Dr Ray O’Connor takes a look at recent clinical papers on physical activity, and how it is essential for supporting cognitive health in individuals with neurodegenerative diseases
Clinical anxiety is a common comorbidity in autistic people. Due to the prevalence of anxiety in the autism population and the adverse effects it causes, there is a critical need to develop effective interventions which address anxiety symptoms for autistic people. Therefore, the purpose of this systematic review1 was to examine the effectiveness of the use of physical activity as an intervention to reduce anxiety in autistic people.
Dr Ray O’Connor
Three databases (PubMed, PsychInfo, and Cochrane RCTs) were searched utilizing key terms. PRISMA systematic search procedures identified 44 studies meeting predetermined inclusion criteria. Participant characteristics, the type of physical activity performed, the nature of the physical activity program/delivery, anxiety-related outcomes, and research methodology were evaluated for each study. Each paper included was appraised and scored for risk of bias.
Titles and abstracts of 44 articles were reviewed and eight articles met inclusion criteria which evaluated interventions. Evidence from eight studies suggests that yoga, a community-based football program, an app-assisted walking program, group exercise programs, and horseback riding interventions reduced anxiety for autistic people.
The authors concluded that the evidence uncovered in the review provide strong-to-moderate evidence that physical activity can reduce anxiety for autistic children and adults. However, additional research is needed to identify which mode of physical activity is most beneficial for anxiety reduction. Future research should evaluate frequency, duration, and intensity and their effects on anxiety for autistic people.
Physical activity interventions positively influence executive functions in both the general population and individuals with Attention Deficit Hyperactivity Disorder (ADHD). However, there is limited research focusing on school-aged children, who have the highest ADHD diagnosis rates. This systematic review and meta-analysis2 aimed to provide targeted intervention strategies for improving executive function in this population, offering a practical reference for selecting specific exercise types when designing interventions for children with ADHD.
Databases searched were PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant randomised controlled trials up to September 2023. Two independent reviewers handled literature screening, data extraction, and quality assessment. The meta-analysis included 19 studies, revealing that physical activity interventions significantly improved executive functions in school-aged children with ADHD. Cognitive flexibility and working memory showed moderate to large effects, while inhibition switching had a small to medium effect.
Subgroup analysis indicated that cognitively engaging exercises were more effective, with intervention outcomes moderated by duration, frequency, and length. A limitation highlighted was that inconsistent measurement tools among the included studies may introduce biases. However, the authors concluded that physical activity interventions are effective in enhancing executive functions in school-aged children with ADHD. Cognitively engaging exercises show the most promise, especially when tailored by intervention duration, frequency, and length.
Many studies have reported that a single measure of physical activity in older adults is associated with incident dementia. In this study3, the authors examined repeated measures of physical activity to determine if this association with incident dementia varied. Participants were from a community-based longitudinal study of older adults (the Rush Memory and Aging Project [MAP]). MAP participants were recruited from retirement centres and subsidised long-term care facilities across northeastern Illinois (USA).
Physical activity level was extracted from biennial multiday wrist-wearing sensor recordings. Dementia diagnosis was based on neuropsychological test scores, clinical history, and examination. Joint modelling integrating a linear mixed-effects model and a Cox model was used to prospectively test the association of repeated measures of physical activity and dementia, and a time-varying effects model was used to retrospectively examine the association of dementia with repeated measures of physical activity before dementia diagnosis.
The analyses included 972 older adults (mean age 80⋅5 years, SD 7⋅3) with frequent (mean 4⋅9, SD 2⋅6) biennial measurements of physical activity. A total of 745 (77 per cent) of 972 participants were female and 227 (23 per cent) were male. Some 286 (29 per cent) of the 972 participants developed dementia, which was clinically diagnosed as Alzheimer’s disease.
The results are confusing. Although the joint model indicated an association between physical activity and incident dementia (hazard ratio [HR] 0⋅78), the model accuracy was stronger for physical activity closer to dementia diagnosis. Baseline physical activity was not related to the risk of dementia more than seven years after baseline (HR 1⋅00), whereas physical activity at year six was (0⋅55).
In a time-varying effects model, repeated physical activity was not associated with incident dementia except during the last two years before dementia diagnosis. The authors’ conclusion was that physical activity might be a modifiable protective factor for dementia in old age.
However, analyses of repeated measures of physical activity suggest that further work is needed to define the timing of the beneficial effects of physical activity relative to the onset of dementia.
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 established neurodegenerative diseases. This systematic review4 specifically addressed the issue of tailored physical activity interventions for individuals with various neurocognitive disorders.
The authors searched for 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.
Mechanisms proposed for cognitive improvement in AD included reductions in β-amyloid and tau protein burdens, improved glucose metabolism, and enhanced brain-derived neurotrophic factor levels. Specific improvements were noted in Parkinson’s disease, with evidence suggesting mediation through dopamine pathways.
Despite evidence of short-term benefits, significant variability exists among studies, highlighting the need for individualized exercise programs tailored to specific neurocognitive conditions. The authors concluded that physical activity stands as a cornerstone non-pharmacological intervention, essential for supporting cognitive health in individuals with neurodegenerative diseases. They recommend that further research is necessary to establish long-term effects and optimal exercise modalities, along with standardized evaluation criteria to assess the cognitive impacts of physical activity reliably. 
References:
- Riis K et al. Physical Activity for Anxiety for Autistic People: A Systematic Review. Journal of Autism and Developmental Disorders (2025) 55:2663–2679 https://doi.org/10.1007/s10803-024-06356-9.
- Li D et al. Effect of physical activity interventions on executive functions in school-age children with ADHD: A meta-analysis of randomized controlled trials. J Affect Disord 2025 Jun 1:378:175-190. doi: 10.1016/j.jad.2025.01.155.
- Oveisgharan S et al. Repeated measures of physical activity before dementia diagnosis in community-dwelling older adults: a longitudinal study. Lancet Healthy Longev 2026; 7: 100824 Published Online March 9, 2026. https://doi.org/10.1016/j.lanhl.2026.100824.
- Decaix T et al. Benefits of physical activity on cognitive function in patients with neurocognitive disorders: A systematic review. The Journal of Frailty & Aging 14 (2025) 100069. https://doi.org/10.1016/j.tjfa.2025.100069.