This systematic review and NMA included 20 RCTs, comprising a total of 1161 obese and overweight participants. It aimed to compare the effects of different exercise modalities on CF, inhibitory control, WM, and adolescents’ AP. The results revealed that CPA, PTE, and MIX showed significant improvements in CF accuracy and reaction time. HIIT, RT, PTE, and CPA demonstrated positive effects on inhibitory, while RT showed significant improvement in WM. AE was found to have a positive effect on AP. Subgroup analyses based on age and intervention duration were conducted for AE, RT, CPA, and PTE. It was found that in the AE intervention, the subgroup of children and adolescents aged 0–17, as well as the acute intervention subgroup, showed significant improvement in EFs. In the CPA intervention, the acute intervention subgroup also exhibited significant improvement. Similarly, in the PTE intervention, the subgroup of adolescents aged 0–17 showed significant improvement in EFs compared to the control group.
4.1 Exercise Effect on EFs
In previous similar Meta-analyses, exercise training interventions have consistently been found to significantly improve EFs in elderly individuals, obese adolescents, individuals with mild cognitive impairment, and healthy populations. 20,43–45 The exercise interventions in these studies are diverse, involving long-term exercise (6 weeks or longer),20 after-school exercise for children or adolescents,43 and combined exercise, among others. 45 Exercise not only improves individuals' EFs directly, but it also activates brain regions associated with EF, including the anterior cingulate and superior frontal gyrus. Additionally, exercise indirectly enhances EF by improving physical fitness components such as speed agility, and cardiorespiratory fitness. 15 However, there are currently no studies comparing the effects of different exercise modalities on EF in obese populations. In the results, we found that CPA has a significantly positive effect on CF and inhibitory control. The CPA interventions included in this study involved jump rope exercises. Previous researchers have found that after CPA intervention, inhibitory control improves in healthy children, children with ADHD, and overweight/obese children and adolescents. 46 Additionally, it can enhance the performance of obese individuals facing food-cue related task conditions of the Stroop task. 25,47 Some studies suggest that children and adolescents, when engaged in more complex coordinated movements, first activate the cerebellum and prefrontal cortex, thereby enhancing subsequent cognitive performance. 48 Similarly, in older adults performing coordinated and flexible movements, there is greater activation in sensorimotor and visual-spatial networks. 49 Furthermore, CPA has been found to improve multiple physical fitness components such as strength, aerobic capacity, and flexibility, all of which are correlated with BMI. 47 Therefore, CPA is recommended for the healthy management of overweight or obese populations
Additionally, PTE also demonstrates positive effects on improving CF and inhibitory control. Studies have found that prolonged uninterrupted sitting behavior can increase fatigue levels in individuals, 50 leading to functional alterations in the nervous and endocrine systems, such as impaired autonomic nervous system function, particularly in chronically fatigued individuals. 51,52 Moreover, prolonged uninterrupted sitting can elevate blood-glucose levels and promote the occurrence of insulin resistance. This metabolic disruption can have negative effects on glucose metabolism in the brain, potentially leading to hippocampal atrophy and harmful effects on the density of the medial temporal lobe, posterior cingulate cortex, and precuneus. This may be due to enhanced neuronal activity, reduced cerebral blood flow, and decreased synaptic plasticity. The reduction in cortical density is believed to be a cause of early cognitive decline and dementia risk. 53,54 In a study by Wheeler et al. (2020) focusing on obese sedentary older adults, it was found that breaking sedentary behavior with physical activity could increase the subjects' serum brain-derived neurotrophic growth factor levels as well as improve WM and EF. 55 PTE, such as increasing daily walking steps and breaking prolonged sitting behavior, may improve cortical circulation, muscle tone, and readiness. It may also regulate leptin, cortisol, and brain-derived neurotrophic factor levels, as well as enhance neural synapses and potentiation, which could have favorable effects on reaction times among obese adults. 24,54
We can also observe that RT and AE have effective roles in improving WM and AP in obese populations. Vints et al. (2024) conducted a 12-week RT intervention on elderly individuals with mild cognitive impairment. The results revealed that the increase in Insulin-like Growth Factor-1 levels was associated with improved reaction times in mathematical processing. Additionally, the elevation in serum Interleukin-6 (IL-6) levels was associated with improvements in memory search reaction speed. 56 IL-6, also known as "exercise factor," is associated with inflammatory responses. Its release promotes the formation of anti-inflammatory cytokines, such as IL-1RA, IL-10, and corticosteroids.57,58 At the molecular level, the connection between IL-6 and memory function has been previously explained through cytokine involvement in synaptic formation, neurogenesis, and memory consolidation. 59 Due to the highest expression of inflammatory cytokine receptors for IL-6 in the hippocampus, changes in peripheral IL-6 levels may affect hippocampus-related memory scores. 60Consistent with previous research findings, after a 10-week aerobic exercise intervention, children's dual-task performance significantly improved. 61This study also found that AE has a positive effect on improving AP, which may be attributed to AE's ability to enhance cardiorespiratory fitness. A longitudinal analysis spanning 2 years, involving 1802 youths, found that after adjusting for other physical health components and BMI, maintaining higher levels of cardiorespiratory fitness and exercise capacity is associated with higher AP.62 This could be because higher cardiorespiratory fitness is positively correlated with gray matter volume in the brain, specifically in frontal regions (e.g., supplementary motor cortex and premotor cortex), subcortical regions (e.g., hippocampus), temporal regions (e.g., inferior temporal gyrus and parahippocampal gyrus), and calcarine cortex. The premotor cortex, supplementary motor cortex, and hippocampus were associated with better AP. 63 Real et al. (2015) also found that AE increases the presynaptic protein and postsynaptic GluA1 and GluA2/3 receptors in the motor cortex, thereby enhancing synaptic efficiency. This may further elevate children's cognitive levels and AP.64
4.2 Subgroup analysis
In this study, subgroup analysis based on age and intervention duration revealed significant improvement in EFs with AE and PTE interventions for children and adolescents aged 0–17. Combining these findings with the results related to AP, it appears that children and adolescents may benefit more from AE. The significant effect of AE interventions lasting 8–16 weeks is consistent with previous research, suggesting that chronic exercise can promote higher-order cognitive functions. 65 However, some studies suggest that acute aerobic exercise may have a greater impact on EF. 66 This discrepancy could be related to differences in the physiological characteristics of the study participants. The former study focused on late middle-aged healthy adults, while our study focused on overweight or obese individuals. Long-term exercise may promote adaptive changes in their cardiovascular function, body composition, and nervous system, thereby enhancing their EFs.20,62,67 Additionally, PTE has a significant effect on improving EFs in individuals aged 59 and above, perhaps because this age group is more prone to be sedentary. Because the exercise modalities of PTE don’t focus on the intensity of exercise, they are also more suitable for older adults. 55
4.3 Limitations and implication for future study
This study has several limitations. Firstly, to ensure the reliability of the outcomes, we only included RCTs, which resulted in a small number of studies included in this paper, with only 20 articles. This limitation may further lead to shortcomings in subgroup analysis (such as not grouping by factors like gender, region, BMI, etc.). It also implies that there are few RCTs investigating the effects of exercise interventions on EFs in obese or overweight populations, and the variety of exercise intervention methods is limited, such as CPA interventions only involving jump rope exercises. Additionally, as mentioned earlier, EFs encompass core EFs and higher-level EFs, but literature searches revealed that most studies only include one or a few aspects of inhibitory control, CF, and WM. In the future, a more comprehensive set of evaluation indicators should be selected for EF in specific populations.