A call to rethink the cognitive benefits of physical exercise: An umbrella review of randomized controlled trials

Abstract

Extensive research links regular physical exercise to an overall enhancement of cognitive function across the lifespan. Here, we assess the causal evidence supporting this relationship in the healthy population, using an umbrella review of meta-analyses limited to randomized controlled trials (RCTs). Despite most of the 24 reviewed meta-analyses reporting a positive overall effect, our assessment reveals evidence of low statistical power in the primary RCTs, selective inclusion of studies, publication bias, and large variation in combinations of preprocessing and analytic decisions. In addition, our meta-analysis of all the primary RCTs included in the revised meta-analyses shows small exercise-related benefits (d = 0.22, 95% CI [0.16, 0.28]) that became substantially smaller after accounting for key moderators (i.e., active control and baseline differences; d = 0.13, 95% CI [0.07, 0.20), and negligible after correcting for publication bias (d = 0.05, 95% CrI [-0.09, 0.14]). These findings suggest caution in claims and recommendations linking regular physical exercise to cognitive benefits in the healthy human population until more reliable causal evidence accumulates.