José D. Jiménez-García1*
Daniel Velázquez-Díaz2
Antonio Martínez-Amat1
Francisco Álvarez-Salvago3
Richard B. Kreider4
Diego A. Bonilla5,6,7*- 1Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
- 2Translational Research Institute, AdventHealth, Orlando, FL, United States
- 3Research Group on Special Populations (FIBIO), Faculty of Biomedical and Health Sciences, Universidad Europea de Valencia, Valencia, Spain
- 4Exercise and Sport Nutrition Laboratory, Human Clinical Research Facility, Texas A&M University, College Station, TX, United States
- 5Research Division, Dynamical Business and Science Society–DBSS International SAS, Bogotá, Colombia
- 6Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, Montería, Colombia
- 7Hologenomiks Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain
Editorial on the Research Topic
Cognitive impairment and physical function in older adults
Introduction
The world’s population is growing older, bringing new and complex challenges for public health systems. This editorial synthesizes published articles in the research topic “Cognitive Impairment and Physical Function in Older Adults” which contribute to the advancement in the interplay between modifiable lifestyle factors, social determinants, and cognitive trajectories in older adults. By integrating longitudinal and cross-sectional evidence, we identify key areas for future interventions and emphasize the importance of personalized approaches to support healthy aging in public health (Figure 1).
Figure 1. Factors influencing cognitive impairment and physical function in older adults. Health practitioners and professionals should prioritize modifiable lifestyle interventions—particularly physical activity, nutrition, and sleep (The Healthy Trinity) as well as social engagement, and smoking cessation—as cost-effective strategies to delay cognitive/functional decline and reduce mortality in older adults.
Physical activity as a cornerstone of cognitive and physical health
Regular physical exercise demonstrates robust benefits for physical and cognitive health in aging populations (Singh et al., 2025; Izquierdo et al., 2025). A longitudinal study of 10,691 Chinese older adults by Xu et al. revealed that sustained physical activity significantly improved instrumental activities of daily living (IADLs) and reduced depressive symptoms over 8 years, even after adjusting for sociodemographic confounders. However, its association with cognitive function was less definitive, suggesting domain-specific effects. Huang et al. also found both direct and indirect associations between IADL function and cognitive status. These findings align with research on modifiable health metrics by Wang et al., where physical activity emerged as a critical factor in reducing all-cause mortality among cognitively impaired older adults, potentially averting 26.6% of deaths through ideal engagement (see Table 1 for more physical activity-related articles of this research topic).
Table 1. Physical activity and exercise-related articles in older adults
Among older adults with cognitive impairment, adherence to ideal health metrics (e.g., ≥150 min/week of physical activity, Healthy Eating Index ≥60) reduced all-cause mortality risk by 48% and 63%, respectively, as demonstrated by Wang et al. Notably, smoking cessation was associated with an 85% reduction in cancer-related deaths, emphasizing the life-saving potential of lifestyle modifications even after cognitive decline begins. In addition, Kawabata et al. demonstrated the feasibility of a darts game intervention in older adults with mild cognitive impairment and highlighted the results of the center of gravity shift test as indicative of early cognitive function decline. Hao and Kim reported a positive association between participation in leisure activities and cognitive function, underscoring the potential cognitive benefits of leisure involvement for older adults with disabilities.
Heterogeneity in cognitive trajectories and predictors
Shen et al. examined the physical aging characteristics of the older people over 70 years old in China, highlighting declines in vital capacity, flexibility, muscle strength, cardiorrespiratory fitness, and balance as key features of the aging process. Notwithstanding, cognitive decline is not uniform across aging populations. A latent growth mixture model analysis of 983 disabled older adults by Pang et al. identified three distinct trajectories: rapid decline (32.6%), slow decline (36.1%), and stable cognition (31.2%). Key predictors of stability included younger age (45–59 years), higher education, urban residence, and social participation. Conversely, rural residency, low income, and depression were linked to rapid decline. This heterogeneity underscores the need for interventions tailored to socioeconomic and health profiles. Sex-related differences also require additional research, as Pal et al. demonstrated that being female, a previous diagnosis of atrial fibrillation, and stroke are risk factors for advanced cognitive dysfunction.
Interestingly, Huang et al. emphasized the crucial role of intergenerational family support—especially from children—in reducing loneliness among older adults. Authors adviced that governments strengthen regulations on children’s alimony support and enhance digital infrastructure to deepen and broaden family-based care for the elderly. As noted by Ai et al., there is a fundamental connection between disability and cognitive impairment in older adults, emphasizing that social relationships and depressive symptoms can directly or indirectly influence this association.
Future directions
To translate evidence into practice, future research should prioritize.
• Personalized interventions: develop algorithms to predict individual cognitive trajectories using biomarkers, socioeconomic data, and lifestyle factors. The diagnostic potential of alternative strategies (e.g., Traditional Chinese medicine) (Wang et al.) and genotype interactions (Li et al.) deserve further research.
• Longitudinal mechanistic studies: Yang et al. showed a positive non-linear relationship between the albumin-to-globulin ratio and cognitive function among U.S. older adults using 2011–2014 NHANES data. Also, there is evidence that physical exercise improves vascular health, its neuroprotective effects may be mediated by inflammation reduction or neurogenesis. In fact, acute cardiorrespiratory exercise likely enhances cerebral blood flow and BDNF secretion, offering transient but actionable cognitive benefits even in diagnosed Alzheimer’s patients (Gao et al.). Clarifying the temporal mechanistic features of sarcopenia (Cannataro et al., 2021) and the relationship between physical activity, depression, social isolation, and cognitive decline is an area of ongoing research.
• Development of integrative programs: beyond physical activity, composite health behaviors—such as diet quality, smoking cessation, and sleep hygiene—play pivotal roles in longevity. This is relevant considering the association between multimorbidity and the risk of cognitive decline (Zhang et al.). Future studies should contribute to the evaluation and standardization of combining physical activity–specially multimodal exercise (de Rondao et al., 2023), and cognitive training with nutritional strategies (e.g., high-protein diet) and optimal sleep hygiene, as seen in successful models for reducing depressive symptoms and mortality. Also, as highlighted by Bonilla et al., the power of creatine monohydrate supplementation plus resistance training should be noticed considering its robust safety profile and benefits in older populations (Xu et al., 2024; Kreider et al., 2025; EFSA Panel on Dietetic Products NaA, 2016).
•Policy advocacy, address structural determinants (e.g., income inequality, rural healthcare deserts) through subsidies for healthy aging programs and caregiver support initiatives (Izquierdo et al., 2021). Rural populations and those with limited education face compounded risks, highlighting the need for equity-focused public health strategies (Liu et al.). Furthermore, as demonstrated by Li and Liu, better spatial accessibility to community health services may enhance the ability of older adults to perform activities of daily living. Finally, Wei et al. reported that both observational and causal evidence support the link between socioeconomic position and sensory impairments, suggesting that early detection, targeted interventions, and educational efforts (Zhang et al.) can help prevent these conditions in middle-aged and older adults.
Physical function and cognitive health in aging is shaped by a complex matrix of modifiable and non-modifiable factors. The evidence underscores the viability of lifestyle interventions—particularly physical activity, nutrition, and sleep (Bonilla et al., 2024) as well as social engagement, and smoking cessation—as cost-effective strategies to delay decline and reduce mortality. By adopting a multidimensional framework that integrates individual, community, and policy-level efforts, we can foster resilience in aging populations and alleviate the global burden of cognitive impairment.
Author contributions
JJ-G: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review and editing. DV-D: Data curation, Investigation, Validation, Writing – review and editing. AM-A: Data curation, Investigation, Validation, Writing – review and editing. FA-S: Data curation, Investigation, Validation, Writing – review and editing. RK: Data curation, Investigation, Validation, Writing – review and editing. DB: Conceptualization, Data curation, Formal Analysis, Methodology, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review and editing.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Acknowledgments
Authors would like to thank the authors and reviewers who have participated in this Research Topic.
Conflict of interest
Author DB serves as scientific and managing director of KreaFood, an R&D&I Project by DBSS; has served as science product manager for MTX Corporation® in Europe; and is the principal investigator of The Healthy Trinity (http://thehealthytrinity.pro/), an operational framework created by DBSS that aims to develop and validate allostatic indices in general population as part of the SDG3. RK has conducted industry-sponsored research on creatine, received financial support for presenting on dietary supplements at industry-sponsored scientific conferences, and has served as an expert witness on cases related to creatine. Finally, RK serves as chair of the “Creatine for Health” scientific advisory board sponsored by Creapure® and Creavitalis®—Alzchem Group AG, while DB serves as member of this board.
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
Generative AI statement
The author(s) declare that no Generative AI was used in the creation of this manuscript.
Publisher’s note
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References
Bonilla D. A., Kočí J., Petro J. L., Kreider R. B. (2024). “The healthy trinity to face non-communicable diseases: physical activity, nutrition and sleep,” in Integrated science for sustainable development goal 3. Integrated Science2024. Editor N. Rezaei, 89–121.
Cannataro R., Carbone L., Petro J. L., Cione E., Vargas S., Angulo H., et al. (2021). Sarcopenia: etiology, nutritional approaches, and miRNAs. Int. J. Mol. Sci. 22 (18), 9724. doi:10.3390/ijms22189724
de Rondao C. A., Mota M. P., Esteves D. (2023). Physical activity interventions in older adults with a cognitive impairment: a critical review of reviews. Aging Med. milt. 6 (3), 290–306. doi:10.1002/agm2.12256
EFSA Panel on Dietetic Products NaA (2016). Creatine in combination with resistance training and improvement in muscle strength: evaluation of a health claim pursuant to article 13(5) of regulation (EC) no 1924/2006. EFSA J. 14 (2), e04523. doi:10.2903/j.efsa.2016.4523
Izquierdo M., de Souto Barreto P., Arai H., Bischoff-Ferrari H. A., Cadore E. L., Cesari M., et al. (2025). Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR). J. Nutr. Health Aging. 29 (1), 100401. doi:10.1016/j.jnha.2024.100401
Izquierdo M., Duque G., Morley J. E. (2021). Physical activity guidelines for older people: knowledge gaps and future directions. Lancet Healthy Longev. 2 (6), e380–e383. doi:10.1016/S2666-7568(21)00079-9
Kreider R. B., Gonzalez D. E., Hines K., Gil A., Bonilla D. A. (2025). Safety of creatine supplementation: analysis of the prevalence of reported side effects in clinical trials and adverse event reports. J. Int. Soc. Sports Nutr. 22 (Suppl. 1), 2488937. doi:10.1080/15502783.2025.2488937
Singh B., Bennett H., Miatke A., Dumuid D., Curtis R., Ferguson T., et al. (2025). Effectiveness of exercise for improving cognition, memory and executive function: a systematic umbrella review and meta-meta-analysis. Br. J. Sports Med. 59 (12), 866–876. doi:10.1136/bjsports-2024-108589
Keywords: exercise programs, elderly, cognition, cognitive impairment, physical exercise, aging, SDG3, good health and wellbeing
Citation: Jiménez-García JD, Velázquez-Díaz D, Martínez-Amat A, Álvarez-Salvago F, Kreider RB and Bonilla DA (2025) Editorial: Cognitive impairment and physical function in older adults. Front. Physiol. 16:1645677. doi: 10.3389/fphys.2025.1645677
Received: 12 June 2025; Accepted: 18 June 2025;
Published: 01 July 2025.
Edited and reviewed by:
Giuseppe D’Antona, University of Pavia, ItalyCopyright © 2025 Jiménez-García, Velázquez-Díaz, Martínez-Amat, Álvarez-Salvago, Kreider and Bonilla. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: José D. Jiménez-García, am9zZWRhbmllbGppbWVuZXpnYXJjaWFAZ21haWwuY29t; Diego A. Bonilla, ZGFib25pbGxhQGRic3MucHJv