BACKGROUND: Aging-related cognitive decline and cognitive impairment greatly impacts older adults' daily life. The worldwide ageing of the population and associated wave of dementia urgently calls for prevention strategies to reduce the risk of cognitive decline. Physical activity (PA) is known to improve cognitive function at older age through processes of neuroplasticity. Yet, emerging studies suggest that larger cognitive gains may be induced when PA interventions are combined with cognitive activity (CA). This meta-analysis evaluates these potential synergistic effects by comparing cognitive effects following combined PA plus CA interventions to PA interventions (PA only), CA interventions (CA only) and control groups. METHODS: PubMed, Embase, PsycINFO, CINAHL and SPORTDiscus were searched for English peer-reviewed papers until April 2018. Data were extracted on cognition and factors potentially influencing the cognitive effects: mode of PA plus CA combination (sequential or simultaneous), session frequency and duration, intervention length and study quality. Differences between older adults with and without mild cognitive impairments were also explored. RESULTS: Forty-one studies were included. Relative to the control group, combined PA plus CA intervention showed significantly larger gains in cognition (g = 0.316; 95% CI 0.188 to 0.443; p < 0.001). Studies that compared combined PA plus CA with PA only, showed small but significantly greater cognitive improvement in favor of combined interventions (g = 0.160; 95% CI 0.041 to 0.279; p = 0.008). No significant difference was found between combined PA plus CA and CA only interventions. Furthermore, cognitive effects tended to be more pronounced for studies using simultaneous designs (g = 0.385; 95%CI 0.214 to 0.555; p < 0.001) versus sequential designs (g = 0.114; 95%CI -0.102 to 0.331, p = 0.301). Effects were not moderated by session frequency, session duration, intervention length or study quality. Also, no differences in effects were found between older adults with and without mild cognitive impairments. CONCLUSION: Findings of the current meta-analysis suggest that PA programs for older adults could integrate challenging cognitive exercises to improve cognitive health. Combined PA plus CA programs should be promoted as a modality for preventing as well as treating cognitive decline in older adults. Sufficient cognitive challenge seems more important to obtain cognitive effects than high doses of intervention sessions.

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