Older women's brains may gain more from exercise than men's

Exercise is one of the few tools without a prescription that seems to protect the ageing brain, yet the research behind it is oddly inconsistent, with some trials showing clear cognitive gains and others very little. Two suspects for that variation are the sex of the people taking part and the type of exercise being tested. Men and women age differently in ways that could plausibly change how the brain responds to training, but most trials have never been designed to look. This review set out to examine both factors systematically in cognitively healthy older adults.

The authors ran a concurrent systematic review and meta-analysis of randomised controlled trials in cognitively healthy older adults. They examined six cognitive domains: executive functions, episodic memory, visuospatial function, word fluency, processing speed and global cognitive function. Three types of exercise intervention were compared: aerobic training, resistance training, and multimodal training combining both. To probe sex differences, they tested whether trials with a higher percentage of women produced larger cognitive effects than trials with a lower percentage of women.

For executive functions, all three exercise types showed larger effects in studies with a higher percentage of women, suggesting women's executive processes may benefit more from exercise than men's. Regardless of sex, all three training approaches improved visuospatial function compared with control, but only multimodal training improved episodic memory. Comparing styles head to head, aerobic training produced greater benefits than resistance training for global cognitive function and executive functions, while multimodal training outdid aerobic training for global cognition, episodic memory and word fluency.

This review helps explain why exercise-and-cognition trials disagree: who is in the room and what training they do both seem to matter. It extends earlier work by showing the pattern holds across multiple exercise types, and the authors discuss brain-derived neurotrophic factor and sex steroid hormones as possible mechanisms behind the sex difference. The key limitation is that the women's advantage was inferred by comparing across trials rather than within them, so trials that directly compare men and women under the same programme are the obvious next step. Why only multimodal training moved episodic memory also remains open.

If you are past middle age and training partly for your brain, this is a reason to think the combination of cardio and strength work covers more cognitive ground than either alone, since only the mixed approach improved episodic memory and it also beat aerobic training for global cognition and word fluency. For women, there is an added signal that executive functions, the planning and self-control machinery of the brain, may be especially responsive to exercise. None of this says men gain nothing; every training style still improved visuospatial function regardless of sex.