise intervention times (3 months, 6 months), and different exercise intensities (low, moderate, and high) on the improvement of depressive symptoms in older adults aged ≥60 years, as well as to explore the impact of the sustainability of these physical exercise intervention programs on depressive symptoms in older adults. METHODS: The randomized controlled trials (RCTs) on the effect of physical exercise on depressive symptoms in older adults were retrieved from Cochrane Library, Web of Science, PubMed, and Embase Data. The retrieval time limit is from establishing the database to January 7, 2024. We conducted a meta-analysis using a 95% confidence interval (95% CI) and the standardized mean differences (SMD). The I 2 statistic was used to assess the heterogeneity of the outcomes of the studies. When I 2 < 50%, we used the fixed-effects model, and when I 2 > 50%, we used the random-effects model. Subgroup and sensitivity analyses investigated heterogeneity origins."},{"id":"source_30","type":"source","study":"The impact of social activities and physical exercise on arterial stiffness (AIP) among older Chinese adults from CHARLS","year":2025,"doi":"10.1097/MD.0000000000043654","url":"https://doi.org/10.1097/MD.0000000000043654","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Zhong 2025","excerpt":"The atherogenic index of plasma (AIP), a biomarker reflecting lipid metabolism and atherosclerotic risk, is increasingly recognized as a critical indicator in cardiovascular health. However, the influence of social activities and physical exercise on AIP, particularly with respect to sex-specific differences, remains underexplored. This study examined these associations using data from 3278 participants aged 60 years or older in the 2015 wave of the China Health and Retirement Longitudinal Study. Results showed that sedentary social activities, such as playing Mahjong or chess, were significantly associated with elevated AIP levels, particularly in females (β = 0.043, P < .05). In contrast, vigorous physical activity significantly reduced AIP levels in both males (β = -0.089, P < .001) and females (β = -0.065, P < .01), with stronger effects observed in males. Moderate and light physical activities showed no significant associations with AIP. These findings highlight the sex-specific associations between social and physical activities and AIP levels in older adults."},{"id":"source_31","type":"source","study":"Association between physical exercise and reemployment among Chinese older adults: the mediation effect of physical health, cognitive function, and social participation","year":2026,"doi":"10.3389/fpubh.2026.1839985","url":"https://doi.org/10.3389/fpubh.2026.1839985","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Wang 2026","excerpt":"OBJECTIVE: This study aims to systematically investigate the effects, mechanisms, and demographic heterogeneity of physical exercise on reemployment among older adults. To address the gaps in current studies, i.e., the lack of exploration of mediating mechanisms and the scarcity of large-sample empirical evidence, this paper provides empirical evidence and practical guidance for activating the human resources of older adults and advancing active aging strategies. METHODS: Data were derived from the 2023 China Longitudinal Aging Social Survey, yielding a sample of 4,597 retired individuals aged 60 and older with complete data. The study treated reemployment as the dependent variable and physical exercise behavior as the primary independent variable, with physical health, cognitive function, and social participation selected as mediating variables. Control variables included factors related to individual and household sociodemographic characteristics. A binary logistic regression model was used to analyze main effects, and the propensity score matching method was employed to address potential endogeneity."},{"id":"source_32","type":"source","study":"Rural active aging as a development strategy: Nexus of physical exercise participation and multidimensional poverty in China","year":2025,"doi":"10.1371/journal.pone.0331199","url":"https://doi.org/10.1371/journal.pone.0331199","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Xia 2025","excerpt":"BACKGROUND: This study aims to assess the intrinsic links between physical exercise and multidimensional poverty among rural older people, focusing on the mediating mechanisms of social and cultural capital, to inform responses to active ageing. METHODS: This study utilized the adult and household databases of the China Household Tracking Survey (CFPS) in 2018 and 2022. Stata17.0 was used to screen and process the data, and the A-F double critical value method was adopted to measure and structurally decompose the multi-dimensional poverty among the elderly of Chinese household farmers. The association between physical exercise participation and multi-dimensional poverty among rural elderly people was estimated using the ordinary Least squares (OLS) method. The mediating effects of social capital and cultural capital were explored by using the stepwise regression method. Finally, the heterogeneous manifestations of the impact of physical exercise participation on multi-dimensional poverty among rural elderly people were investigated by using the grouped regression method."},{"id":"source_33","type":"source","study":"Beneficial effects of physical exercise on the osteo-renal Klotho-FGF-23 axis in Chronic Kidney Disease: A systematic review with meta-analysis","year":2024,"doi":"10.7150/ijms.90195","url":"https://doi.org/10.7150/ijms.90195","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Castillo 2024","excerpt":"The aim of this study was to investigate the efficacy of physical exercise in chronic kidney disease, describing its impact on the Klotho-FGF23 axis. PubMed, Web of Science and Scopus databases, updated to January 2023, were searched. The present study employed mean difference and a 95% confidence interval (CI) to examine the efficacy of the intervention. Heterogeneity was assessed through inconsistency statistics (I2). Out of the 299 studies identified, a total of 4 randomized controlled trials (RCTs), comprising 272 participants, met the eligibility criteria. Compared with the control group, physical exercise significantly decreased the concentrations of FGF23 (MD: -102.07 Pg/mL, 95% CI: -176.23.47, -27.91 I2= 97%, p = 0.001), and a significantly increased the concentrations of Klotho protein: (MD: 158.82 Pg/mL, 95% CI: 123.33, -194.31, I2 = 0%, p = 0.001). The results of our study indicated that the exercise has a direct relationship with Klotho-FGF23 axis. We can conclude that physical exercise in patients with CKD produces beneficial effects on the pathophysiological components related to this disease, including cardiorespiratory fitness and vascular functions."},{"id":"source_34","type":"source","study":"The effect of physical exercise on apathy in older adults: a systematic review and meta-analysis","year":2025,"doi":"10.3389/fpubh.2025.1617272","url":"https://doi.org/10.3389/fpubh.2025.1617272","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Jia 2025","excerpt":"OBJECTIVES: The objectives of this systematic review and meta-analysis were to evaluate the overall efficacy of physical exercise on apathy in older adults and to provide evidence for alleviating and improving apathy. METHODS: This study was conducted following the PRISMA guidelines and the Cochrane Handbook for the Evaluation of Systems of Intervention. A comprehensive search was performed across databases, including Cochrane, EMBASE, PubMed, and Web of Science, with a cutoff date of January 2025. Data extraction, organization, and quality assessment were performed using appropriate software. Stata was used to analyze and process the data and test for publication bias. RESULTS: The analysis included 9 RCTs involving a total of 356 participants. The meta-analysis revealed a significant improvement in apathy (SMD = -0.32; 95% CI -0.53 to -0.11; p < 0.01) after the physical exercise intervention. CONCLUSION: Physical exercise effectively alleviates and improves apathy in older adults. Physical exercise is characterized by low risk and high therapeutic benefits and can be used as an alternative or adjunct to medications for the treatment of apathy."},{"id":"source_35","type":"source","study":"Exergaming Compared to Conventional Physical Exercise Interventions on Health Status in Older People with Parkinson’s Disease: A Systematic Review with Meta-Analysis of Randomized Controlled Trials","year":2025,"doi":"10.3390/medicina61112001","url":"https://doi.org/10.3390/medicina61112001","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Hernandez-Martinez 2025","excerpt":"Background and Objectives : This systematic review aimed to analyze published peer-reviewed studies on the effects of exergaming (EXG) compared to conventional physical exercise (CPE) interventions on health status in older people with Parkinson's disease (PD) according to training dose. Materials and Methods : Using six generic databases: PubMed, EBSCO, Medline, CINAHL Complete, Scopus, and Web of Science, the PRISMA, TESTEX, RoB 2, and GRADE tools assessed methodological quality and certainty. The protocol was registered in PROSPERO (code: CRD42024575969). Results : Out of 805 records, 14 randomized controlled trials with 406 older people with PD were included. Seven overall meta-analyses showed significant improvements ( p < 0.01) in favor of EXG in the Berg Balance Scale (BBS, ES = 0.90), Dynamic Gait Index (DGI, ES = 0.77) and quality of life questionnaire (PDQ-39, ES = 0.52), without significant improvements ( p > 0.05) in the Unified PD Rating Scale, Montreal Cognitive Assessment, Timed Up-and-Go and Falls Efficacy Scale-International. Four subgroup meta-analyses, according to training schedules, showed that there were significant improvements ( p < 0."},{"id":"source_36","type":"source","study":"Does physical exercise inhibit smoking behavior? Evidence from the China General Social Survey","year":2026,"doi":"10.3389/fpubh.2025.1723830","url":"https://doi.org/10.3389/fpubh.2025.1723830","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Zhao 2026","excerpt":"INTRODUCTION: Examining how physical exercise influences smoking behavior and the mediating mechanisms involved helps clarify the broader social benefits of exercise and informs efforts to improve population health and build a more harmonious society. METHODS: This cross-sectional observational study analyzed the nationally representative 2021 China General Social Survey (CGSS). After sample screening, we retained 2,373 valid observations. We estimated OLS models to examine the association between physical exercise and residents' smoking behavior. For robustness, we re-estimated ordered probit and ordered logit specifications and used propensity score matching (PSM) as an endogeneity check against the baseline estimates. We further assessed mediation by mental health and social support and tested the moderating role of individual income. RESULTS: The results showed a significant positive association between physical exercise and reduced smoking ( β = 0.0276), which remained robust after sensitivity and endogeneity checks."},{"id":"source_37","type":"source","study":"Physical Exercise and Brain Health: Exploring Activity Types to Enhance Cognition in Older Adults","year":2025,"doi":"10.1093/geroni/igaf122.2748","url":"https://doi.org/10.1093/geroni/igaf122.2748","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Egbert 2025","excerpt":"This study aimed to examine the relationship between perceived cognitive difficulties (assessed via the Patient Assessment of Own Functioning Inventory-PAOFI), various forms of physical activity (walking, light, moderate, strenuous, and strength/endurance exercises), and sedentary behavior in a sample of adults aged 60-80 years (n = 42). Higher scores on PAOFI Memory Scale were linked to male sex (B=-4.591, p=.003, CI95%=-7.518, -1.665), Caucasian White race/ethnicity (B = 12.538, p=.006, CI95%=3.961, 21.116), and engaging in more physical activities of light (B = 2.982, p=.006, CI95%=.905, 5.058) and moderate intensity (B = 14.093, p=.004, CI95%=4.736, 23.451)."},{"id":"source_38","type":"source","study":"Effectiveness of physical exercise on foot pain and function in adults with rheumatoid arthritis: systematic review and meta-analysis","year":2026,"doi":"10.1007/s10067-026-08044-8","url":"https://doi.org/10.1007/s10067-026-08044-8","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Cruz-Lopez 2026","excerpt":"BACKGROUND: Foot involvement is highly prevalent in rheumatoid arthritis (RA), affecting over 90% of patients during the disease course. However, the specific impact of structured exercise on foot pain and functional limitations remains insufficiently understood. This systematic review and meta-analysis aimed to evaluate the effectiveness of supervised exercise programs on foot-specific outcomes in adults with RA. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines, searching five databases for randomized and controlled quasi-experimental trials evaluating supervised exercise interventions in adults with RA and foot involvement. Primary outcomes included foot pain and physical function measures. Data were pooled using random-effects models, and risk of bias was assessed using Cochrane tools. Analysis was performed with RevMan 5.4 and STATA 17. RESULTS: Thirteen studies (n = 548) were included; ten entered the meta-analysis. Exercise significantly reduced foot pain (SMD - 0.68, 95% CI - 0.89 to - 0.46; p < 0.001) and improved function (Health Assessment Questionnaire SMD - 0.73, 95% CI - 0.96 to - 0.49; 6MWT MD + 47.6 m, 95% CI 31.4 to 63."},{"id":"source_39","type":"source","study":"Measured and supervised physical exercise for older individuals with asthma, chronic obstructive pulmonary disease and obstructive sleep apnoea (MIOLI): protocol of a randomised controlled trial","year":2026,"doi":"10.1136/bmjopen-2026-118045","url":"https://doi.org/10.1136/bmjopen-2026-118045","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Aijo 2026","excerpt":"INTRODUCTION: Asthma, chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are prevalent chronic respiratory diseases associated with increased comorbidity, mortality and healthcare costs. Physical activity and exercise are widely recommended as part of treatment for these conditions, yet the specific effects of Nordic walking (NW) remain underexplored. The aims of this randomised controlled trial (RCT) are to improve physical fitness, functional capacity and respiratory health and increase regular physical activity and quality of life of older adults with asthma and/or COPD and/or OSA through a supervised 3-month group-based NW intervention combined with resistance, balance and mobility training. METHODS AND ANALYSIS: This single-blinded, parallel-group RCT will recruit 100 adults aged 55-80 years diagnosed with asthma and/or COPD and/or OSA in the Northern Savo region of Finland. Participants will be randomly allocated to either an intervention group or a control group."},{"id":"source_40","type":"source","study":"Feasibility and preliminary effects of a mindfulness-based physical exercise (MBPE) program for community-dwelling older people with sarcopenia: A protocol for a parallel, two-armed pilot randomised controlled trial","year":2024,"doi":"10.1371/journal.pone.0302235","url":"https://doi.org/10.1371/journal.pone.0302235","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Li 2024b","excerpt":"INTRODUCTION: Physical exercise (PE) is essential for alleviating the symptoms of sarcopenia. Low motivation is a major barrier to PE. Mindfulness-based intervention (MBI) has the potential to improve motivation. However, few studies have used a mindfulness-based PE (MBPE) intervention among older people with sarcopenia. OBJECTIVES: To assess the feasibility, acceptability and preliminary effects of the MBPE program among community-dwelling older people with sarcopenia. METHODS AND ANALYSIS: A two-arm pilot randomised controlled trial will be conducted to assess the feasibility, acceptability and preliminary effects of an MBPE program among community-dwelling older people with sarcopenia. A total of 60 participants will be randomised into the intervention group, receiving the MBPE intervention twice a week over 12 weeks, or the control group, receiving health education with the same duration, number of sessions and frequency as the intervention group. Each session of the MBPE program will last about 60 min, including 5-10- min introduction, 20-min MBI, 30-min PE and 5-10-min sharing and discussion. The primary outcomes will be the feasibility (i.e."},{"id":"source_41","type":"source","study":"Effects of different types of physical exercise on executive function of older adults: a scoping review","year":2024,"doi":"10.3389/fpsyg.2024.1376688","url":"https://doi.org/10.3389/fpsyg.2024.1376688","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Cai 2024","excerpt":"OBJECTIVE: This scoping review examined the impact of physical exercise on executive function (EF) in older adults and investigated the moderating effects of exercise types. METHODS: We systematically searched four electronic databases for randomized controlled trials (RCTs) investigating the effects of exercise on EF, published until November 26, 2023. The proportions of positive and null/negative effects across all studies were calculated. RESULTS: In total, 91 studies were included in the analysis. Among these, 27 (29.7%) studies employed aerobic exercise interventions for older adults' EF, with 19 (70.4%) studies reporting positive effects. Additionally, 18 (19.8%) studies utilized strength exercise interventions for older adults' EF, with 15 (83.3%) studies demonstrating positive benefits. Furthermore, 32 (35.2%) studies employed coordination exercise interventions for older adults' EF, with 25 (78.1%) studies showing positive benefits. Similarly, 30 (33%) studies applied mixed exercise interventions for older adults' EF, with 25 (83.3%) studies indicating positive benefits."},{"id":"source_42","type":"source","study":"Effects of a smartphone-monitored physical exercise management program on the recovery of patients after endovascular repair of abdominal aortic aneurysm: a randomized controlled trial","year":2026,"doi":"10.1186/s13063-025-08948-x","url":"https://doi.org/10.1186/s13063-025-08948-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Huang 2026","excerpt":"BACKGROUND: Physical exercise is known to enhance vascular function by regulating PPARs, ERs, and RXR signaling pathways. It improves cardiopulmonary capacity through optimized lipid metabolism, immune regulation, and blood pressure reduction. Additionally, exercise reduces postoperative complications by maintaining energy expenditure and skeletal muscle function, which may ultimately improve patients' quality of life (QoL). However, the safety and efficacy of exercise therapy post-endovascular aortic aneurysm repair (EVAR) remain uncertain. Due to the potential impact of exercise training on abdominal pressure, supervised exercise by medical professionals is crucial for ensuring patient safety. Although exercise offers notable benefits, patient adherence tends to be low. Therefore, leveraging smartphones as pervasive monitoring tools may provide timely feedback on patients' exercise status and influence their behavior. This trial aims to assess whether a smartphone-monitored physical exercise management program, including physical exercise interventions under medical supervision for 3 months, affects the short-term QoL of individuals post-EVAR."},{"id":"source_43","type":"source","study":"Transcranial direct current stimulation combined with physical exercise in knee osteoarthritis: a protocol for a randomised controlled clinical trial","year":2025,"doi":"10.1136/bmjopen-2025-100229","url":"https://doi.org/10.1136/bmjopen-2025-100229","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Lima 2025","excerpt":"INTRODUCTION: Osteoarthritis (OA) is a degenerative and progressive joint condition causing pain and disability. Physical exercise is recognised as the most effective intervention since individuals with this condition often experience muscle weakness, balance deficits and chronic pain. Additionally, knee osteoarthritis (KOA) is associated with central sensitisation, contributing to chronic pain conditions. Transcranial Direct Current Stimulation (tDCS), a non-invasive neuromodulation technique, has been employed to induce changes in pain perception by altering cortical excitability, potentially reducing chronic pain. METHODS AND ANALYSIS: This is a protocol for a randomised controlled trial. Participants will be allocated to two groups: G1 (active tDCS combined with exercise) and G2 (sham tDCS combined with exercise). The intervention protocol will last for 5 weeks, with two sessions per week on non-consecutive days. Pain intensity will be assessed as the primary outcome using the Numeric Rating Scale (NRS)."},{"id":"source_44","type":"source","study":"Effectiveness of a home-based physical exercise intervention in patients with fragility fractures on functional independence and hospital readmissions: a protocol for a randomised controlled trial","year":2025,"doi":"10.1136/bmjopen-2025-101342","url":"https://doi.org/10.1136/bmjopen-2025-101342","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Segura-Ruiz 2025","excerpt":"INTRODUCTION: Patients with fragility fractures are two times as likely to suffer future fractures as their peers who have not suffered a fracture. In addition, 40% of those who suffer fragility fractures do not recover their level of functioning in terms of activities of daily living after 1 year. The present study aims to verify the hypothesis that a semipersonalised home-based exercise intervention may improve patients' independence and reduce the number of hospital admissions compared with usual care for a population that suffers fragility fractures. METHODS AND ANALYSIS: This parallel-arm single-blinded randomised-controlled trial will take place at the University of Cordoba (Spain) between September 2022 and September 2024. Patients aged >50 years old who have undergone surgery for a fragility hip fracture and who were prefracture independent (Barthel index (BI)>60) will be invited to participate. Patients will be excluded if they present a different type of fracture, mild or greater cognitive impairment or contraindication to exercise training. Patients will then be randomised into exercise or usual care group."},{"id":"source_45","type":"source","study":"Impact of physical exercise interventions on functional fitness in older adults","year":2026,"doi":"10.3389/fmed.2025.1732129","url":"https://doi.org/10.3389/fmed.2025.1732129","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Chen 2026b","excerpt":"INTRODUCTION: Aging is associated with a progressive decline in functional fitness-the physiological capacity for performing everyday activities safely and independently-which compromises autonomy in older adults. Maintaining functional fitness is crucial for preserving independence and promoting healthy aging. This systematic review synthesized evidence from recent randomized and controlled clinical trials to evaluate the effects of physical exercise on functional fitness in people aged ≥65 years. METHODS: A systematic search was conducted in three major databases (MEDLINE, PMC, and PubMed Central Canada) using comprehensive sets of keywords and MeSH terms related to \"older adults\" and specific exercise modalities (e.g., endurance, strength, resistance training). The search included studies published between 2015 and 2024. After duplicate removal and application of eligibility criteria, 95 studies were included. A meta-analysis was not performed due to substantial methodological heterogeneity among the included studies. RESULTS: The synthesized evidence indicates that most exercise interventions improved functional fitness outcomes in older adults."},{"id":"source_46","type":"source","study":"Using artificial intelligence for physical exercise and healthy ageing among older adults: a scoping review","year":2026,"doi":"10.1186/s12877-026-07544-1","url":"https://doi.org/10.1186/s12877-026-07544-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ye 2026","excerpt":"BACKGROUND: Promoting regular physical exercise is crucial for healthy ageing, yet many older adults remain physically inactive. Artificial intelligence (AI), evolving from rule-based to data-driven systems, offers a promising tool to address this challenge. This scoping review systematically maps existing research on AI in older adult exercise, focusing on intervention characteristics, types of assessed exercise motivation, physical function, mental health outcomes, and underlying theoretical frameworks. METHODS: Adhering to Arksey & O’Malley’s framework, this review systematically searched Scopus, MEDLINE, Web of Science, PubMed, Google Scholar, and IEEE Xplore for English-language studies on data-driven AI in older adult exercise. Four research questions guided the review. Two independent reviewers screened 5760 articles, with 18 included based on PICOS criteria. Data extraction utilized a structured coding scheme and descriptive analysis, achieving high inter-rater reliability (Kappa ≥ 0.897). RESULTS: Academic interest in AI-based exercise for older adults is rapidly increasing, particularly in East and Southeast Asia."},{"id":"source_47","type":"source","study":"Effects of intermittent fasting combined with physical exercise on cardiometabolic outcomes: systematic review and meta-analysis of clinical studies.","year":2024,"doi":"10.1093/nutrit/nuad155","url":"https://doi.org/10.1093/nutrit/nuad155","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kazeminasab 2024","excerpt":"CONTEXT: Different intermittent fasting (IF) protocols have been proven to be efficient in improving cardiometabolic markers, but further research is needed to examine whether or not combining IF regimens plus physical exercise is superior to control diets (ie, nonfasting eating) plus physical exercise in this setting. OBJECTIVE: The aim of this study was to determine whether or not combining IF plus exercise interventions is more favorable than a control diet plus exercise for improving cardiometabolic health outcomes. DATA SOURCE: PubMed, Scopus, and Web of Science were comprehensively searched until April 2023. DATA EXTRACTION: Electronic databases were searched for clinical trials that determined the effect of IF plus exercise vs a control diet plus exercise on body weight, lipid profile (high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides, and total cholesterol), and systolic and diastolic blood pressure (SBP and DBP, respectively). Analyses were conducted for IF plus exercise vs a nonfasting diet plus exercise to calculate weighted mean differences (WMDs)."},{"id":"source_48","type":"source","study":"Physical exercise programmes to improve insomnia or poor sleep quality in non-hospitalised elderly people: a systematic review and meta-analysis","year":2026,"doi":"10.7717/peerj.20764","url":"https://doi.org/10.7717/peerj.20764","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Paz-Monton 2026","excerpt":"BACKGROUND: Insomnia, or poor quality of sleep, among older people increasingly affects both physical and psychological health. This study aimed to evaluate the efficacy of physical exercise programs for improving sleep quality in non-hospitalized older adults, via objective methods such as actigraphy and polysomnography. METHODS: A systematic review and meta-analysis was conducted between January 1, 2025 and March 31, 2025 according to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide. It has been registered in Prospero with the number CRD420251009838. The following databases were consulted: PubMed, Web of Science, CINAHL Complete and Scopus. The studies included groups of participants with a mean age above 60 years, who presented with sleep problems, insomnia or an interest in improving sleep quality. To assess the quality of the studies, the Rob-2 tool for randomized studies and crossover studies and the critical appraisal of the Joanna Briggs Institute were used. RESULTS: Seven experimental or quasi-experimental studies with intervention groups and/or controls published in the last decade were analyzed."},{"id":"source_49","type":"source","study":"Effects of physical exercise interventions on multidimensional health outcomes in patients with substance use disorders: a network meta-analysis","year":2026,"doi":"10.3389/fpsyt.2025.1732663","url":"https://doi.org/10.3389/fpsyt.2025.1732663","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Liu 2026","excerpt":"OBJECTIVE: This study investigated the intervention effects of different physical exercise programs on multidimensional health outcomes in patients with substance use disorders. Through systematic categorization of intervention types, duration, frequency, and outcome indicators, this research aimed to provide evidence-based exercise prescriptions for rehabilitation treatment of patients with substance use disorders. METHODS: A systematic search was conducted across six databases: PubMed, Web of Science, Cochrane Library, EMBASE, SCOPUS, and ScienceDirect, retrieving 11,689 articles related to substance use disorders. The search period was limited from database inception to July 1, 2025. Data extraction and quality assessment were performed using Review Manager 5.4 software, ultimately including 33 articles meeting inclusion criteria, encompassing 2,922 participants. Subsequently, network meta-analysis was conducted using Stata 16.0, with results presented as standardized mean differences (SMD) and 95% confidence intervals (CI). RESULTS: A total of 33 randomized controlled trial articles were included, comprising 57 randomized controlled trials with 2,922 subjects."},{"id":"source_50","type":"source","study":"Effectiveness of combined physical exercise and cognitive training in older adults with cognitive impairment: A systematic review and meta-analysis","year":2024,"doi":"10.52225/narra.v4i3.1040","url":"https://doi.org/10.52225/narra.v4i3.1040","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Wati 2024","excerpt":"Falls among cognitively impaired older adults are a global concern. The aim of this study was to assess the efficacy of combining physical exercise and cognitive training to improve balance among older adults. A systematic search of databases, including Embase, Medline-OVID, CINAHL-EBSCOhost, and Central-Cochrane Library, was conducted from March 9 to April 6, 2023. The search used keywords based on the PICO question, where the population was older adults with cognitive impairment. Compared to a single therapy, the intervention involved a combination of muscle strengthening and cognitive therapy, with the outcome of falls or balance. Inclusion criteria were randomized controlled trials (RCTs) in any setting. Studies with participants under 60 years old and lacking baseline clinical assessments were excluded. EndNote 20 was used as a reference manager tool, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram was used to map out the number of identified records. Two investigators worked independently, and the Jadad scale was used for critical appraisal. The PROSPERO registration number is CRD42023454876."},{"id":"source_51","type":"source","study":"Acute Skeletal Muscle Activation Through Physical Exercise and Its Effects on Cognitive Performance and Neurobiological Markers in Adults: A Scoping Review","year":2026,"doi":"10.3390/muscles5020025","url":"https://doi.org/10.3390/muscles5020025","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Brookman-May 2026","excerpt":"Physical exercise can influence cognitive performance and neurobiological processes, but evidence spans diverse modalities, intensities, and adult populations. Acute exercise represents a state of transient skeletal muscle activation that induces systemic signaling through metabolic, endocrine, and myokine-mediated pathways, which may contribute to neurocognitive modulation. To map the breadth of acute exercise-cognition research, characterize cognitive and biological outcomes, and identify consistent patterns and gaps. Studies of adults (≥18 years) involving a single exercise session or short microcycle (≤7 days) with pre-post assessment of cognition and/or neurobiological markers across any exercise modality (aerobic, resistance, high-intensity interval training/HIIT, combined, vibration, mind-body) were included. PubMed and CENTRAL were systematically searched, yielding 101 studies. Data were extracted using a structured framework capturing exercise modality, dose, cognitive domains, biomarkers, neuroimaging outcomes, population characteristics, and study design features. Most studies examined young adults (53%) or older adults (32%)."},{"id":"source_52","type":"source","study":"Effect of Physical Exercise on Telomere Length: Umbrella Review and Meta-Analysis","year":2025,"doi":"10.2196/64539","url":"https://doi.org/10.2196/64539","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Sanchez-Gonzalez 2025","excerpt":"BACKGROUND: Telomere length (TL) is a marker of cellular health and aging. Physical exercise has been associated with longer telomeres and, therefore, healthier aging. However, results supporting such effects vary across studies. Our aim was to synthesize existing evidence on the effect of different modalities and durations of physical exercise on TL. OBJECTIVE: The aim of this study was to explore the needs and expectations of individuals with physical disabilities and their interventionists for the use of a virtual reality physical activity platform in a community organization. METHODS: We performed an umbrella review and meta-analysis. Data sources included PubMed, Embase, Web of Science, Cochrane Library, and Scopus. We selected systematic reviews and meta-analyses of randomized and nonrandomized controlled clinical trials evaluating the effect of physical exercise on TL. RESULTS: Our literature search retrieved 12 eligible systematic reviews, 5 of which included meta-analyses. We identified 22 distinct primary studies to estimate the overall effect size of physical exercise on TL. The overall effect size was 0.28 (95% CI 0.118-0.439), with a heterogeneity test value Q of 43."},{"id":"source_53","type":"source","study":"The effect of physical exercise and cognition-orientated interventions on post-stroke cognitive function: Protocol for an overview of reviews","year":2025,"doi":"10.1371/journal.pone.0318567","url":"https://doi.org/10.1371/journal.pone.0318567","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"protocol","cited_as":"Smith 2025","excerpt":"BACKGROUND: Strokes are becoming more common, and with improving survival rates, the prevalence of stroke survivors has increased. Almost half of chronic stroke survivors are cognitively impaired, and healthcare services are struggling to manage these patients, leaving some feeling \"abandoned\". Several systematic reviews have investigated the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive impairment, and have produced conflicting findings, making it difficult for clinicians and guideline producers to make evidence-based decisions. This overview of reviews aims to provide a comprehensive overview of systematic reviews investigating the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive function, assess methodological quality and certainty of evidence, and identify sources of discordance between these reviews. METHODS: Eight databases-Embase, Medline, CINAHL, Psycinfo, SPORTDiscus, The Cochrane Database of Systematic reviews, Epistemonikos, and Scopus-plus grey literature sources will be searched."},{"id":"source_54","type":"source","study":"Effects of physical exercise in reducing caregivers burden: a systematic review","year":2025,"doi":"10.3389/fpubh.2025.1474913","url":"https://doi.org/10.3389/fpubh.2025.1474913","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Cardoso 2025","excerpt":"BACKGROUND AND AIM: Caring for someone can be physically and psychologically demanding, predisposing caregivers to muscle injuries, fatigue, exhaustion, depression, anxiety, and burnout. The literature suggests several approaches to reducing caregiver burden, one of which is physical exercise. The aim of this systematic review was to analyze the effectiveness of exercise-based programs or muscle relaxation in reducing caregiver burden and stress among family caregivers. METHOD: A systematic literature review was conducted following the PRISMA guidelines. The search was performed in the Web of Science, Cochrane Library and Scopus databases and through the EBSCOhost aggregator (CINAHL Plus, MEDLINE, and SportDiscus). Studies were selected based on the PICOD acronym. RESULTS: Eleven randomized controlled trials (RCTs) and two other experimental studies were included. The reviewed programs encompassed aerobics, strengthening, and muscle relaxation exercises, delivered by various professionals in diverse settings, such as caregivers' homes, gyms, and hospital environments."},{"id":"source_55","type":"source","study":"Effects of immersive virtual reality stimulation and/or multicomponent physical exercise on cognitive and functional performance in hospitalized older patients with severe functional dependency: study protocol for a randomized clinical trial","year":2024,"doi":"10.1186/s12877-024-05516-x","url":"https://doi.org/10.1186/s12877-024-05516-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Casa-Marin 2024","excerpt":"BACKGROUND: Hospital-associated functional decline affects nearly one-third of the hospitalized older adults. The aim of this trial is to investigate the effect of a cognitive stimulation intervention provided via immersive virtual reality (IVR), with or without a multicomponent physical exercise intervention (ME) in hospitalized patients aged 75 or older with severe functional dependency at admission (Barthel Index < 60 points). METHODS: This clinical randomized controlled trial will be conducted in the Acute Geriatric Unit of a tertiary hospital in Spain. A total of 212 acute patients will be enrolled according to the following criteria: age ≥ 75, Barthel Index < 60, able to collaborate, expected length of stay ≥ 5 days, absence of clinical instability and severe dementia (Global Deterioration Scale 7) or other end-stage disease. Patients will be randomly assigned to a control group (CG) or any of the three intervention groups (IG): IVR, ME, or IVR + ME. The IVR group will watch ad-hoc videos showing Spanish regional landscapes and villages, approximately 4 min per day for three consecutive days."}],"edges":[{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_1","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_2","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_3","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_4","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_5","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_6","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_7","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_8","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_9","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_10","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_11","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_12","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_13","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_14","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_15","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_16","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_17","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_18","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_19","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_20","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_21","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_22","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_23","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_24","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_25","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_26","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_27","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_28","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_29","type":"contains_claim"},{"from":"ba5db8d2-cb82-4c8c-9e0f-d9b682baf215","to":"claim_30","type":"contains_claim"}],"screening":{"identified":55,"screened":55,"excluded":0,"included":55,"included_or_retained":55,"flow":["identified","screened","excluded_with_reasons","included"],"wording":"55 candidate receipts retained after source retrieval, deduplication, and topic filtering. 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