Gender Differences in the Cognitive Benefits of Physical Activity for Older Adults: A Scoping Review

Gender Differences in the Cognitive Benefits of Physical Activity for Older Adults: A Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gender Differences in the Cognitive Benefits of Physical Activity for Older Adults: A Scoping Review Xinyue Zhang, Jiawei Zhao, xin Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5274665/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: With the global population aging rapidly and dementia cases expected to rise substantially, identifying effective strategies to mitigate cognitive decline has become crucial. This scoping review aimed to systematically examine the existing evidence on gender differences in the cognitive protective effects of physical activity among older adults and to provide recommendations for future research. Methods: A comprehensive search of PubMed, Web of Science, and Cochrane Library was conducted following the PRISMA-ScR guidelines. Researches that evaluated the effects of physical activity interventions on cognitive function in older adults and examined gender differences were included. Results: Twenty-two studies met the inclusion criteria. The majority of studies (95.5%) were of moderate to high methodological quality. Approximately 60% of the studies found significant gender differences in cognitive outcomes or other related outcomes following physical activity interventions, while the remaining studies observed no gender differences. In subgroups, studies targeting on the old with mild cognitive impairment all shows significant gender difference. When gender differences were present, women appeared to benefit more from physical activity in cognition, especially executive function, compared to men. Conclusion: This review suggested that physical activity may provide cognitive benefits differing between genders with women benefiting more. However, due to varied study design, intervention and outcome measures among the included studies, future studies should employ more rigorous designs, larger samples, and longer follow-ups to elucidate the underlying mechanisms and optimize interventions for both genders. Physical activity Cognitive aging Gender differences Older adults Scoping review Figures Figure 1 1. Background Cognitive aging, a process characterized by a gradual decline in cognitive function as people age, is a normal part of the aging process. However, more pronounced cognitive decline may indicate a higher risk of developing dementia, a debilitating condition characterized by cognitive impairment, memory loss, and reduced independence in daily activities [1] . According to the World Health Organization, the number of people living with dementia has reached 55 million with an alarming annual increase of 10 million cases. This alarming trend places a significant burden on families and society, highlighting the need for effective prevention and intervention strategies [2] . To mitigate such detrimental effects of cognitive aging and alleviate the burden on individuals and society, there is a growing interest in identifying effective prevention and intervention strategies that can help preserve cognitive function in older adults. Among various approaches, physical activity (PA) has emerged as a promising and cost-effective intervention. A growing body of evidence suggests that frequent PA can significantly improve cardiovascular health in older adults, which indirectly contributes to the preservation of cognitive function [3] . Moreover, PA has been shown to have direct beneficial effects on brain structure and function, such as increased hippocampal volume and enhanced neural plasticity [4,5] . These findings underscore the importance of PA as a potential protective factor against cognitive decline. While PA has been shown to provide cognitive benefits, the potential gender differences in such effect remain a significant topic of ongoing debate. Recent evidence suggests that the effects may differ between men and women. Not only do men and women exhibit distinct patterns of cognitive aging [6] , but they may also respond differently to exercise interventions. A recent study found that after 6 months of aerobic exercise, older women with the BDNF Val/Val genotype showed greater improvements in executive function [7] . On the contrary, another study found that after 5 years of aerobic exercise, male participants had greater improvements in global cognitive function and reduced risk of mild cognitive impairment (MCI), while females did not show this effect [8] . A systematic review analyzed 41 randomized controlled trials, it also revealed that exercise interventions had a greater effect on executive function in older women compared to older men, although significant heterogeneity among studies was noted [9] . In other words, the effects of different types of exercise on cognitive benefits and their interaction with sex are still not well understood, with most studies focusing on a single type of PA. Besides the gender differences in cognitive aging trajectories and exercise effects, it is also worth noting that men and women exhibit differences in brain structure. For instance, women typically have a higher proportion of gray matter, while men have a higher proportion of white matter [10] . These structural differences may contribute to the distinct patterns of exercise responsiveness between gender [11,12] . All these contradictions highlight the need to identify and understand the potential gender differences in these effects to develop more precise and personalized cognitive protection strategies. While previous meta-analyses and empirical studies have provided valuable insights, they often focused on specific aspects of the topic. A scoping review, on the other hand, is particularly suitable for mapping the breadth of evidence in a field, identifying research gaps and informing future directions [13] . Therefore, we chose to conduct a scoping review, aiming to systematically examine the existing research on gender differences in the cognitive protective effects of PA among older adults. To achieve this, we conducted a comprehensive search of PubMed, Web of Science, and other relevant databases, following the PRISMA guidelines, to provide an extensive overview of the literature on gender differences in the cognitive benefits of PA by identifying current research gaps and providing directions for future studies. We seek to contribute to the development of targeted interventions that consider the unique needs and characteristics of each gender. By exploring these differences, researchers can gain valuable insights into the underlying mechanisms and tailor interventions to optimize their effectiveness for both men and women. 2. Method 2.1 Study design and Search strategy This systematic scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). According to Johanna Briggs Institute methodological manual(Peters et al., 2022 ), the databases, including PubMed, Web of Science, and Cochrane Library, were searched. 2.2 Inclusion criteria This scoping review included randomized controlled trials (RCTs), second analysis of RCTs, cohort studies, case-control studies, and cross-sectional studies that evaluated the effects of PA interventions on cognitive function in older adults and examined gender differences. Participants were community-dwelling older adults aged 50 years and above, including both males and females, with or without MCI or dementia. The interventions involved any form of PA or exercise, such as aerobic exercise, resistance training, tai chi, yoga, etc., with a minimum duration of 4 weeks. Comparisons were usual lifestyle, health education, or other non-exercise interventions. Studies must have reported cognitive-related outcomes, such as global cognitive function, memory, executive function, attention, etc., and provided gender-stratified analyses or comparisons. Studies reporting gender differences in brain atrophy, exercise adherence, depression, or other relevant aspects were also considered. Only peer-reviewed journal articles published in English with full-text available from January 1, 2004, to June 23, 2024, were included. The search terms list is provided in Supplemental table. 2.3 Exclusion criteria This review excluded non-human studies, reviews, meta-analyses, protocols, editorials, letters, case reports, conference abstracts, and non-peer-reviewed publications such as dissertations, book chapters, or gray literature. Studies not published in English or not reporting sex- or gender-specific outcomes were also excluded. Observational studies that did not clearly define PA exposure or assessed it only at one time point were not considered. Studies with incomplete or unclear reporting of methods or results were also omitted. In cases where multiple articles were published based on the same RCT, the one with the longest follow-up was included, and others may have been considered, if necessary, but data extraction avoided duplication. 2.4 Study screening and data extraction Two reviewers independently screened the titles and abstracts of the retrieved articles based on the predefined inclusion and exclusion criteria. Any disagreements were resolved through discussion with the third reviewer. After the initial screening, the full texts of the potentially eligible articles were obtained and assessed by the same two reviewers. The reasons for exclusion at the full-text stage were recorded. A standardized data extraction form was developed to collect relevant information from the included studies, such as study characteristics (e.g., authors, year of publication, study design, sample size), participant characteristics (e.g., age, gender, cognitive status), intervention details (e.g., type, duration, frequency, intensity), comparison group, and main findings related to gender differences. The data extraction process was performed independently by two reviewers, and any discrepancies were also resolved through discussion with a third reviewer. The extracted data were then synthesized and summarized narratively. 2.5 Quality assessment The methodological quality of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) too, a validated and reliable instrument designed to evaluate the quality of various study designs, including RCTs, cohort studies, case-control studies, and cross-sectional studies(Armijo-Olivo et al., 2012 ). It consists of eight components: selection bias, study design, confounders, blinding, data collection methods, withdrawals and dropouts, intervention integrity, and analysis. Each component is rated as strong, moderate, or weak based on standardized criteria. A global rating is then assigned to each study based on the ratings of the first six components, with studies classified as strong (no weak ratings), moderate (one weak rating), or weak (two or more weak ratings). Two reviewers independently assessed the quality of the included studies using the EPHPP tool, and any discrepancies were resolved through discussion with a third reviewer. The results of the quality assessment were summarized narratively and presented in a table, highlighting the strengths and limitations of the included studies. 3. Results 3.1 Selection of Studies There were initially 1493 studies identified from the three databases. After removing duplicates, 1326 articles remained for title and abstract screening, and those clearly irrelevant were excluded, resulting in 188 articles for full-text review. After careful evaluation of the full texts, 22 articles(Baker et al., 2010; Barha et al., 2023; Belleville et al., 2022, 2023; Bischoff-Ferrari et al., 2020; Dimitriadis et al., 2024; Guzman et al., 2021; Henskens et al., 2018; Lamb et al., 2018; Liu et al., 2018; Pani et al., 2022; Romera-Liebana et al., 2018; Rosenberg et al., 2018; Sink et al., 2015; Telenius et al., 2015; Toots et al., 2017; van Stralen et al., 2010; van Uffelen et al., 2008; Varma et al., 2015; Wittmann et al., 2024; Zlatar et al., 2019; Zotcheva et al., 2022) met the inclusion criteria and were included in this scoping review. The entire literature screening process is shown in Figure 1. The main reasons for exclusion were: not reporting gender-specific results (n=115), no PA intervention involved studies (n=9), healthy condition of study participants not meeting criteria (n=12), and not measuring cognitive-related outcomes (n=18) and type of studies not meeting criteria (n=11). 3.2 Characteristics of Studies Table 1 and Table 2 summarize basic features and outcomes of the 22 included studies, published from 2008 and 2024. The majority of the studies (n=19, 86.4%) were randomized controlled trials, while others employed cluster-randomized (n=1, 4.5%), longitudinal (n=1, 4.5%), or cross-sectional (n=1, 4.5%) designs. The sample sizes ranged from 14 to 919 participants. 12 studies (54.5%) had a sample size greater than 200 participants, 4 studies (18.2%) had a sample size between 101 and 200 participants, 4 studies (18.2%) had a sample size between 51 and 100 participants, and 2 studies (9.1%) had a sample size of less than 50 participants. The gender distribution of the participants varied among the included studies. In 17 studies (77.3%), women constituted more than 50% of the participants, while in 4 studies (18.2%), women made up less than 50% of the participants. 1 study (4.5%) had an equal proportion of male and female participants. Regarding the baseline cognitive status of the participants, 14 studies (63.7%) included participants without MCI or dementia, 3 studies (13.6%) included participants with MCI, and 5 studies (22.7%) included participants with dementia. 3.3 Intervention and Outcomes Table 3 summarizes the types of PA interventions, duration, and the presence of gender differences in outcomes among the included studies. In terms of intervention types, 11 studies (50%) employed aerobic exercise or light-intensity exercise, 7 studies (31.8%) utilized moderate to high-intensity exercise, and 5 studies (22.7%) incorporated PA as part of a multidomain intervention. Regarding the duration of interventions, 7 studies (31.8%) had an intervention period of less than 6 months, 11 studies (50%) had an intervention duration between 6 and 24 months, and 4 studies (18.2%) had an intervention period exceeding 24 months. In terms of outcomes, 9 studies (40.9%) found no gender differences in the effects of PA on cognitive outcomes, while 7 studies (31.8%) reported gender differences in cognitive outcomes. Additionally, 6 studies (27.3%) identified gender differences in other aspects, such as depressive symptoms, hippocampus volume and activities of daily living. 3.4 Quality assessment Among the 22 studies, 12 studies (54.5%) received a global rating of “strong”, indicating high methodological quality. 9 studies (40.9%) were rated as “moderate” in terms of global quality. Only 1 study (4.5%) received a global rating of “weak”. See the detailed evaluation in Table 4. In summary, the majority of the included studies (95.5%) were of moderate to high methodological quality, providing reliable evidence on the topic of interest. 4. Discussion To the best of our knowledge, this is the first review to systematically map and synthesize the available evidence concerning gender differences in the cognitive protective effects of various forms of physical activities among older adults. By reviewing included studies, it suggest that there are potential gender differences in the cognitive benefits of PA. In specific, 1) among older adults with MCI, women appear to benefit more from PA in terms of cognitive protection compared to men; 2) aerobic exercises seem to be more effective in improving executive function in women compared to men; 3) In the context of multidomain lifestyle interventions, healthy older women tend to experience greater benefits other than cognitive protection compared to men. 4.1 Women with MCI benefits more from PA in cognition Among the reviewed articles, 3 articles specifically targeting participants with MCI and all consistently report gender differences in PA’s protective effects in cognition favoring women(Baker et al., 2010 ; Barha et al., 2023 ; Varma et al., 2015 ). This suggests that women with pre-existing cognitive impairment may be more responsive to the protective effects of physical activity compared to men. One possible explanation for this difference lies in the distinct neurobiological characteristics of men and women. Research has shown that women generally have a higher proportion of gray matter, which is more vulnerable to age-related atrophy than white matter [10,33] . This may explain why women exhibit greater potential for improvement and are more responsive to the neuroprotective effects of PA when cognitive impairment begins to manifest. In contrast, men may possess greater inherent resilience against cognitive decline, leading to less pronounced cognitive benefits from PA in the absence of overt cognitive impairment. Additionally, hormonal and biological changes related to aging, such as menopause in women and andropause in men, may differentially influence cognitive responses to PA. The loss of estrogen’s protective effects after menopause may increase women’s vulnerability to cognitive impairment, thereby amplifying the potential cognitive benefits of PA(Hara et al., 2015 ; Morrison et al., 2006 ). On the other hand, while declining testosterone levels in men are associated with some cognitive changes, the impact on cognitive function appears to be less pronounced than the effects of estrogen depletion in women(Hogervorst et al., 2004 ). Therefore, the possible explanation may be associated not only with the greater vulnerability of gray matter in women but also with fluctuations in sex hormone levels. However, the number of studies specifically targeting MCI patients remains limited, underscoring the need for further research to better understand the gender-specific effects of PA in this high-risk population. Moreover, while existing studies have highlighted gender differences, few have rigorously examined sex-related changes in neurological and hormonal variables. Future research should include key biological measures, such as changes in gray and white matter volume, as well as levels of estrogen and testosterone, to more accurately understand how these factors modulate the cognitive effects of PA. 4.2 Aerobic exercises benefits women more than men in executive function Among the 7 studies that identified gender differences in cognitive outcomes, 4 specifically reported greater improvements in executive function among women and all adopt aerobic exercises as intervention(Baker et al., 2010 ; Barha et al., 2023 ; Belleville et al., 2022 ; Zlatar et al., 2019 ). This gender disparity in cognitive benefits, particularly in executive function, may be attributed to the increased plasticity of the prefrontal cortex in women, which is more responsive to aerobic exercise. Evidence suggests that aerobic exercise enhances functional connectivity between the prefrontal cortex and other brain regions, such as the hippocampus-areas critical for executive function(Voss, 2010 ). Notably, women may exhibit greater plasticity in aerobic exercise-induced changes in prefrontal functional connectivity compared to men(Dimech et al., 2019 ). This enhanced responsiveness of the prefrontal cortex in women could explain their superior improvements in executive function. Therefore, aerobic exercise might confer more pronounced cognitive benefits, particularly in executive function, for women. Interestingly, not all forms of physical activity show greater cognitive benefits for women. High-intensity interval training (HIIT)(Zotcheva et al., 2022 ) has been found to help men experience significant cognitive improvements, while women did not. This suggests that the type of PA may also play a role in modulating gender-specific cognitive outcomes. The findings further underscore the need to explore the specific types and intensities of physical activity that are optimal for each gender. Moreover, differences in intervention duration and frequency across studies may obscure or exaggerate these gender differences. In this review, 7 studies (31.8%) had intervention periods shorter than 6 months and found no significant gender differences, possibly due to insufficient intervention duration. As the finding suggests that, long-term, frequent physical activity may be more beneficial for women’s cognitive function(Barha et al., 2017 ). The variability in intervention designs, particularly in terms of duration and frequency, may have contributed to the inconsistencies observed across studies. In summary, while current evidence suggests greater cognitive benefits for women, particularly in executive function, variability in study designs-especially regarding intervention type, duration and frequency-may obscure a complete understanding of these gender differences. Future studies should prioritize longer intervention periods, incorporate neurobiological and hormonal measurements, and explore optimal types and intensities of PA for each gender. 4.3 Healthy older women benefits more from PA beyond cognition Among the 22 studies reviewed, 6 (27.3%) highlighted gender differences that were not directly related to cognition but revealed other cognitive-related benefits of PA for women(Bischoff-Ferrari et al., 2020 ; Guzman et al., 2021 ; Henskens et al., 2018 ; Pani et al., 2022 ; van Uffelen et al., 2008 ; Wittmann et al., 2024 ). These studies underscore a broader range of advantages that women derive from PA, including depressive symptoms, adherence to exercise protocols, and neurological health improvements. A possible explanation for this gender difference lies in the higher prevalence of depression among women. Research has shown that PA can effectively alleviate depressive symptoms(Craft & Perna, 2004 ), and women are more likely to experience depression than men(Nolen-Hoeksema, 2001 ). This higher prevalence of depression in women may contribute to their greater improvements in depressive symptoms following PA. Furthermore, the alleviation of depressive symptoms through PA may, in turn, enhance women’s motivation and adherence to intervention programs, creating a positive feedback loop. This feedback loop may help explain why women tend to have higher participation rates and adherence in PA interventions, leading to more cognitive benefits. However, the gender-specific emotional outcomes of PA are not always consistent across studies. As the study(Henskens et al., 2018 ) found that men with dementia, rather than women, showed significant improvements in mood. The contrasting findings may, in part, be due to differences in the participant populations. In dementia patients, cognitive decline may influence the capacity for emotional regulation, which may explain the inconsistency. Hence, it also highlights the importance of considering participants’ cognitive status when examining the emotional effects of PA across genders. Adding to this complexity, multidomain intervention studies include multiple components such as PA, cognitive training, and dietary guidance, which may interact with gender in unexpected ways. 2 out of 5 resulted in gender difference in cognition(Belleville et al., 2022 , 2023 ) and 1 resulted in cognitive-related effect, all favoring women(Wittmann et al., 2024 ), while the rest 2 resulted in no gender difference(Romera-Liebana et al., 2018 ; Rosenberg et al., 2018 ). Their inconsistent findings may be attributed to several factors. Apart from the possible explanation from intervention design, another one is that women tend to place greater value on social relationships and derive more emotional benefits from social support compared to men(Kendler et al., 2005 ). The higher level of social engagement and support in multi-domain interventions may contribute to greater cognitive health gains in women. Secondly, gender differences in coping strategies may also play a role. Women are more likely to use emotion-focused coping strategies, such as seeking social support, which may help reduce stress and improve mood in the context of multi-domain interventions(Tamres et al., 2002 ). Lastly, as discussed earlier, the higher rates of depression in women and the positive feedback loop between PA and depressive symptom alleviation may amplify the emotional benefits women receive from these interventions. However, these explanations remain speculative and require further investigation, particularly in the context of multi-domain interventions. In addition to emotional benefits, 3 out of 6 exhibited greater neurological improvements, including significant increase in hippocampal volume(Guzman et al., 2021 ; Varma et al., 2015 ) and greater gray matter density in the parietal lobe and increased cortical thickness in the parietal and temporal regions(Pani et al., 2022 ). All these benefits are associated with better cognitive outcomes and accord with the idea that women has more neuroprotective effects from PA [10,33] . In summary, the evidence from these studies suggests that healthy older women gain not only cognitive and emotional benefits from PA but also exhibit superior neurological outcomes. The positive feedback loop between improvements in depressive symptoms and greater adherence may also contribute to women’s overall greater benefits. Future studies should continue to explore these multidimensional gender differences, focusing on how physical, emotional, and cognitive benefits interact and how different exercise regimens may optimize outcomes for each gender. 4.4 Recommendations for future research While this review has highlighted several key findings regarding gender-specific cognitive, emotional, and neurological benefits of PA among older adults, several gaps and limitations remain in the existing literature. Addressing these gaps through future research will help to develop a more nuanced understanding of how PA can be optimized for both men and women. Firstly, longitudinal studies with extended follow-ups are needed, to fully capture the sustained cognitive and emotional effects of PA, particularly in older adults. Additionally, the small sample sizes in many RCTs, along with the higher proportion of female participants, may limit the ability to conduct robust gender-specific analyses. Future research should aim to recruit larger and more gender-balanced samples to better understand the long-term cognitive benefits of PA across both men and women. Furthermore, inclusion of biological and neurological measures are necessary. Few studies have incorporated detailed neurobiological assessments, such as changes in gray matter, white matter, or hippocampal volume, to explain gender differences in cognitive outcomes. Future studies should integrate neuroimaging techniques and biomarkers, such as estrogen and testosterone levels, to investigate the underlying mechanisms driving the gender-specific effects of PA. This would help clarify how hormonal fluctuations, brain plasticity, and structural changes influence cognitive outcomes in older adults. Thirdly, while aerobic exercise has been shown to confer cognitive benefits, other forms of PA have received less attention in gender-specific studies. Future research should explore how various types and intensities of exercise affect cognitive outcomes in men and women. It would also be beneficial to compare the effectiveness of different PA regimens in promoting specific cognitive functions. Fourthly, tailored interventions based on health status should be considered. The differences in cognitive benefits observed between healthy older adults and those with MCI or dementia suggest that the cognitive status of participants plays a crucial role in modulating the effects of PA. Future studies should consider designing interventions that are tailored to the specific needs of male and female participants, taking into account their cognitive health, hormonal status, and baseline fitness levels. This could help maximize the benefits of PA for each gender and specific subpopulations, such as those with pre-existing cognitive impairments. Lastly, multi-domain interventions have shown potential in promoting cognitive health, but the gender-specific effects remain underexplored. Future research should examine how these comprehensive interventions may differentially benefit men and women. Additionally, understanding how the interactions between various intervention components influence cognitive and emotional outcomes across genders could provide valuable insights into optimizing intervention strategies. 5. Strength and Limitation This scoping review has several notable strengths. First, a rigorous literature screening process was employed, including searches across multiple databases and clearly defined inclusion and exclusion criteria, to comprehensively cover relevant studies on the topic and enhance the reliability of the findings. Second, the included studies varied in sample size, ranging from small to large, encompassing both large-scale cohort studies and RCTs as well as small to medium-sized intervention trials, thereby increasing the persuasiveness of the synthesized results. Third, the interventions in the included studies were diverse with durations, which allows for a more comprehensive evaluation of the gender differences in the effects of various exercise modalities and training periods. Fourth, this review included not only cognitively healthy older adults but also those with MCI and dementia, suggesting that gender differences in the cognitive protective effects of PA may also exist in MCI and dementia populations. This finding expands the scope of research on gender differences to these populations, which is of great significance for developing gender-specific exercise intervention programs. Despite the strengths mentioned above, this scoping review also has some limitations. First, although 22 studies were included, the number of studies in different subgroups was relatively small, which may affect the stability and generalizability of the subgroup analysis results. Second, there was considerable heterogeneity among the included studies, including intervention design and participant characteristics, which may impact the comparability of the results. Third, the interpretation of the results should be cautious. The review only preliminarily suggests that there may be gender differences in the cognitive protective effects of PA, and the findings were not consistent across all studies. Further high-quality research is needed to validate these results. Fourth, due to the limitations of the included studies, the results of this review may be difficult to generalize to all populations. More focused research and reviews targeting specific populations, such as certain age groups or those with particular health conditions, are necessary to provide more tailored insights. 6. Conclusion This scoping review explored the existing evidence on gender differences in the cognitive protective effects of PA among older adults. The findings indicate that while PA interventions generally offer cognitive benefits, these effects may vary between men and women. Although the results across studies were somewhat mixed, this review highlights the importance of incorporating gender considerations when designing and implementing PA interventions aimed at cognitive protection in older populations. While further research is needed to clarify the inconsistencies and elucidate the underlying mechanisms, the findings emphasize the potential of PA as a promising strategy for promoting cognitive health in aging populations, with considerations for gender-specific effects. Healthcare professionals and policymakers should consider these insights when developing and implementing interventions to support healthy cognitive aging in both men and women. Abbreviations PA Physical Activity MCI Mild Cognitive Impairment Declarations Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding This work was supported by Open Research Fund of the State Key Laboratory of Cognitive Neuroscience and Learning, the Natural Science Foundation of China (grant number 32171085) and Tang Scholar. Statement of Author’ Contributions ZXY and LX designed the study. ZXY and ZJW were responsible for article selection and quality assessment. ZXY drafted the manuscript, and LX provided critical revisions and oversight. All authors contributed to the refinement of the manuscript and approved the final version for submission. References [Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology , 8 (1), 19–32. https://doi.org/10.1080/1364557032000119616 Armijo‐Olivo, S., Stiles, C. R., Hagen, N. A., et al. (2012). Assessment of study quality for systematic reviews: A comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. Journal of Evaluation in Clinical Practice , 18 (1), 12–18. https://doi.org/10.1111/j.1365-2753.2010.01516.x Baker, L. D., Frank, L. L., Foster-Schubert, K., et al. (2010). Effects of aerobic exercise on mild cognitive impairment: A controlled trial. Archives of Neurology , 67 (1), 71–79. https://doi.org/10.1001/archneurol.2009.307 Barha, C. K., Galea, L. A., Nagamatsu, L. S., et al. (2017). Personalising exercise recommendations for brain health: Considerations and future directions. British Journal of Sports Medicine , 51 (8), 636–639. https://doi.org/10.1136/bjsports-2016-096710 Barha, C. K., Starkey, S. Y., Hsiung, G. Y. R., et al.. (2023). Aerobic exercise improves executive functions in females, but not males, without the BDNF Val66Met polymorphism. Biology of Sex Differences , 14 (1), 16. https://doi.org/10.1186/s13293-023-00499-7 Belleville, S., Cloutier, S., Mellah, S., et al. (2022). Is more always better? Dose effect in a multidomain intervention in older adults at risk of dementia. ALZHEIMERS & DEMENTIA , 18 (11), 2140–2150. https://doi.org/10.1002/alz.12544 Belleville, S., Cuesta, M., Bieler-Aeschlimann, M., et al. (2023). Pre-frail older adults show improved cognition with StayFitLonger computerized home-based training: A randomized controlled trial. GEROSCIENCE , 45 (2), 811–822. https://doi.org/10.1007/s11357-022-00674-5 Bischoff-Ferrari, H. A., Vellas, B., Rizzoli, R., et al. (2020). Effect of Vitamin D Supplementation, Omega-3 Fatty Acid Supplementation, or a Strength-Training Exercise Program on Clinical Outcomes in Older Adults: The DO-HEALTH Randomized Clinical Trial. JAMA , 324 (18), 1855–1868. https://doi.org/10.1001/jama.2020.16909 Cao, Q., Tan, C.-C., Xu, W., et al. (2020). The Prevalence of Dementia: A Systematic Review and Meta-Analysis. Journal of Alzheimer’s Disease , 73 (3), 1157–1166. https://doi.org/10.3233/JAD-191092 Cosgrove, K. P., Mazure, C. M., & Staley, J. K. (2007). Evolving Knowledge of Sex Differences in Brain Structure, Function, and Chemistry. Biological Psychiatry , 62 (8), 847–855. https://doi.org/10.1016/j.biopsych.2007.03.001 Craft, L. L., & Perna, F. M. (2004). The Benefits of Exercise for the Clinically Depressed. Primary Care Companion to The Journal of Clinical Psychiatry , 6 (3), 104–111. Dimech, C. J., Anderson, J. A. E., Lockrow, A. W., et al. (2019). Sex differences in the relationship between cardiorespiratory fitness and brain function in older adulthood. Journal of Applied Physiology , 126 (4), 1032–1041. https://doi.org/10.1152/japplphysiol.01046.2018 Dimitriadis, S. I., Castells-Sanchez, A., Roig-Coll, F., et al. (2024). Intrinsic functional brain connectivity changes following aerobic exercise, computerized cognitive training, and their combination in physically inactive healthy late-middle-aged adults: The Projecte Moviment. GEROSCIENCE , 46 (1), 573–596. https://doi.org/10.1007/s11357-023-00946-8 Firth, J., Stubbs, B., Vancampfort, D., et al. (2018). Effect of aerobic exercise on hippocampal volume in humans: A systematic review and meta-analysis. NeuroImage , 166 , 230–238. https://doi.org/10.1016/j.neuroimage.2017.11.007 Guzman, J., Aguiñaga, S., Balbim, G. M., et al. (2021). The effects of the BAILAMOS Dance Program on hippocampal volume in older Latinos: A randomized controlled pilot study. Translational Behavioral Medicine , 11 (10), 1857–1862. https://doi.org/10.1093/tbm/ibab009 Hara, Y., Waters, E. M., McEwen, B. S. et al. (2015). Estrogen Effects on Cognitive and Synaptic Health Over the Lifecourse. Physiological Reviews , 95 (3), 785–807. https://doi.org/10.1152/physrev.00036.2014 Henskens, M., Nauta, I. M., van Eekeren, M. C. A., et al. (2018). Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial. Dementia and Geriatric Cognitive Disorders , 46 (1–2), 60–80. https://doi.org/10.1159/000491818 Hogervorst, E., De Jager, C., Budge, M., et al.. (2004). Serum levels of estradiol and testosterone and performance in different cognitive domains in healthy elderly men and women. Psychoneuroendocrinology , 29 (3), 405–421. https://doi.org/10.1016/S0306-4530(03)00053-2 Hsu, C. L., Best, J. R., Davis, J. C., et al. (2018). Aerobic exercise promotes executive functions and impacts functional neural activity among older adults with vascular cognitive impairment. British Journal of Sports Medicine , 52 (3), 184–191. https://doi.org/10.1136/bjsports-2016-096846 Kendler, K. S., Myers, J., & Prescott, C. A. (2005). Sex Differences in the Relationship Between Social Support and Risk for Major Depression: A Longitudinal Study of Opposite-Sex Twin Pairs. American Journal of Psychiatry , 162 (2), 250–256. https://doi.org/10.1176/appi.ajp.162.2.250 Lamb, S. E., Sheehan, B., Atherton, N., et al. (2018). Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: Randomised controlled trial. BMJ (Clinical Research Ed.) , 361 , k1675. https://doi.org/10.1136/bmj.k1675 Li, W., van Tol, M., Li, M., et al. (2012). Regional specificity of sex effects on subcortical volumes across the lifespan in healthy aging. Human Brain Mapping , 35 (1), 238–247. https://doi.org/10.1002/hbm.22168 Liu, Z., Hsu, F.-C., Trombetti, A., et al. (2018). Effect of 24-month physical activity on cognitive frailty and the role of inflammation: The LIFE randomized clinical trial. BMC Medicine , 16 (1), 185. https://doi.org/10.1186/s12916-018-1174-8 Morrison, J. H., Brinton, R. D., Schmidt, P. J., et al. (2006). Estrogen, Menopause, and the Aging Brain: How Basic Neuroscience Can Inform Hormone Therapy in Women. The Journal of Neuroscience , 26 (41), 10332–10348. https://doi.org/10.1523/JNEUROSCI.3369-06.2006 Nolen-Hoeksema, S. (2001). Gender Differences in Depression. Current Directions in Psychological Science , 10 (5), 173–176. https://doi.org/10.1111/1467-8721.00142 Northey, J. M., Cherbuin, N., Pumpa, K. L., et al. (2018). Exercise interventions for cognitive function in adults older than 50: A systematic review with meta-analysis. British Journal of Sports Medicine , 52 (3), 154–160. https://doi.org/10.1136/bjsports-2016-096587 Pani, J., Marzi, C., Stensvold, D., et al. (2022). Longitudinal study of the effect of a 5-year exercise intervention on structural brain complexity in older adults. A Generation 100 substudy. NEUROIMAGE , 256 . https://doi.org/10.1016/j.neuroimage.2022.119226 Peters, M. D. J., Godfrey, C., McInerney, P., et al. (2022). Best practice guidance and reporting items for the development of scoping review protocols. JBI Evidence Synthesis , 20 (4), 953–968. https://doi.org/10.11124/JBIES-21-00242 Romera-Liebana, L., Orfila, F., Segura, J. M., et al. (2018). Effects of a Primary Care-Based Multifactorial Intervention on Physical and Cognitive Function in Frail, Elderly Individuals: A Randomized Controlled Trial. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences , 73 (12), 1688–1674. https://doi.org/10.1093/gerona/glx259 Rosenberg, A., Ngandu, T., Rusanen, M., et al.. (2018). Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial. ALZHEIMERS & DEMENTIA , 14 (3), 263–270. https://doi.org/10.1016/j.jalz.2017.09.006 Sink, K. M., Espeland, M. A., Castro, C. M., et al. (2015). Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults: The LIFE Randomized Trial. JAMA , 314 (8), 781–790. https://doi.org/10.1001/jama.2015.9617 Tamres, L. K., Janicki, D., & Helgeson, V. S. (2002). Sex Differences in Coping Behavior: A Meta-Analytic Review and an Examination of Relative Coping. Personality and Social Psychology Review , 6 (1), 2–30. https://doi.org/10.1207/S15327957PSPR0601_1 Telenius, E. W., Engedal, K., & Bergland, A. (2015). Effect of a High-Intensity Exercise Program on Physical Function and Mental Health in Nursing Home Residents with Dementia: An Assessor Blinded Randomized Controlled Trial. PLOS ONE , 10 (5). https://doi.org/10.1371/journal.pone.0126102 Toots, A., Littbrand, H., Boström, G., et al. (2017). Effects of Exercise on Cognitive Function in Older People with Dementia: A Randomized Controlled Trial. Journal of Alzheimer’s Disease : JAD , 60 (1), 323–332. https://doi.org/10.3233/JAD-170014 Tu, L., Lv, X., Yuan, C., et al. (2024). Sex differences in cognitive function trajectories and their determinants in older adults: Evidence from the Chinese longitudinal healthy longevity survey. International Journal of Geriatric Psychiatry , 39 (3), e6072. https://doi.org/10.1002/gps.6072 van Stralen, M. M., de Vries, H., Bolman, C., Mudde, A. N., et al. (2010). Exploring the efficacy and moderators of two computer-tailored physical activity interventions for older adults: A randomized controlled trial. Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine , 39 (2), 139–150. https://doi.org/10.1007/s12160-010-9166-8 van Uffelen, J. G. Z., Chinapaw, M. J. M., van Mechelen, W., et al. (2008). Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial. British Journal of Sports Medicine , 42 (5), 344–351. https://doi.org/10.1136/bjsm.2007.044735 Varma, V. R., Chuang, Y.-F., Harris, G. C., et al. (2015). Low-intensity daily walking activity is associated with hippocampal volume in older adults. Hippocampus , 25 (5), 605–615. https://doi.org/10.1002/hipo.22397 Voss. (2010). Plasticity of brain networks in a randomized intervention trial of exercise training in older adults. Frontiers in Aging Neuroscience . https://doi.org/10.3389/fnagi.2010.00032 Wittmann, F. G., Pabst, A., Zuelke, A., et al. (2024). Who Benefited the Most? Effectiveness of a Lifestyle Intervention Against Cognitive Decline in Older Women and Men—Secondary Analysis of the AgeWell.de-trial. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE , 11 (2), 348–355. https://doi.org/10.14283/jpad.2024.13 Zlatar, Z. Z., Godbole, S., Takemoto, M., et al. (2019). Changes in Moderate Intensity Physical Activity Are Associated With Better Cognition in the Multilevel Intervention for Physical Activity in Retirement Communities (MIPARC) Study. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry , 27 (10), 1110–1121. https://doi.org/10.1016/j.jagp.2019.04.011 Zotcheva, E., Haberg, A. K., Wisloff, U., et al. (2022). Effects of 5 Years Aerobic Exercise on Cognition in Older Adults: The Generation 100 Study: A Randomized Controlled Trialy. SPORTS MEDICINE , 52 (7), 1689–1699. https://doi.org/10.1007/s40279-021-01608-5 Tables Tables 1 to 4 are available in the Supplementary Files section Supplementary Files PRISMA2020checklist.docx SupplementaryTable.docx Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 20 Jan, 2025 Reviewers invited by journal 04 Nov, 2024 Editor assigned by journal 17 Oct, 2024 First submitted to journal 16 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5274665","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":373931877,"identity":"e8cf9742-3e07-4f34-9059-9ba0fb36eb18","order_by":0,"name":"Xinyue Zhang","email":"","orcid":"","institution":"Beijing Normal University","correspondingAuthor":false,"prefix":"","firstName":"Xinyue","middleName":"","lastName":"Zhang","suffix":""},{"id":373931878,"identity":"f5d1debc-f501-4b26-bd4d-027dddf7cb6b","order_by":1,"name":"Jiawei Zhao","email":"","orcid":"","institution":"Beijing Normal University","correspondingAuthor":false,"prefix":"","firstName":"Jiawei","middleName":"","lastName":"Zhao","suffix":""},{"id":373931879,"identity":"75d4cff6-0a71-488d-b483-7c9a942181d0","order_by":2,"name":"xin Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBACPmYGhgMMFTZyBmAuGxFa2MBazqQZk6AFRDC2HU7cQLwWdh7Dw4Vth9O3S/cYMHwoO8zAP7uBkMPYEg7POJeeu3POGQPGGecOM0jcOUBIC/OBwzxl1rkbbuQYMPO2HWYwkEggpIWx4TAPG3O6AUjLX+K0gGxpc04Aa2EkTgvQLzxn0gx3zkgrONhzLp1H4gYBLfz8Z4w/81TYyJtLJG988KPMWo5/BgEtKOAAEPOQoH4UjIJRMApGAS4AAGwzPVpkOTysAAAAAElFTkSuQmCC","orcid":"","institution":"Beijing Normal University","correspondingAuthor":true,"prefix":"","firstName":"xin","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-10-16 09:38:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5274665/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5274665/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70921692,"identity":"4f8708b4-9128-4a6b-8965-6a3f56769fad","added_by":"auto","created_at":"2024-12-09 08:41:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54455,"visible":true,"origin":"","legend":"\u003cp\u003eAdapted PRISMA flowchart of literature search and screening\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5274665/v1/738ec0f9697d173a2a7c8f27.png"},{"id":70922394,"identity":"3ed3d128-062b-44c3-8c39-d2e5f83b0871","added_by":"auto","created_at":"2024-12-09 08:49:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":500977,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5274665/v1/3a56e573-8adb-487f-b631-644ab2760958.pdf"},{"id":70922393,"identity":"d4d70774-26ac-4d10-b67a-4875fe7599ee","added_by":"auto","created_at":"2024-12-09 08:49:09","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29589,"visible":true,"origin":"","legend":"","description":"","filename":"PRISMA2020checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-5274665/v1/c122ce670dfc08d0dc44151e.docx"},{"id":70921693,"identity":"0a6f6f64-0a42-4872-995f-e1f82cfb7b58","added_by":"auto","created_at":"2024-12-09 08:41:09","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14333,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-5274665/v1/2ed1047fbd7413ee45c05050.docx"},{"id":70921695,"identity":"1c20dd01-2feb-4e94-84a6-c38a4edc76f0","added_by":"auto","created_at":"2024-12-09 08:41:09","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":41086,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5274665/v1/17996b3a35f55f6792afecc3.docx"}],"financialInterests":"","formattedTitle":"Gender Differences in the Cognitive Benefits of Physical Activity for Older Adults: A Scoping Review","fulltext":[{"header":"1. Background","content":"\u003cp\u003eCognitive aging, a process characterized by a gradual decline in cognitive function as people age, is a normal part of the aging process. However, more pronounced cognitive decline may indicate a higher risk of developing dementia, a debilitating condition characterized by cognitive impairment, memory loss, and reduced independence in daily activities\u003csup\u003e[1]\u003c/sup\u003e. According to the World Health Organization, the number of people living with dementia has reached 55\u0026nbsp;million with an alarming annual increase of 10\u0026nbsp;million cases. This alarming trend places a significant burden on families and society, highlighting the need for effective prevention and intervention strategies\u003csup\u003e[2]\u003c/sup\u003e. To mitigate such detrimental effects of cognitive aging and alleviate the burden on individuals and society, there is a growing interest in identifying effective prevention and intervention strategies that can help preserve cognitive function in older adults.\u003c/p\u003e \u003cp\u003eAmong various approaches, physical activity (PA) has emerged as a promising and cost-effective intervention. A growing body of evidence suggests that frequent PA can significantly improve cardiovascular health in older adults, which indirectly contributes to the preservation of cognitive function\u003csup\u003e[3]\u003c/sup\u003e. Moreover, PA has been shown to have direct beneficial effects on brain structure and function, such as increased hippocampal volume and enhanced neural plasticity\u003csup\u003e[4,5]\u003c/sup\u003e. These findings underscore the importance of PA as a potential protective factor against cognitive decline.\u003c/p\u003e \u003cp\u003eWhile PA has been shown to provide cognitive benefits, the potential gender differences in such effect remain a significant topic of ongoing debate. Recent evidence suggests that the effects may differ between men and women. Not only do men and women exhibit distinct patterns of cognitive aging\u003csup\u003e[6]\u003c/sup\u003e, but they may also respond differently to exercise interventions. A recent study found that after 6 months of aerobic exercise, older women with the BDNF Val/Val genotype showed greater improvements in executive function\u003csup\u003e[7]\u003c/sup\u003e. On the contrary, another study found that after 5 years of aerobic exercise, male participants had greater improvements in global cognitive function and reduced risk of mild cognitive impairment (MCI), while females did not show this effect\u003csup\u003e[8]\u003c/sup\u003e. A systematic review analyzed 41 randomized controlled trials, it also revealed that exercise interventions had a greater effect on executive function in older women compared to older men, although significant heterogeneity among studies was noted\u003csup\u003e[9]\u003c/sup\u003e. In other words, the effects of different types of exercise on cognitive benefits and their interaction with sex are still not well understood, with most studies focusing on a single type of PA.\u003c/p\u003e \u003cp\u003eBesides the gender differences in cognitive aging trajectories and exercise effects, it is also worth noting that men and women exhibit differences in brain structure. For instance, women typically have a higher proportion of gray matter, while men have a higher proportion of white matter\u003csup\u003e[10]\u003c/sup\u003e. These structural differences may contribute to the distinct patterns of exercise responsiveness between gender\u003csup\u003e[11,12]\u003c/sup\u003e. All these contradictions highlight the need to identify and understand the potential gender differences in these effects to develop more precise and personalized cognitive protection strategies.\u003c/p\u003e \u003cp\u003eWhile previous meta-analyses and empirical studies have provided valuable insights, they often focused on specific aspects of the topic. A scoping review, on the other hand, is particularly suitable for mapping the breadth of evidence in a field, identifying research gaps and informing future directions\u003csup\u003e[13]\u003c/sup\u003e. Therefore, we chose to conduct a scoping review, aiming to systematically examine the existing research on gender differences in the cognitive protective effects of PA among older adults. To achieve this, we conducted a comprehensive search of PubMed, Web of Science, and other relevant databases, following the PRISMA guidelines, to provide an extensive overview of the literature on gender differences in the cognitive benefits of PA by identifying current research gaps and providing directions for future studies. We seek to contribute to the development of targeted interventions that consider the unique needs and characteristics of each gender. By exploring these differences, researchers can gain valuable insights into the underlying mechanisms and tailor interventions to optimize their effectiveness for both men and women.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and Search strategy\u003c/h2\u003e \u003cp\u003e This systematic scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). According to Johanna Briggs Institute methodological manual(Peters et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), the databases, including PubMed, Web of Science, and Cochrane Library, were searched.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Inclusion criteria\u003c/h2\u003e \u003cp\u003e This scoping review included randomized controlled trials (RCTs), second analysis of RCTs, cohort studies, case-control studies, and cross-sectional studies that evaluated the effects of PA interventions on cognitive function in older adults and examined gender differences. Participants were community-dwelling older adults aged 50 years and above, including both males and females, with or without MCI or dementia. The interventions involved any form of PA or exercise, such as aerobic exercise, resistance training, tai chi, yoga, etc., with a minimum duration of 4 weeks. Comparisons were usual lifestyle, health education, or other non-exercise interventions. Studies must have reported cognitive-related outcomes, such as global cognitive function, memory, executive function, attention, etc., and provided gender-stratified analyses or comparisons. Studies reporting gender differences in brain atrophy, exercise adherence, depression, or other relevant aspects were also considered. Only peer-reviewed journal articles published in English with full-text available from January 1, 2004, to June 23, 2024, were included. The search terms list is provided in Supplemental table.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Exclusion criteria\u003c/h2\u003e \u003cp\u003eThis review excluded non-human studies, reviews, meta-analyses, protocols, editorials, letters, case reports, conference abstracts, and non-peer-reviewed publications such as dissertations, book chapters, or gray literature. Studies not published in English or not reporting sex- or gender-specific outcomes were also excluded. Observational studies that did not clearly define PA exposure or assessed it only at one time point were not considered. Studies with incomplete or unclear reporting of methods or results were also omitted. In cases where multiple articles were published based on the same RCT, the one with the longest follow-up was included, and others may have been considered, if necessary, but data extraction avoided duplication.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Study screening and data extraction\u003c/h2\u003e \u003cp\u003eTwo reviewers independently screened the titles and abstracts of the retrieved articles based on the predefined inclusion and exclusion criteria. Any disagreements were resolved through discussion with the third reviewer. After the initial screening, the full texts of the potentially eligible articles were obtained and assessed by the same two reviewers. The reasons for exclusion at the full-text stage were recorded. A standardized data extraction form was developed to collect relevant information from the included studies, such as study characteristics (e.g., authors, year of publication, study design, sample size), participant characteristics (e.g., age, gender, cognitive status), intervention details (e.g., type, duration, frequency, intensity), comparison group, and main findings related to gender differences. The data extraction process was performed independently by two reviewers, and any discrepancies were also resolved through discussion with a third reviewer. The extracted data were then synthesized and summarized narratively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Quality assessment\u003c/h2\u003e \u003cp\u003eThe methodological quality of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) too, a validated and reliable instrument designed to evaluate the quality of various study designs, including RCTs, cohort studies, case-control studies, and cross-sectional studies(Armijo-Olivo et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). It consists of eight components: selection bias, study design, confounders, blinding, data collection methods, withdrawals and dropouts, intervention integrity, and analysis. Each component is rated as strong, moderate, or weak based on standardized criteria. A global rating is then assigned to each study based on the ratings of the first six components, with studies classified as strong (no weak ratings), moderate (one weak rating), or weak (two or more weak ratings). Two reviewers independently assessed the quality of the included studies using the EPHPP tool, and any discrepancies were resolved through discussion with a third reviewer. The results of the quality assessment were summarized narratively and presented in a table, highlighting the strengths and limitations of the included studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Selection of Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were initially 1493 studies identified from the three databases. After removing duplicates, 1326 articles remained for title and abstract screening, and those clearly irrelevant were excluded, resulting in 188 articles for full-text review. After careful evaluation of the full texts, 22 articles(Baker et al., 2010; Barha et al., 2023; Belleville et al., 2022, 2023; Bischoff-Ferrari et al., 2020; Dimitriadis et al., 2024; Guzman et al., 2021; Henskens et al., 2018; Lamb et al., 2018; Liu et al., 2018; Pani et al., 2022; Romera-Liebana et al., 2018; Rosenberg et al., 2018; Sink et al., 2015; Telenius et al., 2015; Toots et al., 2017; van Stralen et al., 2010; van Uffelen et al., 2008; Varma et al., 2015; Wittmann et al., 2024; Zlatar et al., 2019; Zotcheva et al., 2022) met the inclusion criteria and were included in this scoping review. The entire literature screening process is shown in Figure 1. The main reasons for exclusion were: not reporting gender-specific results (n=115), no PA intervention involved studies (n=9), healthy condition of study participants not meeting criteria (n=12), and not measuring cognitive-related outcomes (n=18) and type of studies not meeting criteria (n=11).\u003c/p\u003e\n\u003cp\u003e\u0026lt; See Figure 1 here \u0026gt;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Characteristics of Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 and Table 2 summarize basic features and outcomes of the 22 included studies, published from 2008 and 2024. The majority of the studies (n=19, 86.4%) were randomized controlled trials, while others employed cluster-randomized (n=1, 4.5%), longitudinal (n=1, 4.5%), or cross-sectional (n=1, 4.5%) designs. The sample sizes ranged from 14 to 919 participants. 12 studies (54.5%) had a sample size greater than 200 participants, 4 studies (18.2%) had a sample size between 101 and 200 participants, 4 studies (18.2%) had a sample size between 51 and 100 participants, and 2 studies (9.1%) had a sample size of less than 50 participants. The gender distribution of the participants varied among the included studies. In 17 studies (77.3%), women constituted more than 50% of the participants, while in 4 studies (18.2%), women made up less than 50% of the participants. 1 study (4.5%) had an equal proportion of male and female participants. Regarding the baseline cognitive status of the participants, 14 studies (63.7%) included participants without MCI or dementia, 3 studies (13.6%) included participants with MCI, and 5 studies (22.7%) included participants with dementia.\u003c/p\u003e\n\u003cp\u003e\u0026lt; Insert Table 1 and Table 2\u0026gt;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Intervention and Outcomes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 summarizes the types of PA interventions, duration, and the presence of gender differences in outcomes among the included studies. In terms of intervention types, 11 studies (50%) employed aerobic exercise or light-intensity exercise, 7 studies (31.8%) utilized moderate to high-intensity exercise, and 5 studies (22.7%) incorporated PA as part of a multidomain intervention. Regarding the duration of interventions, 7 studies (31.8%) had an intervention period of less than 6 months, 11 studies (50%) had an intervention duration between 6 and 24 months, and 4 studies (18.2%) had an intervention period exceeding 24 months.\u003c/p\u003e\n\u003cp\u003eIn terms of outcomes, 9 studies (40.9%) found no gender differences in the effects of PA on cognitive outcomes, while 7 studies (31.8%) reported gender differences in cognitive outcomes. Additionally, 6 studies (27.3%) identified gender differences in other aspects, such as depressive symptoms, hippocampus volume and activities of daily living.\u003c/p\u003e\n\u003cp\u003e\u0026lt; Insert Table 3\u0026gt;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Quality assessment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 22 studies, 12 studies (54.5%) received a global rating of “strong”, indicating high methodological quality. 9 studies (40.9%) were rated as “moderate” in terms of global quality. Only 1 study (4.5%) received a global rating of “weak”. See the detailed evaluation in Table 4. In summary, the majority of the included studies (95.5%) were of moderate to high methodological quality, providing reliable evidence on the topic of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt; Insert Table 4\u0026gt;\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first review to systematically map and synthesize the available evidence concerning gender differences in the cognitive protective effects of various forms of physical activities among older adults. By reviewing included studies, it suggest that there are potential gender differences in the cognitive benefits of PA. In specific, 1) among older adults with MCI, women appear to benefit more from PA in terms of cognitive protection compared to men; 2) aerobic exercises seem to be more effective in improving executive function in women compared to men; 3) In the context of multidomain lifestyle interventions, healthy older women tend to experience greater benefits other than cognitive protection compared to men.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Women with MCI benefits more from PA in cognition\u003c/h2\u003e \u003cp\u003eAmong the reviewed articles, 3 articles specifically targeting participants with MCI and all consistently report gender differences in PA\u0026rsquo;s protective effects in cognition favoring women(Baker et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Barha et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Varma et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). This suggests that women with pre-existing cognitive impairment may be more responsive to the protective effects of physical activity compared to men. One possible explanation for this difference lies in the distinct neurobiological characteristics of men and women. Research has shown that women generally have a higher proportion of gray matter, which is more vulnerable to age-related atrophy than white matter\u003csup\u003e[10,33]\u003c/sup\u003e. This may explain why women exhibit greater potential for improvement and are more responsive to the neuroprotective effects of PA when cognitive impairment begins to manifest. In contrast, men may possess greater inherent resilience against cognitive decline, leading to less pronounced cognitive benefits from PA in the absence of overt cognitive impairment.\u003c/p\u003e \u003cp\u003eAdditionally, hormonal and biological changes related to aging, such as menopause in women and andropause in men, may differentially influence cognitive responses to PA. The loss of estrogen\u0026rsquo;s protective effects after menopause may increase women\u0026rsquo;s vulnerability to cognitive impairment, thereby amplifying the potential cognitive benefits of PA(Hara et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Morrison et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). On the other hand, while declining testosterone levels in men are associated with some cognitive changes, the impact on cognitive function appears to be less pronounced than the effects of estrogen depletion in women(Hogervorst et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, the possible explanation may be associated not only with the greater vulnerability of gray matter in women but also with fluctuations in sex hormone levels. However, the number of studies specifically targeting MCI patients remains limited, underscoring the need for further research to better understand the gender-specific effects of PA in this high-risk population. Moreover, while existing studies have highlighted gender differences, few have rigorously examined sex-related changes in neurological and hormonal variables. Future research should include key biological measures, such as changes in gray and white matter volume, as well as levels of estrogen and testosterone, to more accurately understand how these factors modulate the cognitive effects of PA.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Aerobic exercises benefits women more than men in executive function\u003c/h2\u003e \u003cp\u003eAmong the 7 studies that identified gender differences in cognitive outcomes, 4 specifically reported greater improvements in executive function among women and all adopt aerobic exercises as intervention(Baker et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Barha et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Belleville et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Zlatar et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This gender disparity in cognitive benefits, particularly in executive function, may be attributed to the increased plasticity of the prefrontal cortex in women, which is more responsive to aerobic exercise. Evidence suggests that aerobic exercise enhances functional connectivity between the prefrontal cortex and other brain regions, such as the hippocampus-areas critical for executive function(Voss, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Notably, women may exhibit greater plasticity in aerobic exercise-induced changes in prefrontal functional connectivity compared to men(Dimech et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This enhanced responsiveness of the prefrontal cortex in women could explain their superior improvements in executive function. Therefore, aerobic exercise might confer more pronounced cognitive benefits, particularly in executive function, for women. Interestingly, not all forms of physical activity show greater cognitive benefits for women. High-intensity interval training (HIIT)(Zotcheva et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) has been found to help men experience significant cognitive improvements, while women did not. This suggests that the type of PA may also play a role in modulating gender-specific cognitive outcomes. The findings further underscore the need to explore the specific types and intensities of physical activity that are optimal for each gender. Moreover, differences in intervention duration and frequency across studies may obscure or exaggerate these gender differences. In this review, 7 studies (31.8%) had intervention periods shorter than 6 months and found no significant gender differences, possibly due to insufficient intervention duration. As the finding suggests that, long-term, frequent physical activity may be more beneficial for women\u0026rsquo;s cognitive function(Barha et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The variability in intervention designs, particularly in terms of duration and frequency, may have contributed to the inconsistencies observed across studies.\u003c/p\u003e \u003cp\u003eIn summary, while current evidence suggests greater cognitive benefits for women, particularly in executive function, variability in study designs-especially regarding intervention type, duration and frequency-may obscure a complete understanding of these gender differences. Future studies should prioritize longer intervention periods, incorporate neurobiological and hormonal measurements, and explore optimal types and intensities of PA for each gender.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Healthy older women benefits more from PA beyond cognition\u003c/h2\u003e \u003cp\u003eAmong the 22 studies reviewed, 6 (27.3%) highlighted gender differences that were not directly related to cognition but revealed other cognitive-related benefits of PA for women(Bischoff-Ferrari et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Guzman et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Henskens et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Pani et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; van Uffelen et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Wittmann et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These studies underscore a broader range of advantages that women derive from PA, including depressive symptoms, adherence to exercise protocols, and neurological health improvements.\u003c/p\u003e \u003cp\u003eA possible explanation for this gender difference lies in the higher prevalence of depression among women. Research has shown that PA can effectively alleviate depressive symptoms(Craft \u0026amp; Perna, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), and women are more likely to experience depression than men(Nolen-Hoeksema, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). This higher prevalence of depression in women may contribute to their greater improvements in depressive symptoms following PA. Furthermore, the alleviation of depressive symptoms through PA may, in turn, enhance women\u0026rsquo;s motivation and adherence to intervention programs, creating a positive feedback loop. This feedback loop may help explain why women tend to have higher participation rates and adherence in PA interventions, leading to more cognitive benefits. However, the gender-specific emotional outcomes of PA are not always consistent across studies. As the study(Henskens et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that men with dementia, rather than women, showed significant improvements in mood. The contrasting findings may, in part, be due to differences in the participant populations. In dementia patients, cognitive decline may influence the capacity for emotional regulation, which may explain the inconsistency. Hence, it also highlights the importance of considering participants\u0026rsquo; cognitive status when examining the emotional effects of PA across genders.\u003c/p\u003e \u003cp\u003eAdding to this complexity, multidomain intervention studies include multiple components such as PA, cognitive training, and dietary guidance, which may interact with gender in unexpected ways. 2 out of 5 resulted in gender difference in cognition(Belleville et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and 1 resulted in cognitive-related effect, all favoring women(Wittmann et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), while the rest 2 resulted in no gender difference(Romera-Liebana et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Rosenberg et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Their inconsistent findings may be attributed to several factors. Apart from the possible explanation from intervention design, another one is that women tend to place greater value on social relationships and derive more emotional benefits from social support compared to men(Kendler et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). The higher level of social engagement and support in multi-domain interventions may contribute to greater cognitive health gains in women. Secondly, gender differences in coping strategies may also play a role. Women are more likely to use emotion-focused coping strategies, such as seeking social support, which may help reduce stress and improve mood in the context of multi-domain interventions(Tamres et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Lastly, as discussed earlier, the higher rates of depression in women and the positive feedback loop between PA and depressive symptom alleviation may amplify the emotional benefits women receive from these interventions. However, these explanations remain speculative and require further investigation, particularly in the context of multi-domain interventions.\u003c/p\u003e \u003cp\u003eIn addition to emotional benefits, 3 out of 6 exhibited greater neurological improvements, including significant increase in hippocampal volume(Guzman et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Varma et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and greater gray matter density in the parietal lobe and increased cortical thickness in the parietal and temporal regions(Pani et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). All these benefits are associated with better cognitive outcomes and accord with the idea that women has more neuroprotective effects from PA\u003csup\u003e[10,33]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn summary, the evidence from these studies suggests that healthy older women gain not only cognitive and emotional benefits from PA but also exhibit superior neurological outcomes. The positive feedback loop between improvements in depressive symptoms and greater adherence may also contribute to women\u0026rsquo;s overall greater benefits. Future studies should continue to explore these multidimensional gender differences, focusing on how physical, emotional, and cognitive benefits interact and how different exercise regimens may optimize outcomes for each gender.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Recommendations for future research\u003c/h2\u003e \u003cp\u003eWhile this review has highlighted several key findings regarding gender-specific cognitive, emotional, and neurological benefits of PA among older adults, several gaps and limitations remain in the existing literature. Addressing these gaps through future research will help to develop a more nuanced understanding of how PA can be optimized for both men and women.\u003c/p\u003e \u003cp\u003eFirstly, longitudinal studies with extended follow-ups are needed, to fully capture the sustained cognitive and emotional effects of PA, particularly in older adults. Additionally, the small sample sizes in many RCTs, along with the higher proportion of female participants, may limit the ability to conduct robust gender-specific analyses. Future research should aim to recruit larger and more gender-balanced samples to better understand the long-term cognitive benefits of PA across both men and women. Furthermore, inclusion of biological and neurological measures are necessary. Few studies have incorporated detailed neurobiological assessments, such as changes in gray matter, white matter, or hippocampal volume, to explain gender differences in cognitive outcomes. Future studies should integrate neuroimaging techniques and biomarkers, such as estrogen and testosterone levels, to investigate the underlying mechanisms driving the gender-specific effects of PA. This would help clarify how hormonal fluctuations, brain plasticity, and structural changes influence cognitive outcomes in older adults. Thirdly, while aerobic exercise has been shown to confer cognitive benefits, other forms of PA have received less attention in gender-specific studies. Future research should explore how various types and intensities of exercise affect cognitive outcomes in men and women. It would also be beneficial to compare the effectiveness of different PA regimens in promoting specific cognitive functions. Fourthly, tailored interventions based on health status should be considered. The differences in cognitive benefits observed between healthy older adults and those with MCI or dementia suggest that the cognitive status of participants plays a crucial role in modulating the effects of PA. Future studies should consider designing interventions that are tailored to the specific needs of male and female participants, taking into account their cognitive health, hormonal status, and baseline fitness levels. This could help maximize the benefits of PA for each gender and specific subpopulations, such as those with pre-existing cognitive impairments. Lastly, multi-domain interventions have shown potential in promoting cognitive health, but the gender-specific effects remain underexplored. Future research should examine how these comprehensive interventions may differentially benefit men and women. Additionally, understanding how the interactions between various intervention components influence cognitive and emotional outcomes across genders could provide valuable insights into optimizing intervention strategies.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Strength and Limitation","content":"\u003cp\u003e This scoping review has several notable strengths. First, a rigorous literature screening process was employed, including searches across multiple databases and clearly defined inclusion and exclusion criteria, to comprehensively cover relevant studies on the topic and enhance the reliability of the findings. Second, the included studies varied in sample size, ranging from small to large, encompassing both large-scale cohort studies and RCTs as well as small to medium-sized intervention trials, thereby increasing the persuasiveness of the synthesized results. Third, the interventions in the included studies were diverse with durations, which allows for a more comprehensive evaluation of the gender differences in the effects of various exercise modalities and training periods. Fourth, this review included not only cognitively healthy older adults but also those with MCI and dementia, suggesting that gender differences in the cognitive protective effects of PA may also exist in MCI and dementia populations. This finding expands the scope of research on gender differences to these populations, which is of great significance for developing gender-specific exercise intervention programs.\u003c/p\u003e \u003cp\u003eDespite the strengths mentioned above, this scoping review also has some limitations. First, although 22 studies were included, the number of studies in different subgroups was relatively small, which may affect the stability and generalizability of the subgroup analysis results. Second, there was considerable heterogeneity among the included studies, including intervention design and participant characteristics, which may impact the comparability of the results. Third, the interpretation of the results should be cautious. The review only preliminarily suggests that there may be gender differences in the cognitive protective effects of PA, and the findings were not consistent across all studies. Further high-quality research is needed to validate these results. Fourth, due to the limitations of the included studies, the results of this review may be difficult to generalize to all populations. More focused research and reviews targeting specific populations, such as certain age groups or those with particular health conditions, are necessary to provide more tailored insights.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis scoping review explored the existing evidence on gender differences in the cognitive protective effects of PA among older adults. The findings indicate that while PA interventions generally offer cognitive benefits, these effects may vary between men and women. Although the results across studies were somewhat mixed, this review highlights the importance of incorporating gender considerations when designing and implementing PA interventions aimed at cognitive protection in older populations.\u003c/p\u003e \u003cp\u003eWhile further research is needed to clarify the inconsistencies and elucidate the underlying mechanisms, the findings emphasize the potential of PA as a promising strategy for promoting cognitive health in aging populations, with considerations for gender-specific effects. Healthcare professionals and policymakers should consider these insights when developing and implementing interventions to support healthy cognitive aging in both men and women.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePA \u0026nbsp;Physical Activity\u003c/p\u003e\n\u003cp\u003eMCI \u0026nbsp;Mild Cognitive Impairment\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by\u0026nbsp;Open Research Fund of the State Key Laboratory of Cognitive Neuroscience and Learning, the Natural Science Foundation of China (grant number 32171085) and\u0026nbsp;Tang Scholar.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement of Author\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZXY and LX designed the study. ZXY and ZJW were responsible for article selection and quality assessment. ZXY drafted the manuscript, and LX provided critical revisions and oversight. All authors contributed to the refinement of the manuscript and approved the final version for submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e[Arksey, H., \u0026amp; O\u0026rsquo;Malley, L. (2005). Scoping studies: Towards a methodological framework. \u003cem\u003eInternational Journal of Social Research Methodology\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(1), 19\u0026ndash;32. https://doi.org/10.1080/1364557032000119616\u003c/li\u003e\n \u003cli\u003eArmijo‐Olivo, S., Stiles, C. R., Hagen, N. A., et al. (2012). Assessment of study quality for systematic reviews: A comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. \u003cem\u003eJournal of Evaluation in Clinical Practice\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(1), 12\u0026ndash;18. https://doi.org/10.1111/j.1365-2753.2010.01516.x\u003c/li\u003e\n \u003cli\u003eBaker, L. D., Frank, L. L., Foster-Schubert, K., et al. (2010). Effects of aerobic exercise on mild cognitive impairment: A controlled trial. \u003cem\u003eArchives of Neurology\u003c/em\u003e, \u003cem\u003e67\u003c/em\u003e(1), 71\u0026ndash;79. https://doi.org/10.1001/archneurol.2009.307\u003c/li\u003e\n \u003cli\u003eBarha, C. K., Galea, L. A., Nagamatsu, L. S., et al. (2017). Personalising exercise recommendations for brain health: Considerations and future directions. \u003cem\u003eBritish Journal of Sports Medicine\u003c/em\u003e, \u003cem\u003e51\u003c/em\u003e(8), 636\u0026ndash;639. https://doi.org/10.1136/bjsports-2016-096710\u003c/li\u003e\n \u003cli\u003eBarha, C. K., Starkey, S. Y., Hsiung, G. Y. R., et al.. (2023). Aerobic exercise improves executive functions in females, but not males, without the BDNF Val66Met polymorphism. \u003cem\u003eBiology of Sex Differences\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(1), 16. https://doi.org/10.1186/s13293-023-00499-7\u003c/li\u003e\n \u003cli\u003eBelleville, S., Cloutier, S., Mellah, S., et al. (2022). Is more always better? Dose effect in a multidomain intervention in older adults at risk of dementia. \u003cem\u003eALZHEIMERS \u0026amp; DEMENTIA\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(11), 2140\u0026ndash;2150. https://doi.org/10.1002/alz.12544\u003c/li\u003e\n \u003cli\u003eBelleville, S., Cuesta, M., Bieler-Aeschlimann, M., et al. (2023). Pre-frail older adults show improved cognition with StayFitLonger computerized home-based training: A randomized controlled trial. \u003cem\u003eGEROSCIENCE\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e(2), 811\u0026ndash;822. https://doi.org/10.1007/s11357-022-00674-5\u003c/li\u003e\n \u003cli\u003eBischoff-Ferrari, H. A., Vellas, B., Rizzoli, R., et al. (2020). Effect of Vitamin D Supplementation, Omega-3 Fatty Acid Supplementation, or a Strength-Training Exercise Program on Clinical Outcomes in Older Adults: The \u0026nbsp;DO-HEALTH Randomized Clinical Trial. \u003cem\u003eJAMA\u003c/em\u003e, \u003cem\u003e324\u003c/em\u003e(18), 1855\u0026ndash;1868. https://doi.org/10.1001/jama.2020.16909\u003c/li\u003e\n \u003cli\u003eCao, Q., Tan, C.-C., Xu, W., et al. (2020). The Prevalence of Dementia: A Systematic Review and Meta-Analysis. \u003cem\u003eJournal of Alzheimer\u0026rsquo;s Disease\u003c/em\u003e, \u003cem\u003e73\u003c/em\u003e(3), 1157\u0026ndash;1166. https://doi.org/10.3233/JAD-191092\u003c/li\u003e\n \u003cli\u003eCosgrove, K. P., Mazure, C. M., \u0026amp; Staley, J. K. (2007). Evolving Knowledge of Sex Differences in Brain Structure, Function, and Chemistry. \u003cem\u003eBiological Psychiatry\u003c/em\u003e, \u003cem\u003e62\u003c/em\u003e(8), 847\u0026ndash;855. https://doi.org/10.1016/j.biopsych.2007.03.001\u003c/li\u003e\n \u003cli\u003eCraft, L. L., \u0026amp; Perna, F. M. (2004). The Benefits of Exercise for the Clinically Depressed. \u003cem\u003ePrimary Care Companion to The Journal of Clinical Psychiatry\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(3), 104\u0026ndash;111.\u003c/li\u003e\n \u003cli\u003eDimech, C. J., Anderson, J. A. E., Lockrow, A. W., et al. (2019). Sex differences in the relationship between cardiorespiratory fitness and brain function in older adulthood. \u003cem\u003eJournal of Applied Physiology\u003c/em\u003e, \u003cem\u003e126\u003c/em\u003e(4), 1032\u0026ndash;1041. https://doi.org/10.1152/japplphysiol.01046.2018\u003c/li\u003e\n \u003cli\u003eDimitriadis, S. I., Castells-Sanchez, A., Roig-Coll, F., et al. (2024). Intrinsic functional brain connectivity changes following aerobic exercise, computerized cognitive training, and their combination in physically inactive healthy late-middle-aged adults: The Projecte Moviment. \u003cem\u003eGEROSCIENCE\u003c/em\u003e, \u003cem\u003e46\u003c/em\u003e(1), 573\u0026ndash;596. https://doi.org/10.1007/s11357-023-00946-8\u003c/li\u003e\n \u003cli\u003eFirth, J., Stubbs, B., Vancampfort, D., et al. (2018). Effect of aerobic exercise on hippocampal volume in humans: A systematic review and meta-analysis. \u003cem\u003eNeuroImage\u003c/em\u003e, \u003cem\u003e166\u003c/em\u003e, 230\u0026ndash;238. https://doi.org/10.1016/j.neuroimage.2017.11.007\u003c/li\u003e\n \u003cli\u003eGuzman, J., Agui\u0026ntilde;aga, S., Balbim, G. M., et al. (2021). The effects of the BAILAMOS Dance Program on hippocampal volume in older Latinos: A randomized controlled pilot study. \u003cem\u003eTranslational Behavioral Medicine\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(10), 1857\u0026ndash;1862. https://doi.org/10.1093/tbm/ibab009\u003c/li\u003e\n \u003cli\u003eHara, Y., Waters, E. M., McEwen, B. S. et al. (2015). Estrogen Effects on Cognitive and Synaptic Health Over the Lifecourse. \u003cem\u003ePhysiological Reviews\u003c/em\u003e, \u003cem\u003e95\u003c/em\u003e(3), 785\u0026ndash;807. https://doi.org/10.1152/physrev.00036.2014\u003c/li\u003e\n \u003cli\u003eHenskens, M., Nauta, I. M., van Eekeren, M. C. A., et al. (2018). Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial. \u003cem\u003eDementia and Geriatric Cognitive Disorders\u003c/em\u003e, \u003cem\u003e46\u003c/em\u003e(1\u0026ndash;2), 60\u0026ndash;80. https://doi.org/10.1159/000491818\u003c/li\u003e\n \u003cli\u003eHogervorst, E., De Jager, C., Budge, M., et al.. (2004). Serum levels of estradiol and testosterone and performance in different cognitive domains in healthy elderly men and women. \u003cem\u003ePsychoneuroendocrinology\u003c/em\u003e, \u003cem\u003e29\u003c/em\u003e(3), 405\u0026ndash;421. https://doi.org/10.1016/S0306-4530(03)00053-2\u003c/li\u003e\n \u003cli\u003eHsu, C. L., Best, J. R., Davis, J. C., et al. (2018). Aerobic exercise promotes executive functions and impacts functional neural activity among older adults with vascular cognitive impairment. \u003cem\u003eBritish Journal of Sports Medicine\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(3), 184\u0026ndash;191. https://doi.org/10.1136/bjsports-2016-096846\u003c/li\u003e\n \u003cli\u003eKendler, K. S., Myers, J., \u0026amp; Prescott, C. A. (2005). Sex Differences in the Relationship Between Social Support and Risk for Major Depression: A Longitudinal Study of Opposite-Sex Twin Pairs. \u003cem\u003eAmerican Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e162\u003c/em\u003e(2), 250\u0026ndash;256. https://doi.org/10.1176/appi.ajp.162.2.250\u003c/li\u003e\n \u003cli\u003eLamb, S. E., Sheehan, B., Atherton, N., et al. (2018). Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: Randomised controlled trial. \u003cem\u003eBMJ (Clinical Research Ed.)\u003c/em\u003e, \u003cem\u003e361\u003c/em\u003e, k1675. https://doi.org/10.1136/bmj.k1675\u003c/li\u003e\n \u003cli\u003eLi, W., van Tol, M., Li, M., et al. (2012). Regional specificity of sex effects on subcortical volumes across the lifespan in healthy aging. \u003cem\u003eHuman Brain Mapping\u003c/em\u003e, \u003cem\u003e35\u003c/em\u003e(1), 238\u0026ndash;247. https://doi.org/10.1002/hbm.22168\u003c/li\u003e\n \u003cli\u003eLiu, Z., Hsu, F.-C., Trombetti, A., et al. (2018). Effect of 24-month physical activity on cognitive frailty and the role of inflammation: The LIFE randomized clinical trial. \u003cem\u003eBMC Medicine\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(1), 185. https://doi.org/10.1186/s12916-018-1174-8\u003c/li\u003e\n \u003cli\u003eMorrison, J. H., Brinton, R. D., Schmidt, P. J., et al. (2006). Estrogen, Menopause, and the Aging Brain: How Basic Neuroscience Can Inform Hormone Therapy in Women. \u003cem\u003eThe Journal of Neuroscience\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(41), 10332\u0026ndash;10348. https://doi.org/10.1523/JNEUROSCI.3369-06.2006\u003c/li\u003e\n \u003cli\u003eNolen-Hoeksema, S. (2001). Gender Differences in Depression. \u003cem\u003eCurrent Directions in Psychological Science\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(5), 173\u0026ndash;176. https://doi.org/10.1111/1467-8721.00142\u003c/li\u003e\n \u003cli\u003eNorthey, J. M., Cherbuin, N., Pumpa, K. L., et al. (2018). Exercise interventions for cognitive function in adults older than 50: A systematic review with meta-analysis. \u003cem\u003eBritish Journal of Sports Medicine\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(3), 154\u0026ndash;160. https://doi.org/10.1136/bjsports-2016-096587\u003c/li\u003e\n \u003cli\u003ePani, J., Marzi, C., Stensvold, D., et al. (2022). Longitudinal study of the effect of a 5-year exercise intervention on structural brain complexity in older adults. A Generation 100 substudy. \u003cem\u003eNEUROIMAGE\u003c/em\u003e, \u003cem\u003e256\u003c/em\u003e. https://doi.org/10.1016/j.neuroimage.2022.119226\u003c/li\u003e\n \u003cli\u003ePeters, M. D. J., Godfrey, C., McInerney, P., et al. (2022). Best practice guidance and reporting items for the development of scoping review protocols. \u003cem\u003eJBI Evidence Synthesis\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(4), 953\u0026ndash;968. https://doi.org/10.11124/JBIES-21-00242\u003c/li\u003e\n \u003cli\u003eRomera-Liebana, L., Orfila, F., Segura, J. M., et al. (2018). Effects of a Primary Care-Based Multifactorial Intervention on Physical and Cognitive Function in Frail, Elderly Individuals: A Randomized Controlled Trial. \u003cem\u003eThe Journals of Gerontology. Series A, Biological Sciences and Medical Sciences\u003c/em\u003e, \u003cem\u003e73\u003c/em\u003e(12), 1688\u0026ndash;1674. https://doi.org/10.1093/gerona/glx259\u003c/li\u003e\n \u003cli\u003eRosenberg, A., Ngandu, T., Rusanen, M., et al.. (2018). Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial. \u003cem\u003eALZHEIMERS \u0026amp; DEMENTIA\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(3), 263\u0026ndash;270. https://doi.org/10.1016/j.jalz.2017.09.006\u003c/li\u003e\n \u003cli\u003eSink, K. M., Espeland, M. A., Castro, C. M., et al. (2015). Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults: The LIFE Randomized Trial. \u003cem\u003eJAMA\u003c/em\u003e, \u003cem\u003e314\u003c/em\u003e(8), 781\u0026ndash;790. https://doi.org/10.1001/jama.2015.9617\u003c/li\u003e\n \u003cli\u003eTamres, L. K., Janicki, D., \u0026amp; Helgeson, V. S. (2002). Sex Differences in Coping Behavior: A Meta-Analytic Review and an Examination of Relative Coping. \u003cem\u003ePersonality and Social Psychology Review\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(1), 2\u0026ndash;30. https://doi.org/10.1207/S15327957PSPR0601_1\u003c/li\u003e\n \u003cli\u003eTelenius, E. W., Engedal, K., \u0026amp; Bergland, A. (2015). Effect of a High-Intensity Exercise Program on Physical Function and Mental Health in Nursing Home Residents with Dementia: An Assessor Blinded Randomized Controlled Trial. \u003cem\u003ePLOS ONE\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(5). https://doi.org/10.1371/journal.pone.0126102\u003c/li\u003e\n \u003cli\u003eToots, A., Littbrand, H., Bostr\u0026ouml;m, G., et al. (2017). Effects of Exercise on Cognitive Function in Older People with Dementia: A Randomized Controlled Trial. \u003cem\u003eJournal of Alzheimer\u0026rsquo;s Disease : JAD\u003c/em\u003e, \u003cem\u003e60\u003c/em\u003e(1), 323\u0026ndash;332. https://doi.org/10.3233/JAD-170014\u003c/li\u003e\n \u003cli\u003eTu, L., Lv, X., Yuan, C., et al. (2024). Sex differences in cognitive function trajectories and their determinants in older adults: Evidence from the Chinese longitudinal healthy longevity survey. \u003cem\u003eInternational Journal of Geriatric Psychiatry\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(3), e6072. https://doi.org/10.1002/gps.6072\u003c/li\u003e\n \u003cli\u003evan Stralen, M. M., de Vries, H., Bolman, C., Mudde, A. N., et al. (2010). Exploring the efficacy and moderators of two computer-tailored physical activity interventions for older adults: A randomized controlled trial. \u003cem\u003eAnnals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(2), 139\u0026ndash;150. https://doi.org/10.1007/s12160-010-9166-8\u003c/li\u003e\n \u003cli\u003evan Uffelen, J. G. Z., Chinapaw, M. J. M., van Mechelen, W., et al. (2008). Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial. \u003cem\u003eBritish Journal of Sports Medicine\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(5), 344\u0026ndash;351. https://doi.org/10.1136/bjsm.2007.044735\u003c/li\u003e\n \u003cli\u003eVarma, V. R., Chuang, Y.-F., Harris, G. C., et al. (2015). Low-intensity daily walking activity is associated with hippocampal volume in older adults. \u003cem\u003eHippocampus\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(5), 605\u0026ndash;615. https://doi.org/10.1002/hipo.22397\u003c/li\u003e\n \u003cli\u003eVoss. (2010). Plasticity of brain networks in a randomized intervention trial of exercise training in older adults. \u003cem\u003eFrontiers in Aging Neuroscience\u003c/em\u003e. https://doi.org/10.3389/fnagi.2010.00032\u003c/li\u003e\n \u003cli\u003eWittmann, F. G., Pabst, A., Zuelke, A., et al. (2024). Who Benefited the Most? Effectiveness of a Lifestyle Intervention Against Cognitive Decline in Older Women and Men\u0026mdash;Secondary Analysis of the AgeWell.de-trial. \u003cem\u003eJPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(2), 348\u0026ndash;355. https://doi.org/10.14283/jpad.2024.13\u003c/li\u003e\n \u003cli\u003eZlatar, Z. Z., Godbole, S., Takemoto, M., et al. (2019). Changes in Moderate Intensity Physical Activity Are Associated With Better Cognition in the Multilevel Intervention for Physical Activity in Retirement \u0026nbsp;Communities (MIPARC) Study. \u003cem\u003eThe American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(10), 1110\u0026ndash;1121. https://doi.org/10.1016/j.jagp.2019.04.011\u003c/li\u003e\n \u003cli\u003eZotcheva, E., Haberg, A. K., Wisloff, U., et al. (2022). Effects of 5 Years Aerobic Exercise on Cognition in Older Adults: The Generation 100 Study: A Randomized Controlled Trialy. \u003cem\u003eSPORTS MEDICINE\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(7), 1689\u0026ndash;1699. https://doi.org/10.1007/s40279-021-01608-5\u003cem\u003e\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sports-medicine-open","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"smoa","sideBox":"Learn more about [Sports Medicine-Open](http://sportsmedicine-open.springeropen.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/smoa/default.aspx","title":"Sports Medicine-Open","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Physical activity, Cognitive aging, Gender differences, Older adults, Scoping review","lastPublishedDoi":"10.21203/rs.3.rs-5274665/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5274665/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: With the global population aging rapidly and dementia cases expected to rise substantially, identifying effective strategies to mitigate cognitive decline has become crucial. This scoping review aimed to systematically examine the existing evidence on gender differences in the cognitive protective effects of physical activity among older adults and to provide recommendations for future research.\u003c/p\u003e\n\u003cp\u003eMethods: A comprehensive search of PubMed, Web of Science, and Cochrane Library was conducted following the PRISMA-ScR guidelines. Researches that evaluated the effects of physical activity interventions on cognitive function in older adults and examined gender differences were included.\u003c/p\u003e\n\u003cp\u003eResults: Twenty-two studies met the inclusion criteria. The majority of studies (95.5%) were of moderate to high methodological quality. Approximately 60% of the studies found significant gender differences in cognitive outcomes or other related outcomes following physical activity interventions, while the remaining studies observed no gender differences. In subgroups, studies targeting on the old with mild cognitive impairment all shows significant gender difference. When gender differences were present, women appeared to benefit more from physical activity in cognition, especially executive function, compared to men.\u003c/p\u003e\n\u003cp\u003eConclusion: This review suggested that physical activity may provide cognitive benefits differing between genders with women benefiting more. However, due to varied study design, intervention and outcome measures among the included studies, future studies should employ more rigorous designs, larger samples, and longer follow-ups to elucidate the underlying mechanisms and optimize interventions for both genders.\u003c/p\u003e","manuscriptTitle":"Gender Differences in the Cognitive Benefits of Physical Activity for Older Adults: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 08:41:04","doi":"10.21203/rs.3.rs-5274665/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-01-20T09:58:03+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-04T14:59:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-17T10:51:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sports Medicine-Open","date":"2024-10-17T03:05:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sports-medicine-open","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"smoa","sideBox":"Learn more about [Sports Medicine-Open](http://sportsmedicine-open.springeropen.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/smoa/default.aspx","title":"Sports Medicine-Open","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"29a84086-ace3-41dc-9c1e-617e736faf1c","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T08:41:04+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-09 08:41:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5274665","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5274665","identity":"rs-5274665","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}