Effects of exercise interventions on executive function in adolescents: a systematic review and three-level meta-analysis of randomized controlled trials

Abstract

To estimate the effects of exercise interventions lasting at least 4 weeks on overall executive function and its three domains in adolescents, and to explore differences across population subgroups. Nine databases were systematically searched. Individually randomized parallel-group trials of adolescents aged 10–19 years comparing exercise with no additional structured exercise were included. Dependent Hedges’ g estimates were synthesized using three-level models with approximate within-trial covariance and trial-clustered CR2 inference. Risk of bias and evidence certainty were assessed using RoB 2 and GRADE. Twenty-two independent trials (1,599 unique participants) contributed 27 comparisons and 86 effect sizes. The pooled overall EF effect favored exercise (g = 0.55, 95% CI 0.33 to 0.77; p < 0.001), with substantial total heterogeneity (I² = 84.92%). Domain-specific estimates also favored exercise: inhibitory control (17 trials; g = 0.56, 95% CI 0.28 to 0.84), working memory (10 trials; g = 0.51, 95% CI 0.18 to 0.84), and cognitive flexibility (nine trials; g = 0.43, 95% CI 0.30 to 0.57). The overall estimate was more heavily informed by inhibitory-control scores (47/86) than by working-memory (25/86) or cognitive-flexibility scores (14/86). Correlation, trial-exclusion, risk-of-bias, and task-classification sensitivity analyses retained effects in the same direction. Certainty was low for overall EF, inhibitory control, and working memory, and moderate for cognitive flexibility. Sustained exercise may improve performance on EF tasks in adolescents, but heterogeneous interventions and controls, overlapping task constructs, and mostly low-certainty evidence limit the generality and real-world interpretation of the pooled effects. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261475826 , identifier CRD420261475826