
==== Front
Eur J Sport Sci
Eur J Sport Sci
10.1002/(ISSN)1536-7290
EJSC
European Journal of Sport Science
1746-1391
1536-7290
John Wiley and Sons Inc. Hoboken

39172795
10.1002/ejsc.12124
EJSC12124
Review
REVIEW
Sports and Exercise Medicine and Health
Effectiveness of exercise interventions, alone or in combination with dietary modifications, on working memory in overweight and obese individuals: A systematic review
Cristi‐Montero Carlos https://orcid.org/0000-0002-9940-507X
1 carlos.cristi.montero@gmail.com

Barriga Victoria 2
Peña‐Jorquera Humberto 1
Martínez‐Flores Ricardo 1
Espinoza‐Puelles Juan Pablo 1
Flores Olivares Luis Alberto 2
Quintana Mendias Estefania 2
Enriquez‐del Castillo Liliana Aracely 2
1 IRyS Group Physical Education School Pontificia Universidad Católica de Valparaíso Valparaíso Chile
2 Faculty of Physical Culture Sciences Autonomous University of Chihuahua Chihuahua Mexico
* Correspondence
Carlos Cristi‐Montero, IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Av. El bosque 1290, Viña del Mar, Valparaíso, Chile.
Email: carlos.cristi.montero@gmail.com

22 8 2024
9 2024
24 9 10.1002/ejsc.v24.9 13501364
04 5 2024
01 8 2023
05 5 2024
© 2024 The Author(s). European Journal of Sport Science published by Wiley‐VCH GmbH on behalf of European College of Sport Science.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Abstract

This systematic review aimed to establish the effectiveness of exercise interventions, alone or in combination with dietary modifications, on working memory (WM) in individuals living with overweight and obesity. A comprehensive literature search was conducted using the Scopus, PubMed, Springer‐Link, RefSeek, and Cochrane Library databases to identify relevant publications up to January 18, 2024. Data on participants' characteristics, intervention settings, and key outcomes related to WM were extracted. The quality of the studies was assessed using the PEDro scale. A total of 15 articles met pre‐established inclusion criteria, involving participants across nine countries with a range of 12–125 individuals and ages spanning from 6 to 80 years old. Among the studies analyzed, 10 exclusively investigated exercise interventions, whereas five explored the combined effects. Notably, 70% of the exercise interventions (7 out of 10) exhibited positive improvements in WM. Likewise, 60% of the combined interventions (3 out of 5) demonstrated favorable enhancements in WM. No differences were found between the two protocols. Common features between the protocols were identified and described. Both protocols showed favorable and promising effects on WM in this clinical population. Nonetheless, the limited evidence addressing the combination of exercise and diet in the same research approach reduces the generalizability of the findings. This review offers valuable insights for future clinical and research applications in people with overweight and obesity.

Highlights

Seventy percent of exercise intervention‐alone groups demonstrated significant improvement in working memory (WM).

Sixty percent of the studies found that combining exercise with dietary management may synergistically enhance WM improvement.

High heterogeneity in exercise prescription characteristics hampers dose‐effectiveness understanding.

Limited evidence hinders a comprehensive understanding of combined exercise and dietary interventions.

executive function
fatness
feeding
physical activity
source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:03.09.2024
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pmc1 INTRODUCTION

Working Memory (WM) is a critical cognitive function involved in the executive processes in the brain (Ardila et al., 2018). Impairments in WM can lead to difficulties in self‐regulation, attention, organization, and flexible thinking, regardless of age, sex, or ethnicity (Yang et al., 2020). Furthermore, obesity has a well‐known impact on physical health (Abarca‐Gómez et al., 2017) but also has detrimental effects on cognitive function, including WM (Buie et al., 2019; Yang et al., 2020).

The underlying mechanisms linking obesity and WM impairment are multifaceted (Yang et al., 2020). Excess adipose tissue leads to changes in brain function and structure, metabolic dysfunction, insulin resistance, inflammation, and vascular dysfunction (Farruggia et al., 2019; Tanaka et al., 2020). Chronic low‐grade inflammation, marked by elevated levels of pro‐inflammatory cytokines and immune markers, negatively affects brain health, particularly in the prefrontal cortex, which is crucial for WM function (Nguyen et al., 2014; Shields et al., 2021). This panorama is a relevant concern because it affects brain health and has a significant impact on neurological, cerebrovascular, and mental health disorders globally (CTN and Free Full‐Text; Ibanez et al., 2023).

To mitigate the adverse effects of obesity on brain health, physical exercise and dietary interventions have emerged as effective strategies for improving cognitive function, specifically WM, in individuals living with overweight (Keawtep et al., 2022; Xie et al., 2017). On the one hand, mainly moderate‐to‐vigorous Aerobic exercise, a non‐pharmacological therapy, is able to mitigate neurological conditions and age‐related cognitive decline by influencing the central nervous system through neurotrophin release, enhanced hippocampal neurogenesis, reduced neuroinflammation, cerebral blood flow modulation, and structural reorganization, ultimately enhancing cognitive outcomes and quality of life (Augusto‐Oliveira et al., 2023; Peven et al., 2020). In this sense, physical exercise alone has been shown to have a positive impact on WM in subjects living with overweight, even without additional benefits of weight loss (De Sousa et al., 2021).

On the other hand, a review by Tanaka et al. (2020) concluded that weight loss seems to be linked to improved brain and cognitive results, suggesting that cognitive impairment caused by obesity might be reversible (Tanaka et al., 2020). Dietary factors, including diet and energy restriction, can positively affect brain function through various mechanisms, including systemic inflammation, glycemic response, and cellular adaptation due to weight loss and consumption of nutrient‐rich foods (Calcaterra et al., 2022; Pani, 2015; Shoemaker et al., 2019; Steventon et al., 2020). Conversely, diets high in saturated fats and sugars may adversely affect memory and brain functions (Djuricic et al., 2021; Peña‐Jorquera et al., 2021). Therefore, dietary modifications alone may also have an effect on WM in this population (Napoli et al., 2014); however, a study in older adults living with obesity found that the diet‐exercise group improved more than the diet group but not more than in the exercise group (Napoli et al., 2014).

Hence, exercise and dietary interventions alone appear to be an effective approach for improving cognitive function in individuals living with overweight and obesity; however, there is scarce and inconsistent evidence in the literature regarding whether this combination could be a better strategy (Napoli et al., 2014; Veronese et al., 2017). For example, a meta‐analysis by Veronese et al. (2017) concluded that weight loss was associated with an improvement in attention and memory among individuals living with overweight or obesity (Veronese et al., 2017). Whereas, Napoli et al. (2014) proposed that both weight loss and exercise can improve cognition, but a combination of the two may provide benefits similar to those of exercise alone (Napoli et al., 2014). Indeed, Veronese et al. (2017) acknowledged limited data on weight loss, physical activity, and cognitive outcomes, underscoring the need to assess the effectiveness of various weight loss strategies on cognition, independently and in combination.

Enhancing our understanding of this research gap by thoroughly exploring the potentially synergistic interactions between exercise and dietary interventions could shed light on the most effective strategies for mitigating the detrimental effects of obesity on cognitive function, particularly WM. Therefore, this systematic review aimed to establish the effectiveness of exercise interventions, alone or in combination with dietary modifications, on WM in individuals living with overweight or obesity.

2 METHODS

The present systematic review was carried out following the PRISMA guidelines (Page et al., 2021). Studies were eligible for inclusion if they met the following “PICOS” (Participants, Intervention, Control, Outcome measurements, and Study design) criteria. (a) Participants: Children, adults, and older adults; (b) Intervention: Studies including exercise and dietary intervention as part of the experimental protocol, when correspond; (c) Comparator: Control group (no mandatory); (d) Outcome: WM; (e) Study design: Randomized controlled trials, non‐randomized controlled trials, clinical trials, or interventional longitudinal studies.

2.1 Search strategy

An extensive literature search was conducted across several databases, including Scopus, PubMed, Springer‐Link, RefSeek, and the Cochrane Library. The search was conducted between December 2023 and January 18, 2024 with no restrictions on the publication dates. The following search terms were used: (obesity AND overweight) AND (exercise AND “physical activity”) AND (“WM” OR “executive function”).

2.2 Inclusion criteria

The following inclusion criteria were applied: (a) studies conducted on humans investigating the effects of exercise with or without dietary intervention on WM; (b) studies involving people living with overweight and obesity, considering BMI >25 kg/m2 or fat percentage >25% in men and >35% in women, with no age restriction; (c) studies written in English; and (d) randomized controlled trials, non‐randomized controlled trials, clinical trials, or interventional longitudinal studies.

2.3 Exclusion criteria

The following exclusion criteria were applied: (a) studies that did not report the intensity or protocol of the exercise employed, (b) studies where dietary intervention was not clearly specified, (c) studies where an assessment of executive functions was performed but did not detail the isolated WM outcome, and (d) studies other than randomized controlled trials, non‐randomized controlled trials, clinical trials or interventional longitudinal design.

2.4 Extraction of the data

Two evaluators independently conducted this process. The following data were extracted from the included studies: (a) the characteristics of the article (i.e., authors, location, and design); (b) characteristics of participants (i.e., n, age, sex, and nutritional status); (c) physical exercise and dietary protocol; (d) measured task; and (e) outcome of WM.

2.5 Methodological quality

The methodological quality of the included studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale (Cashin et al., 2020), which assigns scores based on the number of items met in a clinical trial. It is important to note that the scale excludes the assessment of external validity (first item), resulting in a maximum score of 10 points for the remaining 11 items. In cases of discrepancies between assessors (LAF‐O and LAE‐C), a third assessor (CC‐M) was consulted to resolve differences. The PEDro scale assigns higher scores to studies with higher methodological quality. The classification used is as follows: scores ranging from 0 to 4 were rated “poor,” scores between 5 and 6 were rated as “fair,” and scores ranging from 7 to 10 were categorized as "high." Additional information can be found in the Table S1.

3 RESULTS

3.1 Results of the search and study methodological quality

A total of 903 studies were initially identified through the database search. After title screening, 768 articles were excluded, leaving 135 articles for further review. Subsequently, 120 articles were excluded based on the acceptance criteria, resulting in 15 eligible articles for the final evaluation (Figure 1). According to the scoring on the PEDro scale, no study achieved a “high” methodological quality, all 15 articles were considered “fair”, with an average score of 6 (details in Tables 1 and 2). The recruitment was mostly convenience‐based; however, the allocation was randomized in most articles. The evaluators or participants were not blinded to the treatment. Most articles had a follow‐up rate exceeding 85% of the subjects, incorporating data analysis following the intention‐to‐treat principle, along with statistical comparisons and reporting of variability measures and outcome scores.

FIGURE 1 Shows the process used to select studies.

TABLE 1 Results from exercise‐only intervention studies (n = 10).

Study and location	Design/PEDro score	Participant characteristics	Exercise protocol	Measured	Results	
Hao et al. (2023) China	Quasi‐experimental/5 fair	Control group

n = 19

Age: 6 years

Sex: Not mentioned

NS: NW

	Program duration: 16 weeks. Continued their usual routines.	Working memory span task	= No change in WM, and there was no difference between the groups	
Experimental group

n = 23

Age: 6 years

Sex: Not mentioned

NS: OW

	Program duration: 16 weeks.

Frequency: 3 times per week

Intensity: Not mentioned

Time: 60 min

Modality: Aerobic preparation 10 min warm‐up routine included activities, such as running and stretching.

Normal exercise 40 min for aerobic exercise intervention emphasized on exercise enjoyment, safety, and repetition and included activities such as jumping rope and football

The last 10 min was for relaxation

	
Zhang et al. (2023) China	Quasi‐experimental/5 fair	No control group, just divided on:

NW group n = 17

OW group n = 24

OB group, n = 20

Age: 6–7 years

Sex: Boys and girls

NS: NW, OW, and OB

	Program duration: 11 weeks.

Frequency: 4 sessions per week

Intensity: Moderate (60%–70% HRmax)

Time: 40 min

Modality: Aerobic including 5‐min warm‐up exercise, 30‐min physical exercise training and 5‐min cool‐down stage.

This was for all the groups.

	Working memory Span task	↑WM* normal and overweight groups were higher than the obesity group	
Ortega et al. (2022) Spain	RCT/6 fair	Control group: n = 43

Age: 10.1 ± 1.1 years

Sex: Boys and girls

NS: OW or OB

	Continued their usual routines.	Delayed non‐match‐to sample (DNMS) computerized task		
Experimental group: n = 47

Age: 9.9 ± 1.1 years

Sex: Boys and girls

NS: OW or OB

	Program duration: 20 weeks.

Frequency: 3 sessions per week.

Intensity: Vigorous

Time: 90 min

Modality: Aerobic

Exercise sessions were based on games and playful activities that involved coordinative exercises

	↑ WM *	
Tomporowski et al. (2008) USA	RCT/6 fair	No control groups

n = 69

Age: 9.2 ± 1.2 years

Sex: Boys and girls

NS: OW

	Program duration: 2 sessions

Frequency: 1 session between 4 and 8 days

Intensity: Moderate

Time: 23 min in a treadmill

Modality: Aerobic

	Cognitive task protocol (adaptation from Cepeda et al., 2000)	 = No change in WM	
Crova et al. (2014) Italy	RCT/6 fair	Control group

n = 33

Age: 9.6 ± 0.5 years

Sex: Boys and girls

NS: NW and OW

	Control group physical education normal class focused on the development of fundamental motor skills and coordinative abilities, bodily expression, and deliberate play	Random number generation task.	↑ WM* the change was similar between the normal weight and overweight children	
Experimental group

n = 37

Age: 9.6 ± 0.5 years

Sex: Boys and girls

NS: NW and OW

	Program duration: 21 weeks.

Frequency: 1 session per week.

Intensity: Moderate‐to‐vigorous

Time: Not mentioned

Modality: Not mentioned

	↑ WM* the change in the overweight children involved in enhanced physical education obtained a significantly higher improvement than the normal weight children	
(1) The first training hour aimed at developing fundamental motor skills and perceptual–motor adaptation abilities in situational games preceded by warm‐up and followed by static stretching

(2) The second hour dedicated to object control skills in tennis and specifically to learning main tennis shoots and playing individual or team point games

	
Hawani et al. (2023) Tunisia	CRC/6 fair	No control group

n = 28

Age: 12.23 ± 1.58 years.

Sex: Male

NS: OW

	Program duration: 4 weeks.

Frequency: Twice a week

Intensity: Not mentioned

Time: 40 min

Modality: Aerobic

The trial was divided in 3 phases.

First, one was familiarized with the fundamental technical‐tactical

Second, they were randomly divided into two groups of 14 and each one allowed the implementation of a counterbalancing procedure.

Third, each of the two groups took part in a 20‐min SSUFG and a 20‐min SSFG in a counterbalanced crossover design. Indeed, the order of sessions was randomly counterbalanced

	Sternberg paradigm test	↑ WM* there was a significant increase in scores when switching from SSFG to SSUFG	
Sales de Lima et al. (2022) Italy	RCT/6 fair	No control group, just divided on:

MICT

n = 12

Age: 40.5 ± 5.63 years

Sex: Men

NS: OW

	MICT

Program duration: 8 weeks

Frequency: 3 sessions per week

Intensity: Moderate

Time: Not mentioned

Modality: MICT, run continuously on a 300 m track

	Digit span forward and backward test; Wechsler letter‐number sequence	↑ WM *	
HIIT

N = 13

Age: 39.46 ± 5.44 years

Sex: Men

NS: OW

	HIIT

Program duration: 8 weeks

Frequency: 3 sessions per week

Intensity: Moderate‐to‐vigorous

Time: Not mentioned

Modality: HIIT, repeated 10 × 20 m sprints with 1‐min bouts of passive recovery.

	
Drigny et al. (2014) Canada	Longitudinal intervention study/5 fair	No control group

n = 6

Age: 49 ± 8 years.

Sex: Men and woman

NS: OB, fat percentage >25% in men and >35% in women

	Program duration: 4 months.

Frequency: 5 sessions per week.

Intensity: Moderate‐to‐vigorous (60%–80% HRR)

Time: 34–48 min

Modality: HIIT

1 session of moderate intensity continuous exercise, the HIIT sessions comprised 2–3 10‐min sets of repeated bouts of 15–30 s at 80% of maximal aerobic power interspersed by 15–30 s periods of passive recovery

	Digit Span (forward and backward) Rey Auditory Verbal learning Test.	↑ WM*	
Russo et al. (2017) Italy	Quasi‐experimental pilot study/5 fair	No control group

n = 12

Age: 51.4 ± 13.4 years

Sex: Men and women

NS: OB

	Program duration: 26 weeks

Frequency: 2 sessions per week

Intensity: Moderate‐to‐vigorous (65%–70% HRR)

Time: Not mentioned

Modality: Aerobic and resistance training

Using isotonic machines such as leg press, leg extension, lat machine, and chest press machine. The aerobic workout was performed using ergometers for cardiovascular work

	Digit memory test	 = No change in WM	
Bliss et al. (2022) Australia.	RCT/6 fair	Control group

n = 13

Age: 66 ± 9 years

Sex: Male and female

NS: OW

	Did not participate in any exercise training.	Spatial span test	↑ WM *	
Experimental group

n = 14 Age: 67 ± 7 years

Sex: Male and female

NS: OW

	Program duration: 16 weeks.

Frequency: 2–4 sessions per week.

Intensity: Moderate‐to‐vigorous

Time: 40–45 min

Modality: Aerobic

The circuit comprised functional exercises including wall press‐ups, marching, step‐ups, sit‐to‐stands, squats, and basic resistance exercises.

	

TABLE 2 Results from exercise with dietary intervention studies (n = 5).

Study and location	Design/PEDro	Participant characteristics	Exercise protocol	Dietary intervention	Measured	Results	
Vantieghem et al. (2018) Belgium	RCT/6 fair	Control group.

n = 30

Age 16.0 ± 1.1

Sex: Boys and girls

NS: NW sportive guys

	Continue with their regular sportive life.		Ray Auditory Verbal learning Test (RAVLT)	↑ WM*	
Experimental group

n = 48

Age: 15.8 ± 1.8 years

Sex: Boys and girls

NS: OB

	Program duration: 30 weeks

Frequency: 2–3 sessions per week

Intensity: No mentioned

Time: No mentioned

Modality: Aerobic and resistance,

Physiotherapy, psychomotor training and swimming

	Ranging between 1450 and 2690 kcal per day consisting of 23% protein, 51% carbohydrate, and 26% fat	
Drake et al. (2022) USA	RCT/6 fair	No control group, just divided for apolipoprotein E

n = 48

Age: 44.6 ± 8.3 years

Sex: 10 men and 38 women

NS: OW and OB

	Program duration: 12 months.

Frequency: Not mentioned

Intensity: Moderate

Time: Not mentioned

Modality: Aerobic

	Calorie‐restricted diet.	N‐back task with fMRI	↑ WM*	
Peven et al. (2020) USA	RCT/6 fair	No control group, just divided on:

Only diet n = 50

Diet + moderate exercise volume n = 30

Diet + high exercise volume n = 45

Age: 44.63 ± 8.36 years

Sex: 27 men and 98 women.

NS: OW and OB

	Program duration: 12 months.

They were divided into three groups

Group 1: Only diet

Group 2: Diet + moderate exercise

Frequency: 100–150 min per week in the first 9 weeks then the recommendation was 150 min per week

Intensity: Moderate

Modality: Aerobic

Group 3: Diet + high exercise

Frequency: 100–250 min per week in the first 25 weeks; then, the recommendation was 250 min per week

Intensity: Moderate

Modality: Aerobic

	Energy intake was prescribed at 1200–1800 kilocalories per day (kcal/day) based on baseline body weight (<200 pounds (lbs.) = 1200 kcal/day; 200–250 lbs. = 1500 kcal/day; >250 lbs. = 1800 kcal/day) and height. To facilitate the adoption of the dietary recommendations and to provide guidance on meal options and portion sizes	N‐Back	 = No change in WM	
 = No change in WM	
 = No change in WM	
Žlibinaitė et al. (2020) Lithuania	RCT/6 fair	Control group n = 13	The control group did not undergo any intervention and were instructed to maintain their usual physical activity.	Calorie restriction of 12.5% of their normal consumption, in addition to designing a personalized diet for the control group, there was no diet	The mathematical processing task and the memory search task	 = No change in WM	
 = No change in WM	
Experimental group n = 13

Age: 44.9 ± 6.2 years

Sex: Women

NS: OB

	Program duration: 6 months

Frequency: 3 sessions per week

Intensity: Moderate (60%–70% HRmax)

Time: 300 min per week

Modality: Aerobic

Aerobic exercise training sessions on cycle ergometers

	
Wheeler et al. (2020) Australia	Three‐arm crossover RCT/6 fair	Three randomized groups were formed n = 67

Age: 67 ± 7 years.

Sex: 32 men and 35 women

NS: OB

	Program duration: No mentioned

Frequency: 1 session every 6 days

Intensity: Light and moderate (65%–75% HRmax)

Modality: Aerobic

	Standardized dinner: 33% of estimated daily energy requirements with a macronutrient profile of 55%–58% carbohydrate, 29%–31% fat, and 12%–15% protein, as previously described	Cognitive testing (cogstate), one back test, and two back test		
SIT: Uninterrupted sitting 8 h			 = No change in WM	
EX + SIT: Sitting (1 h), 30 min walking moderate‐intensity in treadmill, uninterrupted sitting (6.5 h)			 = No change in WM	
EX + BR: Sitting (1 h), 30 min walking moderate‐intensity in treadmill, sitting interrupted every 30 min with 3 min of light‐intensity walking			↑ WM*	
Abbreviations: BR, breaks.; EX, exercise; fMRI, functional magnetic resonance imaging; HIIT, High intensity interval training; HRmax, Maximum heart rate; HRR, Heart rate reserve; kcal, kilocalorie; MICT, moderate‐intensity continuous training; min, minutes; NS, nutritional status; NW, normal weight; OB, obesity; OW, overweight; SIT, sitting; SSFG, small‐sided football games; SSUFG, small‐sided Ultimate Frisbee games; WM, working memory.

3.1.1 Study characteristics

Fifteen studies were included in this systematic review. General study and participants characteristics, intervention protocols, methods employed for variable measurement, and main outcomes were reported for all participants. Among the 15 studies, only one employed body fat percentage with a cutoff for obesity greater than 25% in men and greater than 35% in women; the rest utilized the traditional body mass index classification of the World Health Organization. The results are summarized in Table 1 for exercise‐only interventions (Bliss et al., 2022; Crova et al., 2014; de Lima et al., 2022; Drigny et al., 2014; Hao et al., 2023; Hawani et al., 2023; Ortega et al., 2022; Russo et al., 2017; Tomporowski et al., 2008; Zhang et al., 2023) and in Table 2 for exercise with diet interventions or modifications (Peven et al., 2020; Vantieghem et al., 2018; Wheeler et al., 2020; Žlibinaitė et al., 2020). Six studies applied moderate‐to‐vigorous exercise within the same intervention program (Bliss et al., 2022; Crova et al., 2014; de Lima et al., 2022; Drigny et al., 2014; Russo et al., 2017; Žlibinaitė et al., 2020), four studies applied only moderate exercise intensity (Drake et al., 2022; Peven et al., 2020; Tomporowski et al., 2008; Zhang et al., 2023), one study focused solely on vigorous exercise program (Ortega et al., 2022), one study applied light and moderate exercise intensity (Wheeler et al., 2020), and three studies did not mention the intensity protocol used (Hao et al., 2023; Hawani et al., 2023; Vantieghem et al., 2018). In terms of modality, nine studies applied only aerobic training modality (Bliss et al., 2022; Drake et al., 2022; Hao et al., 2023; Hawani et al., 2023; Peven et al., 2020; Tomporowski et al., 2008; Wheeler et al., 2020; Zhang et al., 2023; Žlibinaitė et al., 2020), three studies applied both aerobic and resistance training modalities (Ortega et al., 2022; Russo et al., 2017; Vantieghem et al., 2018), two used a moderate‐intensity continuous training ,MICT and High intensity interval training ,HIIT protocol (de Lima et al., 2022; Drigny et al., 2014) and one of them also used resistance training (Drigny et al., 2014), and finally, one study did not mention the modality used (Crova et al., 2014).

The duration of the intervention ranged from 4 weeks to 12 months, and the frequency of the programs varied from one to five times per week. In terms of evaluating WM among participants, all studies used a wide variety of cognitive tasks to measure it; nonetheless, the Digit Span (forward and backward) (de Lima et al., 2022; Drake et al., 2022), n‐back (Bliss et al., 2022; Zhang et al., 2023), and mathematical (Ortega et al., 2022; Žlibinaitė et al., 2020) processing tasks were the most utilized.

3.1.2 Exercise interventions alone

Overall, a significant and positive improvement in WM was observed in 70% of the intervention groups (7 out of 10), which focused solely on exercise (Table 1). Four studies had a control group (Bliss et al., 2022; Crova et al., 2014; Hao et al., 2023; Ortega et al., 2022), four studies had no control group (Drigny et al., 2014; Hawani et al., 2023; Russo et al., 2017; Tomporowski et al., 2008), and two studies had no control group but were separated into two (de Lima et al., 2022) or three subgroups (Zhang et al., 2023). The exercise protocols with significant differences lasted for 10 weeks or more (Bliss et al., 2022; Crova et al., 2014; Drigny et al., 2014; Ortega et al., 2022; Zhang et al., 2023), except in two studies (de Lima et al., 2022; Hawani et al., 2023). Most of them had a frequency of three sessions per week or more (Bliss et al., 2022; de Lima et al., 2022; Drigny et al., 2014; Ortega et al., 2022; Zhang et al., 2023), except in two studies (Crova et al., 2014; Hawani et al., 2023). They used moderate and vigorous intensity separately or together (Bliss et al., 2022; Crova et al., 2014; de Lima et al., 2022; Drigny et al., 2014; Ortega et al., 2022; Zhang et al., 2023), while one study did not mention the intensity (Hawani et al., 2023). The session time ranged from 34 to 48 min (Bliss et al., 2022; Drigny et al., 2014; Hawani et al., 2023; Zhang et al., 2023), aside from one study that had longer sessions lasting 90 min (Ortega et al., 2022); two other studies did not mention the session time (Crova et al., 2014; de Lima et al., 2022). The most commonly used modalities were aerobic exercise, MICT, and HIIT (Bliss et al., 2022; de Lima et al., 2022; Drigny et al., 2014; Hawani et al., 2023; Ortega et al., 2022; Zhang et al., 2023); however, one study did not specify the exercise modality used (Crova et al., 2014).

According to the primary outcome and the population assessed, the results indicated that only three studies did not find a significant difference in WM, where two of them were conducted in children (Hao et al., 2023; Tomporowski et al., 2008) and one was in adults (Russo et al., 2017). The remaining seven studies demonstrated positive and significant changes, where four of them (Crova et al., 2014; Hawani et al., 2023; Ortega et al., 2022; Zhang et al., 2023) were conducted in children, two (de Lima et al., 2022; Drigny et al., 2014) included adults, and one study were conducted on older adults (Bliss et al., 2022). The exercise protocols in the studies that did not show significant differences varied widely. One study had only two intervention sessions (Tomporowski et al., 2008), while others lasted for 16 weeks or more (Hao et al., 2023; Russo et al., 2017), except one study that had only 2 sessions of intervention (Tomporowski et al., 2008). The frequency ranged from one to three sessions per week (Hao et al., 2023; Russo et al., 2017; Tomporowski et al., 2008), and intensities were described as moderate or moderate‐to‐vigorous (Russo et al., 2017; Tomporowski et al., 2008), except one study that did not mention the intensity (Hao et al., 2023). Session times varied from 23 to 60 min (Hao et al., 2023; Tomporowski et al., 2008), with one study not mentioning time per session (Russo et al., 2017). Both aerobic and resistance exercises were used as modalities across the studies (Hao et al., 2023; Russo et al., 2017; Tomporowski et al., 2008).

Nadi.

3.1.3 Exercise in combination with dietary intervention

In general, a significant and favorable improvement in WM was observed in 60% of the intervention groups (3 of 5) that combined exercise with any form of dietary intervention (Table 2). Two studies had a control group (Vantieghem et al., 2018; Žlibinaitė et al., 2020), and three studies had no control group but were separated into three subgroups.

According to the outcomes, four studies found significant improvement in WM. However, Wheeler et al. (2020) found that exercise and subsequent breaks of 3 min of walking to light intensity every 30 min improved WM, but no significant change was observed after exercise and sitting protocols. Regarding age, one study was conducted on adolescents (Vantieghem et al., 2018), three studies included adults (Drake et al., 2022; Peven et al., 2020; Žlibinaitė et al., 2020), and only one study focused on older adults (Wheeler et al., 2020). Based on dietary intervention, three studies applied an energy restriction diet arranged from moderate to severe total calorie intake (Drake et al., 2022; Peven et al., 2020; Žlibinaitė et al., 2020), whereas two studies employed a standard meal intervention (Vantieghem et al., 2018; Wheeler et al., 2020).

4 DISCUSSION

This systematic review aimed to assess the effectiveness of exercise interventions, either alone or in combination with dietary modifications, on WM in individuals living with overweight and obesity. The main finding of this review indicates that physical exercise interventions lead to improvements in WM, with positive outcomes observed in 10 of 15 studies included (66.7%). Moreover, interventions involving aerobic exercise and dietary restriction seemed to show a favorable trend concerning to WM.

4.1 Exercise effectiveness only exercise intervention

Exercise variables, such as the intensity and duration of a physical program, are crucial factors that can significantly influence cognitive outcomes. While the majority of studies have reported positive results (70.0%), there are contexts where no significant changes in cognitive performance were observed (Russo et al., 2017; Wheeler et al., 2020; Zhang et al., 2023). While moderate‐intensity exercises tend to produce a greater positive response in global cognition, executive function, and memory compared to light intensity, it is noteworthy that favorable changes were only observed in three of five studies when combined with diet (Drake et al., 2022; Vantieghem et al., 2018; Wheeler et al., 2020). It has been shown that age is a modulating factor to improve executive functions; it has been shown that exercise mainly favors older adults compared to young adults or children.

Nonetheless, it is widely recognized that physical activity has numerous beneficial effects on cognitive domains, including WM, attributed to various physiological and emotional processes that enhance brain function and learning performance (Latino et al., 2023; Walsh et al., 2018). In this context, brain‐derived neurotrophic factor (BDNF) emerges as a pivotal factor involved in cognitive enhancement. This protein is produced during exercise in response to muscle contraction, especially during aerobic exercise, and plays a crucial role in neurogenesis, neuronal survival, and synaptic transmission (Cassilhas et al., 2016). Additionally, it has been found that exercise can increase blood flow and oxygenation in the prefrontal cortex, which is primarily responsible for executive functions, including WM (Cristofori et al., 2019; Hillman et al., 2008). In our review, most studies (4 out of 7, 57.1%) showed positive results utilizing aerobic exercise. All 7 studies implemented protocols lasting between 8 and 21 weeks, with sessions lasting over 30 min, reported in five out of 7 studies. This chronic intervention frequency and duration may enhance BDNF upregulation, potentially contributing to the observed outcomes (Walsh et al., 2020).

Supporting these findings, de Lima et al. (2022) conducted an 8‐week study involving middle‐aged men living with overweight and obesity, which indicated that both MICT and high‐intensity interval training improved cognitive function and increased BDNF levels. However, it is important to acknowledge that not all the evidence aligns with these results. For instance, Žlibinaitė et al. (2020) observed that women with overweight and obesity who participated in a 6‐month intervention involving aerobic exercise and caloric restriction did not exhibit significant differences in cognitive parameters, including BDNF levels, compared to the control group.

One possible explanation for these discrepancies lies in variations in the study protocols or individual responses to exercise. In line with this, Wheeler et al. (2020) (Wheeler et al., 2020) demonstrated that a bout of moderate exercise in the morning led to improvements in BDNF levels and executive functions in older adults. Nonetheless, previous reviews and meta‐analyses have consistently indicated a beneficial relationship between physical exercise, BDNF, and executive functions (De Greeff et al., 2018; Fernandes et al., 2018; Smith et al., 2010). The studies do not show the intensity through the lactate threshold. We can attribute it to the fact that the effort made was a determining factor for the increase in WM since in 7 of 10 studies the minimum intensity was 60% HR corresponding to the second threshold of this metabolite, which influences a wide range of neuronal responses, from the configuration of neuronal excitability to the induction and expression of structural and synaptic plasticity (Griego et al., 2023).

Although there was a significant increase in WM in the studies presented only with exercise intervention in children and adults, we observed that in the study by Hao et al. (2023) and Crova et al. (2014) (Crova et al., 2014; Hao et al., 2023), who evaluated children aged 6 and 9 years, respectively, there were no significant changes in WM. In this sense, in the study by Wheeler et al. (2020), who worked with 51‐year‐old adults, there were no favorable changes either. It is important to note that the wide range of studies encompassing diverse age groups and populations, along with varying exercise and diet interventions, presents a challenge in drawing definitive conclusions about the efficacy of specific interventions to improve WM. Therefore, future research should delve into investigating the modulating effect of age in such interventions.

4.2 Exercise with diet intervention

The variety of exercise protocols used in different studies poses challenges when attempting to comprehensively compare exercise interventions with and without dietary support. However, most of the evidence consistently indicates that incorporating a dietary intervention alongside an exercise program increases the likelihood of achieving greater cognitive outcomes (Drake et al., 2022; Peven et al., 2020; Vantieghem et al., 2018).

Two studies implemented caloric restriction. In the first, Žlibinaitė et al. (2020) employed a protocol involving severe caloric restriction for 2 days to assess stress, mood, cognitive, and motor functions in young women living with obesity. The authors found that very low caloric restriction induced moderate stress, but surprisingly improved spatial processing and visuospatial WM while decreasing cognitive flexibility. It is worth mentioning that the diet included milk and oatmeal as major components, which have been associated with improved WM in both people with obesity and healthy individuals (Crichton et al., 2012; Kennedy et al., 2020). While in the second, Drake et al. (2022) (Drake et al., 2022) conducted a study using functional MRI and n‐back testing to evaluate cognitive function following a 12‐month moderate‐to‐vigorous intensity exercise program combined with caloric restriction in 48 subjects with overweight and obesity. Their results indicated improvements in WM.

On one hand, previous studies have suggested that the underlying mechanism behind these findings may be mediated by weight loss (Smith et al., 2010; Tussing‐Humphreys et al., 2022). Weight loss has been linked to alleviating the pro‐inflammatory state associated with obesity, reducing neural oxidative stress, promoting synaptic plasticity through neurotrophic/neuroprotective factors, and preventing beta‐amyloid neuropathology in Alzheimer's transgenic models (Gillette‐Guyonnet et al., 2008). Animal studies have also demonstrated that caloric restriction can improve brain health and lifespan (Wahl et al., 2018).

On the other hand, Vantieghem et al. (2018) implemented an exercise and dietary energy control protocol over 30 weeks in adolescents living with obesity. The authors found that in addition to changes in cognitive function, the subjects experienced improvements in body composition and self‐perceived fatigue. The authors attributed the latter benefit to improved cognition, including short‐term memory, rather than to changes in body composition. Similar results were reported by Wheeler et al. (2020), who employed a protocol involving light and moderate intensity exercise with dietary control in 67 older adults with obesity. In this case, improvements in WM were observed, leading the authors to conclude that physical exercise played a crucial role in this relationship.

These findings support the hypothesis that dietary control is important, but it appears to yield greater results when combined with caloric restriction owing to the various benefits it offers for brain health (Gillette‐Guyonnet et al., 2008). This hypothesis can be confirmed previously (Napoli et al., 2014; Veronese et al., 2017), where significant changes in WM were observed in adults and older adults who performed exercise along with dietary modification, in contrast to those in the dietary intervention‐alone group.

5 STRENGTHS AND LIMITATIONS

Our study acknowledges some limitations that are important to mention for a more in‐depth understanding. Firstly, none of the studies incorporated in this review achieved a high methodological quality. Secondly, certain studies failed to clearly report the intensity of the physical exercise protocol employed in their interventions, hindering a thorough analysis and potentially introducing confounding factors. Finally, the high age heterogeneity observed, coupled with the limited number of studies, hindered our ability to conduct subgroup analyses and accurately interpret the results across different age ranges. WM varies significantly across age groups; therefore, future reviews should consider conducting separate analyses for distinct age categories and drawing different conclusions to ensure robust findings. Therefore, caution is advised in interpreting our results.

Conversely, it is imperative to highlight several strengths of our study. Our review covers data from different stages of life, ranging from children to older adults. Along with this, the comparative analysis between exercise alone or in combination with dietary interventions provides a promising understanding about the influence and the potentially synergistic effect of incorporating both variables to enhance WM.

6 PERSPECTIVES

This systematic review provides evidence suggesting that both exercise alone and exercise combined with diet modifications hold promise for improving WM in individuals living with overweight and obesity. However, it is important to acknowledge that the available evidence is limited in terms of both quantity and quality, underscoring the need for further research in this area. Thus, future studies should consider exploring additional aspects such as the optimal duration, intensity, and long‐term effects of these interventions on WM. Furthermore, this review identified several gaps in the literature, including a lack of studies (a) comparing groups with exercise and exercise in combination with dietary intervention, (b) focusing on children and older adults, and (c) investigating the impact of dietary interventions targeting essential nutrients and antioxidants on brain health. Addressing these gaps would provide valuable insights into the effectiveness of interventions across different age groups and the potential role of specific dietary components in optimizing cognitive benefits.

7 CONCLUSION

This systematic review found promising but limited evidence regarding the effectiveness of combining exercise and dietary interventions on WM in subjects living with overweight and obesity. These results suggest that a combination of aerobic exercise and caloric restriction may be an effective strategy for improving WM in this population. Given that overweight constitutes a significant health risk factor predisposing individuals to obesity, which is recognized as a multidimensional disease, it is necessary to establish that the synergetic effects of caloric restriction and aerobic exercise can have favorable effects on WM, taking into account age. Therefore, establishing this type of exercise and dietary modifications during basic education could improve factors related to executive functions, which are new lines of interest for governments, to establish public policies that help the population. In turn, the review provides information that the combination of this type of exercise and dietary modification can help address the problems generated by the executive functions of adults and older adults.

Therefore, future research should consider age cut‐off points, incorporate designs that include control groups, and carefully outline the characteristics of the exercise and diet programs. Moreover, efforts should be directed toward the homogenization of the results derived from the large number of instruments used to obtain more precise information about the effects of exercise and diet on WM, and in this way, cover these gaps to enhance our understanding of how lifestyle modifications can optimize cognitive function in different populations.

AUTHOR CONTRIBUTION

Liliana Aracely Enriquez‐del Castillo, Humberto Peña‐Jorquera, Ricardo Martínez‐Flores, Juan Pablo Espinoza‐Puelles, and Carlos Cristi‐Montero were involved in the conception, design, and interpretation of the data extracted for the study. Victoria Barriga and Liliana Aracely Enriquez‐del Castillo performed the literature search, and Carlos Cristi‐Montero was involved in the study selection and data extraction. Humberto Peña‐Jorquera, Ricardo Martínez‐Flores, and Juan Pablo Espinoza‐Puelles performed quality assessment of the study. Luis Alberto Flores Olivares and Estefania Quintana Mendias methodologically reviewed the paper. Victoria Barriga was responsible for the initial writing and drafting of the paper, which was reviewed and edited by Liliana Aracely Enriquez‐del Castillo and Carlos Cristi‐Montero, who approved the final version before submission.

CONFLICT OF INTEREST STATEMENT

There are no competing interests.

Supporting information

Table S1

ACKNOWLEDGMENTS

There are no acknowledgments. No funding was associated with the production of this review.

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.
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