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Abstract

Cognitive decline represents one of the most pressing public health challenges associated with global population ageing, prompting growing interest in accessible and scalable exercise-based interventions. This narrative review synthesizes evidence from 15 randomized controlled trials to compare the cognitive effects of 3 exercise modalities in older adults across varying cognitive and functional profiles: conventional aerobic and resistance training, exergame-based interventions, and dual-task or multicomponent training. Interventions were evaluated on their capacity to improve global cognition, executive function, working memory, and attention, with additional consideration of adherence, supervision format, and implementation feasibility. The evidence consistently demonstrates that dual-task and multicomponent training produces the broadest and most durable cognitive improvements, particularly in global cognition and executive function, outperforming both conventional exercise and exergaming across healthy older adults and those with Mild Cognitive Impairment (MCI) or frailty. Conventional exercise yielded reliable but domain-specific benefits highly sensitive to training intensity and adherence, while exergaming extended gains to global cognition yet remained constrained by platform-dependent cognitive challenge and intensity ceilings. The superiority of dual-task training is mechanistically attributed to concurrent engagement of prefrontal and hippocampal circuits, driving BDNF-mediated neurogenesis, IGF-1 signaling, and enhanced prefrontal-hippocampal connectivity. An optimal prescription of 2 to 3 sessions per week, 45 to 60 minutes per session, over a minimum of 10 to 24 weeks under supervised or remotely monitored conditions is recommended. Future research should prioritize standardized cognitive outcome measures, longer follow-up periods, and head-to-head controlled comparisons across modalities in diverse populations.

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