Differential Impacts of Exercise Modalities on Executive Function and Working Memory Performance: A Community-Based 3-Month Intervention Trial in Older Adults

Differential Impacts of Exercise Modalities on Executive Function and Working Memory Performance: A Community-Based 3-Month Intervention Trial in Older Adults | 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 Differential Impacts of Exercise Modalities on Executive Function and Working Memory Performance: A Community-Based 3-Month Intervention Trial in Older Adults Shanshan Wu, Yan Zhao, Shiyang Weng, Huayu Shang, Zhi Xia, Hongqing Ji This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7304481/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background With the rapidly ageing global population, exercise and physical activity are increasingly becoming important for societal advancement. Objective To investigate the impact of various exercise methods on Executive Function (EF) and working memory in community-dwelling older adults. Methods This study involved 111 community-dwelling older adults (mean age = 73 ± 9.3 years), randomly assigned to six groups: Traditional Qigong Group (TQG, n = 19), Multimodal Exercise Group (MEG, n = 18), Dance-Based Exercise Group (DBEG, n = 18), Elastic Resistance Training Group (ERTG, n = 18), Brisk Walking Group (BWG, n = 19), and Control Group (CG, n = 19). The study lasted 12 weeks, with pre- and post-intervention assessments conducted using N-Back and Stroop tasks to evaluate EF and working memory performance. The effects of time (pre- vs post-intervention), group, and Group × Time × Task interactions were assessed using Repeated-Measures Analysis of Variance (RM-ANOVA). Results Compared to the CG, all the exercise groups demonstrated greater improvements in N-back and Stroop task accuracy. Furthermore, while the exercise groups showed significantly shorter Reaction Times (RTs) post-intervention, the CG exhibited no RT changes. Additionally, the exercise groups exhibited more pronounced task-related cognitive gains, with significant group × time × task interactions, indicating differential intervention effects across modalities. Moreover, post-hoc analyses confirmed differential intervention effects across groups. Conclusions Multimodal exercise programs that integrate physical activity with cognitive stimulation are promising interventions for enhancing Executive Function and Working Memory in community-dwelling elderly individuals. Trial registration: Clinical trial number: not applicable. Exercise Modalities Executive Function Working Memory Older Adults Community-Based Intervention Trial Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction The rapidly ageing global population significantly impacts public health, resource allocation, and community interaction patterns [ 1 , 2 ], ultimately influencing Executive Functions (EFs) such as Inhibitory Control (IC), working memory, and cognitive flexibility [ 3 – 6 ]. In this regard, it is noteworthy that community-organized collective activities, such as interest groups and volunteer services, could promote social interaction and engagement, thus enhancing mental functions [ 7 – 10 ]. Conversely, active services, such as involuntary home medical care, may limit autonomous activities, exacerbating cognitive decline [ 11 , 12 ]. Communal environments crucially impact cognitive health among the elderly [ 13 , 14 ]. According to research, a sense of community belonging, resulting from social participation and psychological security, could enhance cognitive function [ 13 ]. Furthermore, community features such as walkability, cycling infrastructure, and mixed land use were linked with better working memory [ 13 ]. Meanwhile, other factors such as high street integration and proximity to major roads could impair cognitive abilities [ 15 ]. Additionally, while community-based services, such as home-based medical care, could improve depression and cognition [ 16 , 17 ], an over-reliance on "door-to-door" assistance may reduce independent activities, adversely affecting elderly health [ 9 ]. Socially engaging community activities can alleviate depression and strengthen cognitive reserve, thus enhancing cognition [ 18 ]. It is also noteworthy that the lack of community resources affects women and older individuals more [ 19 ]. Moreover, through education, urban environments may indirectly influence cognition, contributing to cognitive reserves and addressing some urban-rural disparities [ 20 ]. Based on these insights, the community is a crucial social determinant of cognitive health among older adults. Therefore, a multidimensional program integrating environmental optimization, physical activity, nutritional interventions, and cognitive training could facilitate ecological transformation, service optimization, and strong social support networks, thus promoting active ageing. Regular exercise, a cost-effective and easily implemented lifestyle intervention, may improve cognitive function in older adults—particularly EF and working memory [ 21 – 24 ]. According to epidemiological and intervention studies, older individuals who exercise regularly perform better cognitively than their inactive counterparts. Some of the physiological mechanisms underlying this effect might include increased blood flow, enhanced neurotrophic factor release, neuroplasticity, inflammation inhibition, and neurotransmitter balance maintenance [ 25 – 27 ]. While exercises positively impact cognitive function, EF, and working memory, the differences between them regarding their impact on these functions remain unclear. Moderate-intensity exercises could reduce the risk of cognitive impairment by 40% [ 3 , 8 – 10 , 12 , 25 , 28 ]. Randomized Controlled Trials (RCTs) also revealed that aerobic exercises (walking, swimming, running, and so on) increased the hippocampal volume and spatial memory by 2% each [ 29 , 30 ]. Furthermore, resistance training and coordination exercises (such as Tai Chi) could stimulate the Prefrontal Cortex (PFC), improving EF [ 31 ]. Different exercise types are also mediated differently. For instance, moderate to high-intensity aerobic exercise activates the PFC [ 17 , 18 ], while dancing could increase the Fronto-Parietal Network (FPN) [ 27 , 28 , 32 – 34 ]. Moreover, exercise and cognitive training could jointly increase Brain-Derived Neurotrophic Factor (BDNF) levels [ 25 – 27 ]. Nonetheless, Multimodal Controlled Trials (MCTs) have not fully explored the various effects of different exercise modes on EF and working memory in community-dwelling elderly people. Herein, we conducted a 3-month community-controlled trial to compare six intervention modes: Traditional qigong, aerobic training, dance fitness, elastic band resistance training, walking, and health education. Specifically, we quantitatively assessed the Stroop and N-back tasks to elucidate how these exercise modes improve EF and working memory in elderly participants. We hope that our findings will inform individualized community strategies for cognitive enhancement. 2. Methods 2.1 Participants Initially, 150 older adults aged ≥ 60 were recruited from five communities in Wenzhou City, Zhejiang Province, China. The participants were recruited through social media advertisements and informational posters placed at local community centers frequented by individuals who could be interested in exercise programs. The inclusion criteria were: (1) Participants aged ≥ 60 years; (2) Participants with a Mini-Mental State Examination (MMSE) score of 27–30; and (3) Participants who can walk unaided. To mitigate the risk of Adverse Events (AEs), individuals with a history of falls, dizziness, or those using walking aids were excluded from the study. All participants provided written informed consent before enrollment. The Chengdu Sport University Institutional Review Board approved the study protocol ([2023]65). Copyright Compliance Statement: During the initial phase of this study, an unauthorized version of the Chinese MMSE was used by the study team without permission, however this has now been rectified with PAR. The MMSE is a copyrighted instrument and may not be used or reproduced in whole or in part, in any form or language, or by any means without written permission of PAR ( www.parinc.com ). This rectification ensures the study’s adherence to academic copyright regulations. Sample size All participants were randomly divided into six groups: Traditional Qigong Group (TQG, n = 25), Multimodal Exercise Group (MEG, n = 25), Dance-Based Exercise Group (DBEG, n = 25), Elastic Resistance Training Group (ERTG, n = 25), Brisk Walking Group (BWG, n = 25), and Control Group (CG, n = 25). After 4 weeks of exercise interventions, 6–7 participants from each group withdrew from the study (Fig. 1). Consequently, only 19 TQG participants, 18 MEG participants, 18 DBEG participants, 18 ERTG participants, 19 BWG participants, and 19 CG participants completed the 12-week exercise program and were included in the final analysis. The sample size was determined using G*Power (version 3.1.9.2 for Windows), with an effect size, statistical power, and statistical significance level of 0.29, 0.80, and 0.05, respectively. The effect size used was derived from previous studies [ 35 , 36 ]. Each group’s sample size was approximated at 20 patients, with 25 patients recruited for each group after considering a potential 20% dropout rate. 2.2 Exercise Training Interventions Six different exercises were performed over 12 weeks, each comprising three 60-min sessions/week. Exercise intensity was measured using a Rating of Perceived Exertion (RPE) scale, targeting a rating of 12–14 on the Borg 6–20 scale. Each group’s intensity was 60–80% of the Heart Rate Reserve (HRR). The specific exercise interventions are discussed in subsequent sections. 2.2.1 Traditional Qigong Group (TQG) Two traditional Chinese health Qigong forms were used: Baduanjin (Weeks 1–6) and Wuqinxi (Weeks 7–8). Certified instructors taught the classes using official videos from China’s General Administration of Sport. 2.2.2 Multimodal Exercise Group (MEG) The participants engaged in rhythm-synchronized callisthenics, involving upper-limb and trunk movements, as well as lower-limb cycling. The exercise lasted 4 min at 120 bpm (beats per minute), followed by 2 min of active recovery. Movement complexity and cadence were increased biweekly. 2.2.3 Dance-Based Exercise Group (DBEG) The exercises included low- (steps, shifts, and V-steps) and high-impact (plyometric jumps and knee drives) activities. The choreography consisted of 8–9 combinations, varying in kinematic range of motion and ground reaction forces according to the musical tempo (110–135 bpm), and was updated every 28 days. 2.2.4 Elastic Resistance Training Group (ERTG) The exercises comprised ten machine-alternative exercises using Thera-Band® elastic tubing, including: One chest press, shoulder press, reverse fly, and bicep curl; and two knee flexion/extension, hip abduction, leg press, and calf raise. The exercises were performed in two sets of 10–12 repetitions, with 30–60 s rest between sets, and a 5–8 intensity on the OMNI-Resistance Exercise Scale. Based on the Thera-Band color-coded system, resistance was increased every 4 weeks, with each session involving a series of 5-min warm-ups, 30-min resistance, and 5-min cool-down. 2.2.5 Brisk Walking Group (BWG) Biomechanical improvement was achieved as follows: One postural alignment (neck extension and thoracic elevation); two gait modifications (metatarsophalangeal joint propulsion); three upper-limb movements (increased arm swing); and four respiration activities (diaphragmatic breathing). During a circular walk in community settings, we maintained a pace of 120 bpm (as measured with Polar heart rate devices). 2.2.6 Control Group (CG) Participants attended weekly 60-min health education seminars covering non-physical exercise-related wellness topics, including nutritional guidance, sleep hygiene, and stress management strategies. 2.3 N-Back task The participants’ working memory was assessed using the N-back task. The color N-back task was implemented using E-prime 3 software, with Response Time (RT) and accuracy as the key criteria. Based on previous reports, we selected two colors (red and green) and two memory loads (n = 1,2). The test involved 1- and 2-back tasks, which began with 20 practice trials and 50 formal tests. Color stimuli were randomly displayed for 1.8 s, followed by a 1.0-s blank screen. Participants pressed the “G” key for matches; otherwise, no response was required. 2.4 Stroop task The participants’ EF was assessed using the Stroop task with E-prime 3 software. The RTs and accuracy were analyzed. The Stroop task evaluates color perception and word interpretation. It involves two subtasks: Stroop A and Stroop B. Stroop A involves participants identifying the patch color and pressing the corresponding key. On the other hand, Stroop B involves responding to color words by clicking buttons corresponding to the word's meaning. Each subtask comprised 20 practice trials and 50 formal trials, where color stimuli were randomly displayed for 1.8 s. Subsequently, a blank screen was displayed for 1 s to indicate color matches: F1, F2, F3, and F4 for red, green, yellow, and blue, respectively. The experiment comprised two counterbalanced cognitive conditions: A (Perceptual Color Matching), where participants read using a 4-button response pad to distinguish between solid colors (red, green, blue, yellow); and B (Semantic-Interference Task), where participants read manually to identify the matching colors (e.g., word "red" in blue) followed by Stroop effect quantification. 2.5 Statistical Analysis Statistical analyses were performed using SPSS v24.0 (α = 0.05). Normality (Shapiro-Wilk test), variance homogeneity (Levene’s test), and sphericity (Mauchly’s test with Greenhouse-Geisser correction) were all validated. Three-way Repeated-Measures Analysis of Variance (RM-ANOVA) (Group×Time, Group×Task, Time×Task, Group×Time×Task) were used for N-Back/Stroop tasks, followed by Bonferroni-corrected pairwise comparisons. Partial η²ₚ effect sizes (η² p ; small ≥ 0.01, medium ≥ 0.06, large ≥ 0.14) were also reported. Non-parametric tests or ANCOVA (Analysis of Covariance; covariate adjustment) were used as supplements if the assumptions were violated. Data were presented as mean ± Standard Deviation (SD). 3 Results 3.1 Participants Of the 150 participants initially included, 19 from the TQG (two were not compliant and four had unknown reasons) were lost to follow-up at 4 weeks. In the MEG, 18 participants were excluded (four had health problems, one was not compliant, and two had an unknown reason). In the DBEG, 18 participants were excluded (two lacked motivation, two were not compliant, and three had unknown reasons). In the ERTG, 18 participants were excluded (two had had health problems, one did not perform reevaluations and analyses, and four had unknown reasons). In the BWG, 19 participants were excluded (two had health problems, one lacked motivation, and three had unknown reasons). In the CG, 19 participants were excluded (six had unknown reasons). Consequently, only 19 TQG (male: n = 2, female: n = 17), 18 MEG (male: n = 2, female: n = 16), 18 DBEG (male: n = 1, female: n = 17), 18 ERTG (male: n = 1, female: n = 17), 19 BWG (male: n = 2, female: n = 17), and 19 CG (male: n = 2, female: n = 19) participants completed the 12-week exercise program. The mean age of the 111 participants who completed the study was 73 ± 9.3 years. Table 1 summarizes all subjects’ demographic and physical characteristics. Table 1 Baseline demographic information. Group Variables TQG (n = 19) MEG (n = 18) DBEG (n = 18) ERTG (n = 18) BWG (n = 19) CG (n = 19) Gender ratio (Male: Female) 2:17 2:16 1:17 1:17 2:17 2:17 Age (years) 70.6 ± 9.6 73.3 ± 10 69.2 ± 8.2 72.6 ± 9.6 74.4 ± 8.4 75.2 ± 9.7 Height (cm) 154.9 ± 5.5 155.5 ± 8.5 158.5 ± 7.2 154.4 ± 8.8 157.7 ± 7.6 154.8 ± 8.3 Weight (kg) 56.6 ± 9.2 54.5 ± 13.7 61.7 ± 9.7 58.9 ± 11.4 60.7 ± 11.4 62.2 ± 9.2 MMSE (score) 30 30 30 30 30 30 BMI (kg/m 2 ) 23.5 ± 3.3 22.7 ± 4.6 24.5 ± 3.3 24.5 ± 3.4 24.3 ± 3.4 26.2 ± 4.7 Visceral Adipose Tissue (VAT; kg) 8.8 ± 3.3 7.4 ± 3.4 9.9 ± 3.8 11.3 ± 4.1 10.9 ± 3.9 12.3 ± 5.4 Muscle mass (kg) 20.2 ± 3.2 19.6 ± 4.8 22.1 ± 5.4 19.5 ± 5.1 20.6 ± 5.1 24.9 ± 8.6 Notes : Values are presented as Mean ± SD; TQG = Traditional Qigong Group; MEG = Multimodal Exercise; DBEG = Dance-Based Exercise Group; ERTG = Elastic Resistance Training Group; BWG = Brisk Walking Group; CG = Control Group; MMSE = Mini Mental State Examination; and BMI = Body Mass Index 3.2 N-Back task For N-BACK AR (Fig. 4 ), RM-ANOVA revealed significant main effects of Time [F(1,105) = 1069.79, p < 0.001, η² p =0.911], Group [F(5,105) = 2026.161, p < 0.001, η² p =0.189], and Task [F(1,105) = 77.284, p < 0.001, η² p =0.424]. Significant interaction effects were also observed, including Time×Group [F(5,105) = 38.194, p < 0.001, η² p =0.645], Task×Group [F(5,105) = 3.061, p = 0.013, η² p =0.127], Task×Time [F(1,105) = 16.561, p < 0.001, η² p =0.136], and Task×Time×Group [F(5,105) = 4.595, p = 0.001, η² p =0.180]. Post-hoc comparisons further revealed significant group differences. Specifically, BWG performed significantly differently from TQG (p = 0.014), MEG (p = 0.004), and DBEG (p = 0.004). Furthermore, CG showed marked disparities with FQG (p = 0.002), MEG (p < 0.001), DBEG (p < 0.001), and ERTG (p = 0.037), highlighting distinct inter-group intervention effects. For N-BACK RT (Fig. 4 ), RM-ANOVA revealed significant main effects of Time [F(1,105) = 567.253, p < 0.001, η² p =0.844] and Group [F(5,105) = 2.507, p = 0.035, η² p =0.107]. Furthermore, significant interaction effects were observed for Time×Group [F(5,105) = 43.426, p < 0.001, η² p =0.674], Task×Group [F(5,105) = 6.232, p < 0.001, η² p =0.229], and Task×Time×Group [F(5,105) = 4.887, p < 0.001, η² p =0.189]. Task demonstrated a marginally significant main effect [F(1,105) = 4.958, p = 0.028, η² p =0.045], while Task×Time [F(1,105) = 2.158, p = 0.145, η² p =0.020] showed no significant main effect. According to the pairwise tests, TQG vs. MEG (p = 0.043), CG vs. MEG (p = 0.001), and ERTG (p = 0.044) demonstrated differential RT improvement patterns across groups. 3.3 Stroop task For Stroop AR (Fig. 5 ), RM-ANOVA revealed significant main effects of Time [F(1,105) = 670.962, p < 0.001, η² p =0.865] and Group [F(5,105) = 10.744, p < 0.001, η² p =0.338]. Furthermore, significant interactions were observed for Time×Group [F(5,105) = 28.148, p < 0.001, η² p =0.573], Task×Group [F(5,105) = 3.393, p = 0.007, η² p =0.139], and Task×Time×Group [F(5,105) = 2.692, p = 0.025, η² p =0.114]. Non-significant effects were observed for Task [F(1,105) = 0.694, p = 0.407, η² p =0.007] and Task×Time [F(1,105) = 0.237, p = 0.627, η² p =0.002]. The groups further showed significant differences. Specifically, BWG performed significantly differently from TQG (p = 0.006) and MEG (p = 0.027), while CG showed marked disparities with FQG, MEG, DBEG, ERTG and BWG (p < 0.001). For Stroop RT (Fig. 5 ), RM-ANOVA revealed significant main effects of Time [F(1,105) = 684.438, p < 0.001, η² p =0.867], Group [F(5,105) = 5.816, p < 0.001, η² p =0.217], and Task [F(1,105) = 77.195, p < 0.001, η² p =0.424]. Significant interactions were also observed for Time×Group [F(5,105) = 35.852, p < 0.001, η² p =0.631], Task×Group [F(5,105) = 28.582, p < 0.001, η² p =0.576], Task×Time [F(1,105) = 30.050, p < 0.001, η² p =0.223], and Task×Time×Group [F(5,105) = 8.822, p < 0.001, η² p =0.296]. The significant differences across groups included: EBTG vs. TQG (p = 0.019), DBEG (p = 0.035); BWG vs. TQG (p < 0.001), DBFG (p = 0.001); and CG vs. MEG (p = 0.005), ERTG (p = 0.002), BWG (p < 0.001). 4 Discussion Herein, we evaluated the effects of various exercise methods on EF and working memory in community-dwelling older adults. Our key findings were: 1) In Stroop tasks, improvements in both accuracy and RT favorably impacted EF in IC accuracy and conflict resolution efficiency; 2) In N-Back tests, improvements in both accuracy and RT similarly improved working memory storage and processing, a phenomenon attributable to enhanced EFs such as attention control and information updating. Moreover, varying effects of different exercises aligned with previous research, suggesting that exercise, along with cognitive stimulation, could improve brain function. In the Stroop task, the TQG and MEG groups were significantly more effective than the BWG group. According to research, Baduanjin alters the PFC blood flow and plasticity, thus enhancing EFs, such as IC [ 28 , 37 , 38 ]. Additionally, adults with Mild Cognitive Impairment (MCI) previously outperformed the CG on EF tests after 24 weeks [ 39 ]. It is also noteworthy that brisk walking, a standalone aerobic exercise, did not significantly impact high-order IC in conflict tasks, such as the Stroop task, with less effective impacts compared to multimodal or mind-body exercises [ 35 , 40 , 41 ]. Based on these insights, it is plausible that mind-body exercises could enhance IC and that intervention programs for improving cognitive function should incorporate more comprehensive mind-body exercises. Although multiple exercise modes (MEG, ERG, and BWG) demonstrated a significant improvement in IC and conflict resolution, different reactions were observed for TQG and DEG. Compared to both TQG and DEG, these reactions were slower for ERG but faster for BWG, a phenomenon attributable to exercise modes differing in coordination requirements. Due to the need for synchronization and cognitive control, which may necessitate more neural plasticity, high-coordination exercises, such as fitness qigong or dance, may optimize RT more effectively [ 42 , 43 ]. Conversely, low-coordination aerobic exercises, such as walking, although they may improve basic RT, may exhibit weaker adaptivity in complex conflict tasks [ 44 , 45 ]. Besides offering new insights, these findings could enhance our understanding of the differences between various exercise modes in terms of IC and conflict resolution. In the N-Back task, TQG, MEG, DEG, and ERG significantly outperformed CG in working memory. Additionally, TQG, MEG, and DEG had better working memory than BWG (and CG). These findings align with previous results on multimodal exercise, which combines aerobics, strength, and balance training, thus increasing working memory more broadly [ 46 , 47 ]. Multimodal exercises combine various exercise forms, such as coordination training and cognitive tasks, activating multiple brain regions, including the PFC and hippocampus, thus enhancing working memory storage and processing [ 42 , 48 ]. Conversely, although BWG, as a single aerobic exercise, could improve working memory in low-load tasks (e.g., back), it is less effective in higher-order tasks (e.g., 1-back and 2-back) [ 49 ]. Additionally, regarding working memory accuracy, BWG outperformed MEG. Regarding working memory, MEG had a faster RT than TQG and CG, with ERG outperforming CG. This phenomenon could be attributed to the distinctive dual-task training in multimodal exercise. Dual task training (motor and cognitive tasks) previously reduced cognitive resource allocation, improving working memory RT [ 50 – 53 ]. Furthermore, this approach was found to be more effective than aerobic exercise alone [ 54 – 56 ]. Overall, dual-task training in multimodal exercise maximizes cognitive resource allocation and RT more effectively than aerobic exercises. Despite its valuable insights, this study has several notable limitations. First, expanding sample size and improving diversity balancing gender ratios (current 89.5%-94.4% female predominance) and including participants with broader cognitive baselines (e.g., mild cognitive impairment, MCI) to enhance findings’ generalizability. Second, conducting 6–12 month post-intervention follow-ups to assess sustainability of observed cognitive improvements and explore potential cumulative benefits. Third, cognitive evaluation relied on Stroop and N-Back tasks, focusing only on attention and overlooking neurophysiological indicators, such as Cerebral Blood Flow (CBF) and BDNF, thus weakening mechanistic explanations. Fourth, standardizing intervention parameters (intensity, frequency, duration) and exploring dose-response relationships (e.g., exercise intensity vs. cognitive improvement) to optimize personalized exercise prescriptions for older adults. Conclusions In this 12-week community-based intervention study, we found traditional Qigong (TQG) and multimodal exercise (MEG) improved executive function and working memory in community-dwelling cognitively healthy older adults, providing preliminary evidence for designing short-term cognitive enhancement interventions for this group. Brisk walking (BWG, single-mode aerobic exercise) also benefited cognition enhancing information processing accuracy and working memory (especially low-load N-Back tasks) and is reasonably recommended for such older adults, particularly those with limited physical capacity or inability to do complex exercises like TQG/MEG. For community cognitive enhancement programs, organizers may prioritize TQG/MEG for cognitively healthy older adults with sufficient physical capacity, and offer BWG as an alternative for those with reduced mobility or exercise tolerance. Declarations Ethics approval and consent to participate : The study was approved by the Institutional Review Board of Chengdu Sport University ([2023]65) and adhered to the Helsinki Declaration guidelines. Consent for publication : All subjects provided informed consent to participate in the study and written informed consent authorising result publication. Availability of data and materials : All datasets used and/or analysed in this study are available from the corresponding author upon reasonable request. Conflicts of Interest: None declared. Funding: This study was supported by grants from the National Natural Science Foundation of China (Grant no. 31960192), the Zhejiang Provincial Natural Science Foundation of China (Grant no. LY23C110001), the Basic Scientific Research Project of Wenzhou City (Grant no. Y20220209 and Y20240018), and the Scientific Research Fund of Zhejiang Provincial Education Department (Grant no. Y202248769 and Y202352718). Author information: Shanshan Wu and Yan Zhao contributed equally to this work and share first authorship. Authors' contributions: SS-W, Z-X and HQ-J: Study conception, design, and hypothesis; SS-W, HQ-J, Y-Z and SY-W: Systematic search, data extraction, and bias risk assessment; SS-W, HY-S, Y-Z and HQ-J: All statistical analyses; and SS-W, Z-X and HQ-J: Manuscript drafting and revision (including the final version). All authors read and approved the draft and the final manuscript. Acknowledgments: We would like to thank all participants for their time and effort during the study. The results of the survey are presented honestly and without fabrication, falsification, or inappropriate data manipulation. No conflicts of interest are declared. References McVeigh KS, Mehl MR, Polsinelli AJ, Moseley SA, Sbarra DA, Glisky EL, Grilli MD. Loneliness and social isolation are not associated with executive functioning in a cross-sectional study of cognitively healthy older adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2024;31(5):777–94. Wei CC, Hsieh MJ, Chuang YF. The Effects of Social Interaction Intervention on Cognitive Functions Among Older Adults Without Dementia: A Systematic Review and Meta-Analysis. Innov Aging. 2024;8(10):igae084. Fan D, Che X, Jiang Y, He Q, Yu J, Zhao H. Noninvasive brain stimulations modulated brain modular interactions to ameliorate working memory in community-dwelling older adults. Cereb Cortex 2024, 34(4). Franco-O'Byrne D, Sepúlveda JPM, Gonzalez-Gomez R, Ibáñez A, Huepe-Artigas D, Matus C, Manen R, Ayala J, Fittipaldi S, Huepe D. The neurocognitive impact of loneliness and social networks on social adaptation. Sci Rep. 2023;13(1):12048. Hopper S, Wister AV, Cosco TD, Best JR. Social Isolation, Physical Activity, and Subsequent Changes in Cognition Among Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging. Psychosom Med. 2024;86(2):107–15. Ai M, Tinney EM, España-Irla G, Hillman CH, Kramer AF, Morris TP. Brain Resting-state Functional Connectivity Mediates the Age-associated Decline in Physical Activity Engagement. J Gerontol Biol Sci Med Sci 2025, 80(6). Zhai B, Liu X, Fu J, Zhu X, Li J. More cognitive gains from social activity in the oldest-old: evidence from a 10-year longitudinal study. Front Psychol. 2024;15:1382141. Cunha C, Rodrigues P, Voss G, Martinez-Pecino R, Delerue-Matos A. Association between formal social participation and cognitive function in middle-aged and older adults: a longitudinal study using SHARE data. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2024;31(5):932–55. Lin W, Yin W, Yuan D. Association of home and community-based services and cognitive function of Chinese older adults: social participation as a mediator. BMC Geriatr. 2023;23(1):691. Lugtmeijer S, Geerligs L, Tsvetanov KA, Mitchell DJ, Cam C, Campbell KL. Lifespan differences in visual short-term memory load-modulated functional connectivity. NeuroImage. 2023;270:119982. Roberts AL, Qiu X, McAlaine KA, Germine LT, Rotem RS, Weisskopf MG. Early-life cognitively stimulating activities and late-life cognitive function in the St. Louis Baby Tooth Later Life Health Study. Sci Rep. 2025;15(1):2105. Han S, Lee JY, Cho SI, Oh DJ, Yoon DH. Risk Factors for Various Cognitive Function Decline Trajectories in Adults Over 40 Years of Age: A Retrospective Cohort Study. Psychiatry Investig. 2023;20(4):293–300. Nemeth SR, Thomas PA, Stoddart CM, Ferraro KF. Racial and Ethnic Differences in Community Belonging and its Impact on Cognitive Function in Older Adults. J Gerontol B Psychol Sci Soc Sci 2025, 80(6). Luo M, Kim EK, Weibel R, Martin M, Rocke C. Distance from home and working memory: daily associations varying by neighborhood environments in community-dwelling older adults. Eur J Ageing. 2025;22(1):17. Song Y, Liu Y, Bai X, Yu H. Effects of neighborhood built environment on cognitive function in older adults: a systematic review. BMC Geriatr. 2024;24(1):194. Yang X, Ke H, Song Y, Han H, Zhao Y, Shi S. The impact of community health care services on the mental health of older adults in China. BMC Health Serv Res. 2025;25(1):877. Zhang Y, Ma L, Zhao J. Longitudinal association of community and residential environment with the risk of cognitive impairment in middle-aged and older Chinese adults. Sci Rep. 2025;15(1):13233. Lv R, Yang L, Li J, Wei X, Ren Y, Wang W, Hou J, Fang X. Relationship between social participation and life satisfaction in community-dwelling older adults: Multiple mediating roles of depression and cognitive function. Arch Gerontol Geriatr. 2024;117:105233. Reed RG, Hillmann AR. Neighborhood-level socioeconomic disadvantage is associated with multiple cognitive domains in a community sample of older adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2025;32(4):621–35. Orsholits D, Cullati S, Cheval B, Ghisletta P, Oris M, Maurer J, Studer M, Marques A, Marconcin P, Gouveia ER, et al. Residential trajectories across the life course and their association with cognitive functioning in later life. Sci Rep. 2022;12(1):17004. Liu H, Sun Z, Zeng H, Han J, Hu M, Mao D, Tian X, Li R. Meta-analysis of the effects of multi-component exercise on cognitive function in older adults with cognitive impairment. Front Aging Neurosci. 2025;17:1551877. Ballester-Ferrer JA, Bonete-López B, Roldan A, Cervelló E, Pastor D. Effect of acute exercise intensity on cognitive inhibition and well-being: Role of lactate and BDNF polymorphism in the dose-response relationship. Front Psychol. 2022;13:1057475. Krootnark K, Chaikeeree N, Saengsirisuwan V, Boonsinsukh R. Effects of low-intensity home-based exercise on cognition in older persons with mild cognitive impairment: a direct comparison of aerobic versus resistance exercises using a randomized controlled trial design. Front Med (Lausanne). 2024;11:1392429. Ding L, Lou L, Zhang M, Zhang X. The regular effects of concurrent aerobic and resistance exercise on global cognition in healthy elderly populations: A systematic review with meta-analysis of randomized trials. Exp Gerontol. 2025;200:112652. Keawtep P, Sungkarat S, Boripuntakul S, Sa-Nguanmoo P, Wichayanrat W, Chattipakorn SC, Worakul P. Effects of combined dietary intervention and physical-cognitive exercise on cognitive function and cardiometabolic health of postmenopausal women with obesity: a randomized controlled trial. Int J Behav Nutr Phys Act. 2024;21(1):28. Mottolese N, Uguagliati B, Tassinari M, Cerchier CB, Loi M, Candini G, Rimondini R, Medici G, Trazzi S, Ciani E. Voluntary Running Improves Behavioral and Structural Abnormalities in a Mouse Model of CDKL5 Deficiency Disorder. Biomolecules 2023, 13(9). Cui X, Gui W, Miao J, Liu X, Zhu X, Zheng Z, Wan W, Shao Q, Kray J, Jiang Y, et al. A Combined Intervention of Aerobic Exercise and Video Game in Older Adults: The Efficacy and Neural Basis on Improving Mnemonic Discrimination. J Gerontol Biol Sci Med Sci. 2023;78(8):1436–44. Lin H, Ye Y, Wan M, Qiu P, Xia R, Zheng G. Effect of Baduanjin exercise on cerebral blood flow and cognitive frailty in the community older adults with cognitive frailty: A randomized controlled trial. J Exerc Sci Fit. 2023;21(1):131–7. Dhahbi W, Briki W, Heissel A, Schega L, Dergaa I, Guelmami N, Omri AEL, Chaabene H. Physical Activity to Counter Age-Related Cognitive Decline: Benefits of Aerobic, Resistance, and Combined Training—A Narrative Review. Sports Med - Open 2025, 11(1). Boecker H, Daamen M, Kunz L, Geiss M, Muller M, Neuss T, Henschel L, Stirnberg R, Upadhyay N, Scheef L, et al. Hippocampal subfield plasticity is associated with improved spatial memory. Commun Biol. 2024;7(1):271. Kusleikiene S, Ziv G, Vints WAJ, Krasinske E, Sarkinaite M, Qipo O, Bautmans I, Himmelreich U, Masiulis N, Cesnaitiene VJ, et al. Cognitive gains and cortical thickness changes after 12 weeks of resistance training in older adults with low and high risk of mild cognitive impairment: Findings from a randomized controlled trial. Brain Res Bull. 2025;222:111249. Ye M, Song T, Xia H, Hou Y, Chen A. Effects of aerobic exercise on executive function of healthy middle-aged and older adults: A systematic review and meta-analysis. Int J Nurs Stud. 2024;160:104912. Luo Q, Tian Z, Hu Y, Wang C. Effects of Aerobic Exercise on Executive and Memory Functions in Patients With Alzheimer's Disease: A Systematic Review. J Aging Phys Act. 2024;32(4):541–53. Ludyga S, Held S, Rappelt L, Donath L, Klatt S. A network meta-analysis comparing the effects of exercise and cognitive training on executive function in young and middle-aged adults. Eur J Sport Sci. 2023;23(7):1415–25. Chen CR, Huang YC, Lee YW, Hsieh HH, Lee YC, Lin KC. The effects of Baduanjin exercise vs. brisk walking on physical fitness and cognition in middle-aged patients with schizophrenia: A randomized controlled trial. Front Psychiatry. 2022;13:983994. Aminirakan D, Losekamm B, Wollesen B. Effects of combined cognitive and resistance training on physical and cognitive performance and psychosocial well-being of older adults ≥ 65: study protocol for a randomised controlled trial. BMJ Open. 2024;14(4):e082192. Goldbeck F, Xie YL, Hautzinger M, Fallgatter AJ, Sudeck G, Ehlis AC. Relaxation or Regulation: The Acute Effect of Mind-Body Exercise on Heart Rate Variability and Subjective State in Experienced Qi Gong Practitioners. Evid Based Complement Alternat Med 2021, 2021:6673190. Han YMY, Chan MMY, Choi CXT, Law MCH, Ahorsu DK, Tsang HWH. The neurobiological effects of mind-body exercise: a systematic review and meta-analysis of neuroimaging studies. Sci Rep. 2023;13(1):10948. Wan M, Xia R, Lin H, Ye Y, Qiu P, Zheng G. Baduanjin exercise modulates the hippocampal subregion structure in community-dwelling older adults with cognitive frailty. Front Aging Neurosci. 2022;14:956273. Çakaloğlu E, Yüksel HS, Şahin FN, Güler Ö, Arslanoğlu E, Yamak B, Aydoğmuş M, Yaşar OM, Gürkan AC, Söyler M et al. The Acute Effects of Moderate-Intensity Aerobic Exercise on Core Executive Functions in Healthy Older Adults: A Systematic Review. Life (Basel) 2025, 15(2). Dhir S, Teo WP, Chamberlain SR, Tyler K, Yücel M, Segrave RA. The Effects of Combined Physical and Cognitive Training on Inhibitory Control: A Systematic Review and Meta-Analysis. Neurosci Biobehav Rev. 2021;128:735–48. Wen CT, Chu CL, Chen HC, Chueh TY, Lin CC, Wu SY, Hsu WC, Huang CJ, Hung TM. Effects of acute slackline exercise on executive function in college students. Front Psychol. 2023;14:1092804. Contreras-Osorio F, Ramirez-Campillo R, Cerda-Vega E, Campos-Jara R, Martínez-Salazar C, Araneda R, Ebner-Karestinos D, Arellano-Roco C, Campos-Jara C. Effects of Sport-Based Exercise Interventions on Executive Function in Older Adults: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022, 19(19). Yang Z, Zhu L, He Q, Li X, Zhang J, Tang Y. The relationship between acute aerobic exercise and inhibitory control in college students: The impact of physical and cognitive engagement. Physiol Behav. 2025;290:114779. Ludyga S, Gerber M, Schwarz A, Greco A, Müller T, Pühse U, Hanke M. Effects of Cognitive and Physical Load of Acute Exercise on Inhibitory Control and Prefrontal Cortex Hemodynamics in Children. Med Sci Sports Exerc. 2024;56(7):1328–36. Zhong X, Dai Y, Xu M, Jiang C. Volleyball training improves working memory in children aged 7 to 12 years old: an fNIRS study. Cereb Cortex 2024, 34(7). Li GQ, Chen JW, Wang FL. Optimal exercise therapy for improving executive function in middle-aged and older patients with mild cognitive impairment: A systematic review with pairwise and network meta-analyses. Geriatr Nurs. 2025;64:103394. Chang YK, Erickson KI, Aghjayan SL, Chen FT, Li RH, Shih JR, Chang SH, Huang CM, Chu CH. The multi-domain exercise intervention for memory and brain function in late middle-aged and older adults at risk for Alzheimer's disease: A protocol for Western-Eastern Brain Fitness Integration Training trial. Front Aging Neurosci. 2022;14:929789. Luo SS, Chen L, Wang GB, Wang YG, Su XY. Effects of long-term Wuqinxi exercise on working memory in older adults with mild cognitive impairment. Eur Geriatr Med. 2022;13(6):1327–33. Vrinceanu T, Blanchette CA, Intzandt B, Lussier M, Pothier K, Vu TTM, Nigam A, Bosquet L, Karelis AD, Li KZH, et al. A Comparison of the Effect of Physical Activity and Cognitive Training on Dual-Task Performance in Older Adults. J Gerontol B Psychol Sci Soc Sci. 2022;77(6):1069–79. Wu S, Ji H, Won J, Jo EA, Kim YS, Park JJ. The Effects of Exergaming on Executive and Physical Functions in Older Adults With Dementia: Randomized Controlled Trial. J Med Internet Res. 2023;25:e39993. Wu S, Jo EA, Ji H, Kim KH, Park JJ, Kim BH, Cho KI. Exergaming Improves Executive Functions in Patients With Metabolic Syndrome: Randomized Controlled Trial. JMIR Serious Games. 2019;7(3):e13575. Ji H, Wu S, Won J, Weng S, Lee S, Seo S, Park JJ. The Effects of Exergaming on Attention in Children With Attention Deficit/Hyperactivity Disorder: Randomized Controlled Trial. JMIR Serious Games. 2023;11:e40438. Zhang W, Liu H, Zhang T. Immediate and short-term effects of single-task and motor-cognitive dual-task on executive function. PLoS ONE. 2023;18(8):e0290171. Moreira PED, Dieguez GTO, Bredt S, Praça GM. The Acute and Chronic Effects of Dual-Task on the Motor and Cognitive Performances in Athletes: A Systematic Review. Int J Environ Res Public Health 2021, 18(4). Mou H, Tian S, Fang Q, Qiu F. The Immediate and Sustained Effects of Moderate-Intensity Continuous Exercise and High-Intensity Interval Exercise on Working Memory. Front Psychol. 2022;13:766679. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Dec, 2025 Reviews received at journal 08 Dec, 2025 Reviewers agreed at journal 25 Oct, 2025 Reviews received at journal 24 Oct, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviewers invited by journal 29 Sep, 2025 Editor invited by journal 22 Sep, 2025 Editor assigned by journal 17 Sep, 2025 Submission checks completed at journal 16 Sep, 2025 First submitted to journal 16 Sep, 2025 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. 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1","display":"","copyAsset":false,"role":"figure","size":175063,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of participant eligibility, withdrawals, and final study sample.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7304481/v1/54f81dfc2b388ab2f12b5894.png"},{"id":93222698,"identity":"6d2d2a89-24d7-4186-a00e-bac22711ef1a","added_by":"auto","created_at":"2025-10-10 11:21:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":118100,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the N-Back test\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7304481/v1/9070be4307ecf68ba81e0724.png"},{"id":93222699,"identity":"26191823-a69c-4b3e-a076-fba93acb75c8","added_by":"auto","created_at":"2025-10-10 11:21:28","extension":"png","order_by":3,"title":"Figure 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11:29:28","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":159759,"visible":true,"origin":"","legend":"\u003cp\u003eGroup differences and time × group interaction effects of Stroop task accuracy and RT before and after the intervention.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7304481/v1/84119ba8811832c25f1f11cc.png"},{"id":93224501,"identity":"5cb57128-c061-41b8-b918-9748d8b86fa9","added_by":"auto","created_at":"2025-10-10 11:45:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1364389,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7304481/v1/15ff8d5c-3f16-48b2-8b31-e6e5d7ae7bba.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Differential Impacts of Exercise Modalities on Executive Function and Working Memory Performance: A Community-Based 3-Month Intervention Trial in Older Adults","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe rapidly ageing global population significantly impacts public health, resource allocation, and community interaction patterns [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], ultimately influencing Executive Functions (EFs) such as Inhibitory Control (IC), working memory, and cognitive flexibility [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In this regard, it is noteworthy that community-organized collective activities, such as interest groups and volunteer services, could promote social interaction and engagement, thus enhancing mental functions [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Conversely, active services, such as involuntary home medical care, may limit autonomous activities, exacerbating cognitive decline [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCommunal environments crucially impact cognitive health among the elderly [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. According to research, a sense of community belonging, resulting from social participation and psychological security, could enhance cognitive function [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, community features such as walkability, cycling infrastructure, and mixed land use were linked with better working memory [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Meanwhile, other factors such as high street integration and proximity to major roads could impair cognitive abilities [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, while community-based services, such as home-based medical care, could improve depression and cognition [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], an over-reliance on \"door-to-door\" assistance may reduce independent activities, adversely affecting elderly health [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Socially engaging community activities can alleviate depression and strengthen cognitive reserve, thus enhancing cognition [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It is also noteworthy that the lack of community resources affects women and older individuals more [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Moreover, through education, urban environments may indirectly influence cognition, contributing to cognitive reserves and addressing some urban-rural disparities [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Based on these insights, the community is a crucial social determinant of cognitive health among older adults. Therefore, a multidimensional program integrating environmental optimization, physical activity, nutritional interventions, and cognitive training could facilitate ecological transformation, service optimization, and strong social support networks, thus promoting active ageing.\u003c/p\u003e\u003cp\u003eRegular exercise, a cost-effective and easily implemented lifestyle intervention, may improve cognitive function in older adults\u0026mdash;particularly EF and working memory [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. According to epidemiological and intervention studies, older individuals who exercise regularly perform better cognitively than their inactive counterparts. Some of the physiological mechanisms underlying this effect might include increased blood flow, enhanced neurotrophic factor release, neuroplasticity, inflammation inhibition, and neurotransmitter balance maintenance [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile exercises positively impact cognitive function, EF, and working memory, the differences between them regarding their impact on these functions remain unclear. Moderate-intensity exercises could reduce the risk of cognitive impairment by 40% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Randomized Controlled Trials (RCTs) also revealed that aerobic exercises (walking, swimming, running, and so on) increased the hippocampal volume and spatial memory by 2% each [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, resistance training and coordination exercises (such as Tai Chi) could stimulate the Prefrontal Cortex (PFC), improving EF [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Different exercise types are also mediated differently. For instance, moderate to high-intensity aerobic exercise activates the PFC [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], while dancing could increase the Fronto-Parietal Network (FPN) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Moreover, exercise and cognitive training could jointly increase Brain-Derived Neurotrophic Factor (BDNF) levels [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Nonetheless, Multimodal Controlled Trials (MCTs) have not fully explored the various effects of different exercise modes on EF and working memory in community-dwelling elderly people.\u003c/p\u003e\u003cp\u003eHerein, we conducted a 3-month community-controlled trial to compare six intervention modes: Traditional qigong, aerobic training, dance fitness, elastic band resistance training, walking, and health education. Specifically, we quantitatively assessed the Stroop and N-back tasks to elucidate how these exercise modes improve EF and working memory in elderly participants. We hope that our findings will inform individualized community strategies for cognitive enhancement.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Participants\u003c/h2\u003e\u003cp\u003eInitially, 150 older adults aged\u0026thinsp;\u0026ge;\u0026thinsp;60 were recruited from five communities in Wenzhou City, Zhejiang Province, China. The participants were recruited through social media advertisements and informational posters placed at local community centers frequented by individuals who could be interested in exercise programs. The inclusion criteria were: (1) Participants aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years; (2) Participants with a Mini-Mental State Examination (MMSE) score of 27\u0026ndash;30; and (3) Participants who can walk unaided. To mitigate the risk of Adverse Events (AEs), individuals with a history of falls, dizziness, or those using walking aids were excluded from the study. All participants provided written informed consent before enrollment. The Chengdu Sport University Institutional Review Board approved the study protocol ([2023]65).\u003c/p\u003e\u003cp\u003eCopyright Compliance Statement: During the initial phase of this study, an unauthorized version of the Chinese MMSE was used by the study team without permission, however this has now been rectified with PAR. The MMSE is a copyrighted instrument and may not be used or reproduced in whole or in part, in any form or language, or by any means without written permission of PAR (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.parinc.com\u003c/span\u003e\u003cspan address=\"http://www.parinc.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). This rectification ensures the study\u0026rsquo;s adherence to academic copyright regulations.\u003c/p\u003e\u003cp\u003e\u003cem\u003eSample size\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eAll participants were randomly divided into six groups: Traditional Qigong Group (TQG, n\u0026thinsp;=\u0026thinsp;25), Multimodal Exercise Group (MEG, n\u0026thinsp;=\u0026thinsp;25), Dance-Based Exercise Group (DBEG, n\u0026thinsp;=\u0026thinsp;25), Elastic Resistance Training Group (ERTG, n\u0026thinsp;=\u0026thinsp;25), Brisk Walking Group (BWG, n\u0026thinsp;=\u0026thinsp;25), and Control Group (CG, n\u0026thinsp;=\u0026thinsp;25). After 4 weeks of exercise interventions, 6\u0026ndash;7 participants from each group withdrew from the study (Fig.\u0026nbsp;1). Consequently, only 19 TQG participants, 18 MEG participants, 18 DBEG participants, 18 ERTG participants, 19 BWG participants, and 19 CG participants completed the 12-week exercise program and were included in the final analysis.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe sample size was determined using G*Power (version 3.1.9.2 for Windows), with an effect size, statistical power, and statistical significance level of 0.29, 0.80, and 0.05, respectively. The effect size used was derived from previous studies [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Each group\u0026rsquo;s sample size was approximated at 20 patients, with 25 patients recruited for each group after considering a potential 20% dropout rate.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Exercise Training Interventions\u003c/h2\u003e\u003cp\u003eSix different exercises were performed over 12 weeks, each comprising three 60-min sessions/week. Exercise intensity was measured using a Rating of Perceived Exertion (RPE) scale, targeting a rating of 12\u0026ndash;14 on the Borg 6\u0026ndash;20 scale. Each group\u0026rsquo;s intensity was 60\u0026ndash;80% of the Heart Rate Reserve (HRR). The specific exercise interventions are discussed in subsequent sections.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1 Traditional Qigong Group (TQG)\u003c/h2\u003e\u003cp\u003eTwo traditional Chinese health Qigong forms were used: Baduanjin (Weeks 1\u0026ndash;6) and Wuqinxi (Weeks 7\u0026ndash;8). Certified instructors taught the classes using official videos from China\u0026rsquo;s General Administration of Sport.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2 Multimodal Exercise Group (MEG)\u003c/h2\u003e\u003cp\u003eThe participants engaged in rhythm-synchronized callisthenics, involving upper-limb and trunk movements, as well as lower-limb cycling. The exercise lasted 4 min at 120 bpm (beats per minute), followed by 2 min of active recovery. Movement complexity and cadence were increased biweekly.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3 Dance-Based Exercise Group (DBEG)\u003c/h2\u003e\u003cp\u003eThe exercises included low- (steps, shifts, and V-steps) and high-impact (plyometric jumps and knee drives) activities. The choreography consisted of 8\u0026ndash;9 combinations, varying in kinematic range of motion and ground reaction forces according to the musical tempo (110\u0026ndash;135 bpm), and was updated every 28 days.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.2.4 Elastic Resistance Training Group (ERTG)\u003c/h2\u003e\u003cp\u003eThe exercises comprised ten machine-alternative exercises using Thera-Band\u0026reg; elastic tubing, including: One chest press, shoulder press, reverse fly, and bicep curl; and two knee flexion/extension, hip abduction, leg press, and calf raise. The exercises were performed in two sets of 10\u0026ndash;12 repetitions, with 30\u0026ndash;60 s rest between sets, and a 5\u0026ndash;8 intensity on the OMNI-Resistance Exercise Scale. Based on the Thera-Band color-coded system, resistance was increased every 4 weeks, with each session involving a series of 5-min warm-ups, 30-min resistance, and 5-min cool-down.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.2.5 Brisk Walking Group (BWG)\u003c/h2\u003e\u003cp\u003eBiomechanical improvement was achieved as follows: One postural alignment (neck extension and thoracic elevation); two gait modifications (metatarsophalangeal joint propulsion); three upper-limb movements (increased arm swing); and four respiration activities (diaphragmatic breathing). During a circular walk in community settings, we maintained a pace of 120 bpm (as measured with Polar heart rate devices).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e2.2.6 Control Group (CG)\u003c/h2\u003e\u003cp\u003eParticipants attended weekly 60-min health education seminars covering non-physical exercise-related wellness topics, including nutritional guidance, sleep hygiene, and stress management strategies.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.3 N-Back task\u003c/h2\u003e\u003cp\u003e The participants\u0026rsquo; working memory was assessed using the N-back task. The color N-back task was implemented using E-prime 3 software, with Response Time (RT) and accuracy as the key criteria. Based on previous reports, we selected two colors (red and green) and two memory loads (n\u0026thinsp;=\u0026thinsp;1,2). The test involved 1- and 2-back tasks, which began with 20 practice trials and 50 formal tests. Color stimuli were randomly displayed for 1.8 s, followed by a 1.0-s blank screen. Participants pressed the \u0026ldquo;G\u0026rdquo; key for matches; otherwise, no response was required.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Stroop task\u003c/h2\u003e\u003cp\u003e The participants\u0026rsquo; EF was assessed using the Stroop task with E-prime 3 software. The RTs and accuracy were analyzed. The Stroop task evaluates color perception and word interpretation. It involves two subtasks: Stroop A and Stroop B. Stroop A involves participants identifying the patch color and pressing the corresponding key. On the other hand, Stroop B involves responding to color words by clicking buttons corresponding to the word's meaning. Each subtask comprised 20 practice trials and 50 formal trials, where color stimuli were randomly displayed for 1.8 s. Subsequently, a blank screen was displayed for 1 s to indicate color matches: F1, F2, F3, and F4 for red, green, yellow, and blue, respectively.\u003c/p\u003e\u003cp\u003eThe experiment comprised two counterbalanced cognitive conditions: A (Perceptual Color Matching), where participants read using a 4-button response pad to distinguish between solid colors (red, green, blue, yellow); and B (Semantic-Interference Task), where participants read manually to identify the matching colors (e.g., word \"red\" in blue) followed by Stroop effect quantification.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using SPSS v24.0 (α\u0026thinsp;=\u0026thinsp;0.05). Normality (Shapiro-Wilk test), variance homogeneity (Levene\u0026rsquo;s test), and sphericity (Mauchly\u0026rsquo;s test with Greenhouse-Geisser correction) were all validated. Three-way Repeated-Measures Analysis of Variance (RM-ANOVA) (Group\u0026times;Time, Group\u0026times;Task, Time\u0026times;Task, Group\u0026times;Time\u0026times;Task) were used for N-Back/Stroop tasks, followed by Bonferroni-corrected pairwise comparisons. Partial η\u0026sup2;ₚ effect sizes (η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e; small\u0026thinsp;\u0026ge;\u0026thinsp;0.01, medium\u0026thinsp;\u0026ge;\u0026thinsp;0.06, large\u0026thinsp;\u0026ge;\u0026thinsp;0.14) were also reported. Non-parametric tests or ANCOVA (Analysis of Covariance; covariate adjustment) were used as supplements if the assumptions were violated. Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation (SD).\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Participants\u003c/h2\u003e\u003cp\u003eOf the 150 participants initially included, 19 from the TQG (two were not compliant and four had unknown reasons) were lost to follow-up at 4 weeks. In the MEG, 18 participants were excluded (four had health problems, one was not compliant, and two had an unknown reason). In the DBEG, 18 participants were excluded (two lacked motivation, two were not compliant, and three had unknown reasons). In the ERTG, 18 participants were excluded (two had had health problems, one did not perform reevaluations and analyses, and four had unknown reasons). In the BWG, 19 participants were excluded (two had health problems, one lacked motivation, and three had unknown reasons). In the CG, 19 participants were excluded (six had unknown reasons). Consequently, only 19 TQG (male: n\u0026thinsp;=\u0026thinsp;2, female: n\u0026thinsp;=\u0026thinsp;17), 18 MEG (male: n\u0026thinsp;=\u0026thinsp;2, female: n\u0026thinsp;=\u0026thinsp;16), 18 DBEG (male: n\u0026thinsp;=\u0026thinsp;1, female: n\u0026thinsp;=\u0026thinsp;17), 18 ERTG (male: n\u0026thinsp;=\u0026thinsp;1, female: n\u0026thinsp;=\u0026thinsp;17), 19 BWG (male: n\u0026thinsp;=\u0026thinsp;2, female: n\u0026thinsp;=\u0026thinsp;17), and 19 CG (male: n\u0026thinsp;=\u0026thinsp;2, female: n\u0026thinsp;=\u0026thinsp;19) participants completed the 12-week exercise program. The mean age of the 111 participants who completed the study was 73\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 years. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes all subjects\u0026rsquo; demographic and physical characteristics.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline demographic information.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTQG\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMEG\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDBEG\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eERTG\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBWG\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCG\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender ratio (Male: Female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2:17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2:16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1:17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1:17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2:17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2:17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e74.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e154.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e158.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e154.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e157.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e154.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e60.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e62.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMSE (score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisceral Adipose Tissue (VAT; kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMuscle mass (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNotes\u003c/em\u003e: Values are presented as Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD; TQG\u0026thinsp;=\u0026thinsp;Traditional Qigong Group; MEG\u0026thinsp;=\u0026thinsp;Multimodal Exercise; DBEG\u0026thinsp;=\u0026thinsp;Dance-Based Exercise Group; ERTG\u0026thinsp;=\u0026thinsp;Elastic Resistance Training Group; BWG\u0026thinsp;=\u0026thinsp;Brisk Walking Group; CG\u0026thinsp;=\u0026thinsp;Control Group; MMSE\u0026thinsp;=\u0026thinsp;Mini Mental State Examination; and BMI\u0026thinsp;=\u0026thinsp;Body Mass Index\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.2 N-Back task\u003c/h2\u003e\u003cp\u003eFor N-BACK AR (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e4\u003c/span\u003e), RM-ANOVA revealed significant main effects of Time [F(1,105)\u0026thinsp;=\u0026thinsp;1069.79, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.911], Group [F(5,105)\u0026thinsp;=\u0026thinsp;2026.161, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.189], and Task [F(1,105)\u0026thinsp;=\u0026thinsp;77.284, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.424]. Significant interaction effects were also observed, including Time\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;38.194, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.645], Task\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;3.061, p\u0026thinsp;=\u0026thinsp;0.013, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.127], Task\u0026times;Time [F(1,105)\u0026thinsp;=\u0026thinsp;16.561, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.136], and Task\u0026times;Time\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;4.595, p\u0026thinsp;=\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.180].\u003c/p\u003e\u003cp\u003ePost-hoc comparisons further revealed significant group differences. Specifically, BWG performed significantly differently from TQG (p\u0026thinsp;=\u0026thinsp;0.014), MEG (p\u0026thinsp;=\u0026thinsp;0.004), and DBEG (p\u0026thinsp;=\u0026thinsp;0.004). Furthermore, CG showed marked disparities with FQG (p\u0026thinsp;=\u0026thinsp;0.002), MEG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), DBEG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and ERTG (p\u0026thinsp;=\u0026thinsp;0.037), highlighting distinct inter-group intervention effects.\u003c/p\u003e\u003cp\u003eFor N-BACK RT (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e4\u003c/span\u003e), RM-ANOVA revealed significant main effects of Time [F(1,105)\u0026thinsp;=\u0026thinsp;567.253, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.844] and Group [F(5,105)\u0026thinsp;=\u0026thinsp;2.507, p\u0026thinsp;=\u0026thinsp;0.035, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.107]. Furthermore, significant interaction effects were observed for Time\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;43.426, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.674], Task\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;6.232, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.229], and Task\u0026times;Time\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;4.887, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.189]. Task demonstrated a marginally significant main effect [F(1,105)\u0026thinsp;=\u0026thinsp;4.958, p\u0026thinsp;=\u0026thinsp;0.028, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.045], while Task\u0026times;Time [F(1,105)\u0026thinsp;=\u0026thinsp;2.158, p\u0026thinsp;=\u0026thinsp;0.145, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.020] showed no significant main effect.\u003c/p\u003e\u003cp\u003eAccording to the pairwise tests, TQG vs. MEG (p\u0026thinsp;=\u0026thinsp;0.043), CG vs. MEG (p\u0026thinsp;=\u0026thinsp;0.001), and ERTG (p\u0026thinsp;=\u0026thinsp;0.044) demonstrated differential RT improvement patterns across groups.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Stroop task\u003c/h2\u003e\u003cp\u003eFor Stroop AR (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e5\u003c/span\u003e), RM-ANOVA revealed significant main effects of Time [F(1,105)\u0026thinsp;=\u0026thinsp;670.962, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.865] and Group [F(5,105)\u0026thinsp;=\u0026thinsp;10.744, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.338]. Furthermore, significant interactions were observed for Time\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;28.148, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.573], Task\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;3.393, p\u0026thinsp;=\u0026thinsp;0.007, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.139], and Task\u0026times;Time\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;2.692, p\u0026thinsp;=\u0026thinsp;0.025, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.114]. Non-significant effects were observed for Task [F(1,105)\u0026thinsp;=\u0026thinsp;0.694, p\u0026thinsp;=\u0026thinsp;0.407, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.007] and Task\u0026times;Time [F(1,105)\u0026thinsp;=\u0026thinsp;0.237, p\u0026thinsp;=\u0026thinsp;0.627, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.002].\u003c/p\u003e\u003cp\u003eThe groups further showed significant differences. Specifically, BWG performed significantly differently from TQG (p\u0026thinsp;=\u0026thinsp;0.006) and MEG (p\u0026thinsp;=\u0026thinsp;0.027), while CG showed marked disparities with FQG, MEG, DBEG, ERTG and BWG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eFor Stroop RT (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e5\u003c/span\u003e), RM-ANOVA revealed significant main effects of Time [F(1,105)\u0026thinsp;=\u0026thinsp;684.438, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.867], Group [F(5,105)\u0026thinsp;=\u0026thinsp;5.816, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.217], and Task [F(1,105)\u0026thinsp;=\u0026thinsp;77.195, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.424]. Significant interactions were also observed for Time\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;35.852, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.631], Task\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;28.582, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.576], Task\u0026times;Time [F(1,105)\u0026thinsp;=\u0026thinsp;30.050, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.223], and Task\u0026times;Time\u0026times;Group [F(5,105)\u0026thinsp;=\u0026thinsp;8.822, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;\u003csub\u003ep\u003c/sub\u003e=0.296].\u003c/p\u003e\u003cp\u003eThe significant differences across groups included: EBTG vs. TQG (p\u0026thinsp;=\u0026thinsp;0.019), DBEG (p\u0026thinsp;=\u0026thinsp;0.035); BWG vs. TQG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), DBFG (p\u0026thinsp;=\u0026thinsp;0.001); and CG vs. MEG (p\u0026thinsp;=\u0026thinsp;0.005), ERTG (p\u0026thinsp;=\u0026thinsp;0.002), BWG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eHerein, we evaluated the effects of various exercise methods on EF and working memory in community-dwelling older adults. Our key findings were: 1) In Stroop tasks, improvements in both accuracy and RT favorably impacted EF in IC accuracy and conflict resolution efficiency; 2) In N-Back tests, improvements in both accuracy and RT similarly improved working memory storage and processing, a phenomenon attributable to enhanced EFs such as attention control and information updating. Moreover, varying effects of different exercises aligned with previous research, suggesting that exercise, along with cognitive stimulation, could improve brain function.\u003c/p\u003e\u003cp\u003eIn the Stroop task, the TQG and MEG groups were significantly more effective than the BWG group. According to research, Baduanjin alters the PFC blood flow and plasticity, thus enhancing EFs, such as IC [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Additionally, adults with Mild Cognitive Impairment (MCI) previously outperformed the CG on EF tests after 24 weeks [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. It is also noteworthy that brisk walking, a standalone aerobic exercise, did not significantly impact high-order IC in conflict tasks, such as the Stroop task, with less effective impacts compared to multimodal or mind-body exercises [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Based on these insights, it is plausible that mind-body exercises could enhance IC and that intervention programs for improving cognitive function should incorporate more comprehensive mind-body exercises.\u003c/p\u003e\u003cp\u003eAlthough multiple exercise modes (MEG, ERG, and BWG) demonstrated a significant improvement in IC and conflict resolution, different reactions were observed for TQG and DEG. Compared to both TQG and DEG, these reactions were slower for ERG but faster for BWG, a phenomenon attributable to exercise modes differing in coordination requirements. Due to the need for synchronization and cognitive control, which may necessitate more neural plasticity, high-coordination exercises, such as fitness qigong or dance, may optimize RT more effectively [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Conversely, low-coordination aerobic exercises, such as walking, although they may improve basic RT, may exhibit weaker adaptivity in complex conflict tasks [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Besides offering new insights, these findings could enhance our understanding of the differences between various exercise modes in terms of IC and conflict resolution.\u003c/p\u003e\u003cp\u003eIn the N-Back task, TQG, MEG, DEG, and ERG significantly outperformed CG in working memory. Additionally, TQG, MEG, and DEG had better working memory than BWG (and CG). These findings align with previous results on multimodal exercise, which combines aerobics, strength, and balance training, thus increasing working memory more broadly [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Multimodal exercises combine various exercise forms, such as coordination training and cognitive tasks, activating multiple brain regions, including the PFC and hippocampus, thus enhancing working memory storage and processing [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Conversely, although BWG, as a single aerobic exercise, could improve working memory in low-load tasks (e.g., back), it is less effective in higher-order tasks (e.g., 1-back and 2-back) [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Additionally, regarding working memory accuracy, BWG outperformed MEG.\u003c/p\u003e\u003cp\u003eRegarding working memory, MEG had a faster RT than TQG and CG, with ERG outperforming CG. This phenomenon could be attributed to the distinctive dual-task training in multimodal exercise. Dual task training (motor and cognitive tasks) previously reduced cognitive resource allocation, improving working memory RT [\u003cspan additionalcitationids=\"CR51 CR52\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Furthermore, this approach was found to be more effective than aerobic exercise alone [\u003cspan additionalcitationids=\"CR55\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Overall, dual-task training in multimodal exercise maximizes cognitive resource allocation and RT more effectively than aerobic exercises.\u003c/p\u003e\u003cp\u003eDespite its valuable insights, this study has several notable limitations. First, expanding sample size and improving diversity balancing gender ratios (current 89.5%-94.4% female predominance) and including participants with broader cognitive baselines (e.g., mild cognitive impairment, MCI) to enhance findings\u0026rsquo; generalizability. Second, conducting 6\u0026ndash;12 month post-intervention follow-ups to assess sustainability of observed cognitive improvements and explore potential cumulative benefits. Third, cognitive evaluation relied on Stroop and N-Back tasks, focusing only on attention and overlooking neurophysiological indicators, such as Cerebral Blood Flow (CBF) and BDNF, thus weakening mechanistic explanations. Fourth, standardizing intervention parameters (intensity, frequency, duration) and exploring dose-response relationships (e.g., exercise intensity vs. cognitive improvement) to optimize personalized exercise prescriptions for older adults.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this 12-week community-based intervention study, we found traditional Qigong (TQG) and multimodal exercise (MEG) improved executive function and working memory in community-dwelling cognitively healthy older adults, providing preliminary evidence for designing short-term cognitive enhancement interventions for this group. Brisk walking (BWG, single-mode aerobic exercise) also benefited cognition enhancing information processing accuracy and working memory (especially low-load N-Back tasks) and is reasonably recommended for such older adults, particularly those with limited physical capacity or inability to do complex exercises like TQG/MEG. For community cognitive enhancement programs, organizers may prioritize TQG/MEG for cognitively healthy older adults with sufficient physical capacity, and offer BWG as an alternative for those with reduced mobility or exercise tolerance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe study was approved by the Institutional Review Board of Chengdu Sport University ([2023]65) and adhered to the Helsinki Declaration guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eAll subjects provided informed consent to participate in the study and written informed consent authorising result publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eAll datasets used and/or analysed in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study was supported by grants from the National Natural Science Foundation of China (Grant no. 31960192), the Zhejiang Provincial Natural Science Foundation of China (Grant no. LY23C110001), the Basic Scientific Research Project of Wenzhou City (Grant no. Y20220209 and Y20240018), and the Scientific Research Fund of Zhejiang Provincial Education Department (Grant no. Y202248769 and Y202352718).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information:\u0026nbsp;\u003c/strong\u003eShanshan Wu and Yan Zhao contributed equally to this work and share first authorship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSS-W, Z-X and HQ-J: Study conception, design, and hypothesis; SS-W, HQ-J, Y-Z and SY-W: Systematic search, data extraction, and bias risk assessment; SS-W, HY-S, Y-Z and HQ-J: All statistical analyses; and SS-W, Z-X and HQ-J: Manuscript drafting and revision (including the final version). All authors read and approved the draft and the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eWe would like to thank all participants for their time and effort during the study. The results of the survey are presented honestly and without fabrication, falsification, or inappropriate data manipulation. No conflicts of interest are declared.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMcVeigh KS, Mehl MR, Polsinelli AJ, Moseley SA, Sbarra DA, Glisky EL, Grilli MD. Loneliness and social isolation are not associated with executive functioning in a cross-sectional study of cognitively healthy older adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2024;31(5):777\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWei CC, Hsieh MJ, Chuang YF. The Effects of Social Interaction Intervention on Cognitive Functions Among Older Adults Without Dementia: A Systematic Review and Meta-Analysis. Innov Aging. 2024;8(10):igae084.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFan D, Che X, Jiang Y, He Q, Yu J, Zhao H. Noninvasive brain stimulations modulated brain modular interactions to ameliorate working memory in community-dwelling older adults. Cereb Cortex 2024, 34(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFranco-O'Byrne D, Sep\u0026uacute;lveda JPM, Gonzalez-Gomez R, Ib\u0026aacute;\u0026ntilde;ez A, Huepe-Artigas D, Matus C, Manen R, Ayala J, Fittipaldi S, Huepe D. The neurocognitive impact of loneliness and social networks on social adaptation. Sci Rep. 2023;13(1):12048.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHopper S, Wister AV, Cosco TD, Best JR. Social Isolation, Physical Activity, and Subsequent Changes in Cognition Among Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging. Psychosom Med. 2024;86(2):107\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAi M, Tinney EM, Espa\u0026ntilde;a-Irla G, Hillman CH, Kramer AF, Morris TP. Brain Resting-state Functional Connectivity Mediates the Age-associated Decline in Physical Activity Engagement. J Gerontol Biol Sci Med Sci 2025, 80(6).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhai B, Liu X, Fu J, Zhu X, Li J. More cognitive gains from social activity in the oldest-old: evidence from a 10-year longitudinal study. Front Psychol. 2024;15:1382141.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCunha C, Rodrigues P, Voss G, Martinez-Pecino R, Delerue-Matos A. Association between formal social participation and cognitive function in middle-aged and older adults: a longitudinal study using SHARE data. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2024;31(5):932\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin W, Yin W, Yuan D. Association of home and community-based services and cognitive function of Chinese older adults: social participation as a mediator. BMC Geriatr. 2023;23(1):691.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLugtmeijer S, Geerligs L, Tsvetanov KA, Mitchell DJ, Cam C, Campbell KL. Lifespan differences in visual short-term memory load-modulated functional connectivity. NeuroImage. 2023;270:119982.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoberts AL, Qiu X, McAlaine KA, Germine LT, Rotem RS, Weisskopf MG. Early-life cognitively stimulating activities and late-life cognitive function in the St. Louis Baby Tooth Later Life Health Study. Sci Rep. 2025;15(1):2105.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHan S, Lee JY, Cho SI, Oh DJ, Yoon DH. Risk Factors for Various Cognitive Function Decline Trajectories in Adults Over 40 Years of Age: A Retrospective Cohort Study. Psychiatry Investig. 2023;20(4):293\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNemeth SR, Thomas PA, Stoddart CM, Ferraro KF. Racial and Ethnic Differences in Community Belonging and its Impact on Cognitive Function in Older Adults. J Gerontol B Psychol Sci Soc Sci 2025, 80(6).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLuo M, Kim EK, Weibel R, Martin M, Rocke C. Distance from home and working memory: daily associations varying by neighborhood environments in community-dwelling older adults. Eur J Ageing. 2025;22(1):17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSong Y, Liu Y, Bai X, Yu H. Effects of neighborhood built environment on cognitive function in older adults: a systematic review. BMC Geriatr. 2024;24(1):194.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang X, Ke H, Song Y, Han H, Zhao Y, Shi S. The impact of community health care services on the mental health of older adults in China. BMC Health Serv Res. 2025;25(1):877.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Y, Ma L, Zhao J. Longitudinal association of community and residential environment with the risk of cognitive impairment in middle-aged and older Chinese adults. Sci Rep. 2025;15(1):13233.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLv R, Yang L, Li J, Wei X, Ren Y, Wang W, Hou J, Fang X. Relationship between social participation and life satisfaction in community-dwelling older adults: Multiple mediating roles of depression and cognitive function. Arch Gerontol Geriatr. 2024;117:105233.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReed RG, Hillmann AR. Neighborhood-level socioeconomic disadvantage is associated with multiple cognitive domains in a community sample of older adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2025;32(4):621\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrsholits D, Cullati S, Cheval B, Ghisletta P, Oris M, Maurer J, Studer M, Marques A, Marconcin P, Gouveia ER, et al. Residential trajectories across the life course and their association with cognitive functioning in later life. Sci Rep. 2022;12(1):17004.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu H, Sun Z, Zeng H, Han J, Hu M, Mao D, Tian X, Li R. Meta-analysis of the effects of multi-component exercise on cognitive function in older adults with cognitive impairment. Front Aging Neurosci. 2025;17:1551877.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBallester-Ferrer JA, Bonete-L\u0026oacute;pez B, Roldan A, Cervell\u0026oacute; E, Pastor D. Effect of acute exercise intensity on cognitive inhibition and well-being: Role of lactate and BDNF polymorphism in the dose-response relationship. Front Psychol. 2022;13:1057475.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrootnark K, Chaikeeree N, Saengsirisuwan V, Boonsinsukh R. Effects of low-intensity home-based exercise on cognition in older persons with mild cognitive impairment: a direct comparison of aerobic versus resistance exercises using a randomized controlled trial design. Front Med (Lausanne). 2024;11:1392429.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDing L, Lou L, Zhang M, Zhang X. The regular effects of concurrent aerobic and resistance exercise on global cognition in healthy elderly populations: A systematic review with meta-analysis of randomized trials. Exp Gerontol. 2025;200:112652.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKeawtep P, Sungkarat S, Boripuntakul S, Sa-Nguanmoo P, Wichayanrat W, Chattipakorn SC, Worakul P. Effects of combined dietary intervention and physical-cognitive exercise on cognitive function and cardiometabolic health of postmenopausal women with obesity: a randomized controlled trial. Int J Behav Nutr Phys Act. 2024;21(1):28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMottolese N, Uguagliati B, Tassinari M, Cerchier CB, Loi M, Candini G, Rimondini R, Medici G, Trazzi S, Ciani E. Voluntary Running Improves Behavioral and Structural Abnormalities in a Mouse Model of CDKL5 Deficiency Disorder. \u003cem\u003eBiomolecules\u003c/em\u003e 2023, 13(9).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCui X, Gui W, Miao J, Liu X, Zhu X, Zheng Z, Wan W, Shao Q, Kray J, Jiang Y, et al. A Combined Intervention of Aerobic Exercise and Video Game in Older Adults: The Efficacy and Neural Basis on Improving Mnemonic Discrimination. J Gerontol Biol Sci Med Sci. 2023;78(8):1436\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin H, Ye Y, Wan M, Qiu P, Xia R, Zheng G. Effect of Baduanjin exercise on cerebral blood flow and cognitive frailty in the community older adults with cognitive frailty: A randomized controlled trial. J Exerc Sci Fit. 2023;21(1):131\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDhahbi W, Briki W, Heissel A, Schega L, Dergaa I, Guelmami N, Omri AEL, Chaabene H. Physical Activity to Counter Age-Related Cognitive Decline: Benefits of Aerobic, Resistance, and Combined Training\u0026mdash;A Narrative Review. Sports Med - Open 2025, 11(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoecker H, Daamen M, Kunz L, Geiss M, Muller M, Neuss T, Henschel L, Stirnberg R, Upadhyay N, Scheef L, et al. Hippocampal subfield plasticity is associated with improved spatial memory. Commun Biol. 2024;7(1):271.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKusleikiene S, Ziv G, Vints WAJ, Krasinske E, Sarkinaite M, Qipo O, Bautmans I, Himmelreich U, Masiulis N, Cesnaitiene VJ, et al. Cognitive gains and cortical thickness changes after 12 weeks of resistance training in older adults with low and high risk of mild cognitive impairment: Findings from a randomized controlled trial. Brain Res Bull. 2025;222:111249.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYe M, Song T, Xia H, Hou Y, Chen A. Effects of aerobic exercise on executive function of healthy middle-aged and older adults: A systematic review and meta-analysis. Int J Nurs Stud. 2024;160:104912.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLuo Q, Tian Z, Hu Y, Wang C. Effects of Aerobic Exercise on Executive and Memory Functions in Patients With Alzheimer's Disease: A Systematic Review. J Aging Phys Act. 2024;32(4):541\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLudyga S, Held S, Rappelt L, Donath L, Klatt S. A network meta-analysis comparing the effects of exercise and cognitive training on executive function in young and middle-aged adults. Eur J Sport Sci. 2023;23(7):1415\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen CR, Huang YC, Lee YW, Hsieh HH, Lee YC, Lin KC. The effects of Baduanjin exercise vs. brisk walking on physical fitness and cognition in middle-aged patients with schizophrenia: A randomized controlled trial. Front Psychiatry. 2022;13:983994.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAminirakan D, Losekamm B, Wollesen B. Effects of combined cognitive and resistance training on physical and cognitive performance and psychosocial well-being of older adults\u0026thinsp;\u0026ge;\u0026thinsp;65: study protocol for a randomised controlled trial. BMJ Open. 2024;14(4):e082192.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoldbeck F, Xie YL, Hautzinger M, Fallgatter AJ, Sudeck G, Ehlis AC. Relaxation or Regulation: The Acute Effect of Mind-Body Exercise on Heart Rate Variability and Subjective State in Experienced Qi Gong Practitioners. \u003cem\u003eEvid Based Complement Alternat Med\u003c/em\u003e 2021, 2021:6673190.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHan YMY, Chan MMY, Choi CXT, Law MCH, Ahorsu DK, Tsang HWH. The neurobiological effects of mind-body exercise: a systematic review and meta-analysis of neuroimaging studies. Sci Rep. 2023;13(1):10948.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWan M, Xia R, Lin H, Ye Y, Qiu P, Zheng G. Baduanjin exercise modulates the hippocampal subregion structure in community-dwelling older adults with cognitive frailty. Front Aging Neurosci. 2022;14:956273.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Ccedil;akaloğlu E, Y\u0026uuml;ksel HS, Şahin FN, G\u0026uuml;ler \u0026Ouml;, Arslanoğlu E, Yamak B, Aydoğmuş M, Yaşar OM, G\u0026uuml;rkan AC, S\u0026ouml;yler M et al. The Acute Effects of Moderate-Intensity Aerobic Exercise on Core Executive Functions in Healthy Older Adults: A Systematic Review. Life (Basel) 2025, 15(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDhir S, Teo WP, Chamberlain SR, Tyler K, Y\u0026uuml;cel M, Segrave RA. The Effects of Combined Physical and Cognitive Training on Inhibitory Control: A Systematic Review and Meta-Analysis. Neurosci Biobehav Rev. 2021;128:735\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWen CT, Chu CL, Chen HC, Chueh TY, Lin CC, Wu SY, Hsu WC, Huang CJ, Hung TM. Effects of acute slackline exercise on executive function in college students. Front Psychol. 2023;14:1092804.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eContreras-Osorio F, Ramirez-Campillo R, Cerda-Vega E, Campos-Jara R, Mart\u0026iacute;nez-Salazar C, Araneda R, Ebner-Karestinos D, Arellano-Roco C, Campos-Jara C. Effects of Sport-Based Exercise Interventions on Executive Function in Older Adults: A Systematic Review and Meta-Analysis. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e 2022, 19(19).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang Z, Zhu L, He Q, Li X, Zhang J, Tang Y. The relationship between acute aerobic exercise and inhibitory control in college students: The impact of physical and cognitive engagement. Physiol Behav. 2025;290:114779.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLudyga S, Gerber M, Schwarz A, Greco A, M\u0026uuml;ller T, P\u0026uuml;hse U, Hanke M. Effects of Cognitive and Physical Load of Acute Exercise on Inhibitory Control and Prefrontal Cortex Hemodynamics in Children. Med Sci Sports Exerc. 2024;56(7):1328\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhong X, Dai Y, Xu M, Jiang C. Volleyball training improves working memory in children aged 7 to 12 years old: an fNIRS study. Cereb Cortex 2024, 34(7).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi GQ, Chen JW, Wang FL. Optimal exercise therapy for improving executive function in middle-aged and older patients with mild cognitive impairment: A systematic review with pairwise and network meta-analyses. Geriatr Nurs. 2025;64:103394.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChang YK, Erickson KI, Aghjayan SL, Chen FT, Li RH, Shih JR, Chang SH, Huang CM, Chu CH. The multi-domain exercise intervention for memory and brain function in late middle-aged and older adults at risk for Alzheimer's disease: A protocol for Western-Eastern Brain Fitness Integration Training trial. Front Aging Neurosci. 2022;14:929789.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLuo SS, Chen L, Wang GB, Wang YG, Su XY. Effects of long-term Wuqinxi exercise on working memory in older adults with mild cognitive impairment. Eur Geriatr Med. 2022;13(6):1327\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVrinceanu T, Blanchette CA, Intzandt B, Lussier M, Pothier K, Vu TTM, Nigam A, Bosquet L, Karelis AD, Li KZH, et al. A Comparison of the Effect of Physical Activity and Cognitive Training on Dual-Task Performance in Older Adults. J Gerontol B Psychol Sci Soc Sci. 2022;77(6):1069\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu S, Ji H, Won J, Jo EA, Kim YS, Park JJ. The Effects of Exergaming on Executive and Physical Functions in Older Adults With Dementia: Randomized Controlled Trial. J Med Internet Res. 2023;25:e39993.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu S, Jo EA, Ji H, Kim KH, Park JJ, Kim BH, Cho KI. Exergaming Improves Executive Functions in Patients With Metabolic Syndrome: Randomized Controlled Trial. JMIR Serious Games. 2019;7(3):e13575.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJi H, Wu S, Won J, Weng S, Lee S, Seo S, Park JJ. The Effects of Exergaming on Attention in Children With Attention Deficit/Hyperactivity Disorder: Randomized Controlled Trial. JMIR Serious Games. 2023;11:e40438.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang W, Liu H, Zhang T. Immediate and short-term effects of single-task and motor-cognitive dual-task on executive function. PLoS ONE. 2023;18(8):e0290171.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoreira PED, Dieguez GTO, Bredt S, Pra\u0026ccedil;a GM. The Acute and Chronic Effects of Dual-Task on the Motor and Cognitive Performances in Athletes: A Systematic Review. Int J Environ Res Public Health 2021, 18(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMou H, Tian S, Fang Q, Qiu F. The Immediate and Sustained Effects of Moderate-Intensity Continuous Exercise and High-Intensity Interval Exercise on Working Memory. Front Psychol. 2022;13:766679.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Exercise Modalities, Executive Function, Working Memory, Older Adults, Community-Based Intervention Trial","lastPublishedDoi":"10.21203/rs.3.rs-7304481/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7304481/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWith the rapidly ageing global population, exercise and physical activity are increasingly becoming important for societal advancement.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo investigate the impact of various exercise methods on Executive Function (EF) and working memory in community-dwelling older adults.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study involved 111 community-dwelling older adults (mean age\u0026thinsp;=\u0026thinsp;73\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 years), randomly assigned to six groups: Traditional Qigong Group (TQG, n\u0026thinsp;=\u0026thinsp;19), Multimodal Exercise Group (MEG, n\u0026thinsp;=\u0026thinsp;18), Dance-Based Exercise Group (DBEG, n\u0026thinsp;=\u0026thinsp;18), Elastic Resistance Training Group (ERTG, n\u0026thinsp;=\u0026thinsp;18), Brisk Walking Group (BWG, n\u0026thinsp;=\u0026thinsp;19), and Control Group (CG, n\u0026thinsp;=\u0026thinsp;19). The study lasted 12 weeks, with pre- and post-intervention assessments conducted using N-Back and Stroop tasks to evaluate EF and working memory performance. The effects of time (pre- vs post-intervention), group, and Group \u0026times; Time \u0026times; Task interactions were assessed using Repeated-Measures Analysis of Variance (RM-ANOVA).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCompared to the CG, all the exercise groups demonstrated greater improvements in N-back and Stroop task accuracy. Furthermore, while the exercise groups showed significantly shorter Reaction Times (RTs) post-intervention, the CG exhibited no RT changes. Additionally, the exercise groups exhibited more pronounced task-related cognitive gains, with significant group \u0026times; time \u0026times; task interactions, indicating differential intervention effects across modalities. Moreover, post-hoc analyses confirmed differential intervention effects across groups.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eMultimodal exercise programs that integrate physical activity with cognitive stimulation are promising interventions for enhancing Executive Function and Working Memory in community-dwelling elderly individuals.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e","manuscriptTitle":"Differential Impacts of Exercise Modalities on Executive Function and Working Memory Performance: A Community-Based 3-Month Intervention Trial in Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-10 11:21:23","doi":"10.21203/rs.3.rs-7304481/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-09T08:05:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-08T20:26:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314217336218520474329947474298791834898","date":"2025-10-25T12:20:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-24T04:00:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295487228181612470495049957655487900103","date":"2025-10-24T00:00:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-29T14:32:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-22T07:27:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-17T12:09:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-16T07:51:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-09-16T07:47:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9beef27d-11fb-4787-9912-5eba5b5bab49","owner":[],"postedDate":"October 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T12:09:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-10 11:21:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7304481","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7304481","identity":"rs-7304481","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}