Digital exercise interventions show domain-specific cognitive benefits in older adults

Immersive VR also outperformed no intervention (SMD 0.74) and ranked highest overall by SUCRA scoring, though with wider confidence intervals. Executive function showed more modest gains: only nonimmersive exergames versus no intervention reached significance (SMD 0.39 across 33 studies). For memory function (20 studies), remote exercise demonstrated the most robust benefit—significantly superior to both no intervention (SMD 1.30) and routine care (SMD 1.22), with a prediction interval that excluded zero. Cumulative training of 1,000+ minutes was associated with more stable memory improvements. The certainty of evidence was rated very low to low for most comparisons, downgraded due to unclear allocation concealment, heterogeneity across studies, and suspected reporting bias, particularly in executive function assessments.

The analysis reveals striking domain specificity: nonimmersive exergames (think interactive games played on a screen or tablet) consistently benefited global cognition and executive function, whereas remote-based physical exercise—coaching or instruction delivered online—produced the only statistically robust memory improvements, with prediction intervals excluding the null. This suggests the cognitive demand of exergames may optimize attention and processing speed, while the consistency of remote exercise programs may be crucial for memory consolidation. Immersive VR ranked highest by SUCRA but with substantially wider confidence intervals, indicating high uncertainty; the addition of formal cognitive training to VR (VR_EC) actually weakened memory outcomes compared to remote exercise alone (SMD −1.54), possibly due to cognitive overload. The 1,000-minute threshold for stable memory benefit translates to roughly 12–16 weeks of twice-weekly 90-minute sessions—a practical planning metric. Most comparisons carried very low certainty due to unclear randomization concealment, substantial between-study variation, and evidence of selective reporting, especially in executive function trials, meaning future high-quality trials are needed before firm recommendations.