{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:14:15Z","timestamp":1786115655873,"version":"build-2736575974"},"reference-count":64,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Exercise training is frequently examined in relation to cognitive and brain health in aging populations. Yet many exercise\u2013cognition studies remain difficult to interpret mechanistically because cognitive outcomes are often assessed without sufficient alignment with exercise dose, biological endpoints, or participant vulnerability. This mechanism-informed narrative review argues that future research in cognitive aging should move beyond outcome-based interpretation alone and more explicitly connect the exercise stimulus with cerebrovascular endpoints, supportive biological markers, baseline vulnerability, and cognitive or translational outcomes. The review treats cerebrovascular endpoints, including cerebral blood flow, cerebrovascular reactivity, endothelial function, vascular compliance, and neurovascular coupling, as primary mechanistic anchors because they are closely related to vascular cognitive vulnerability and are more proximal to biological adaptation than cognitive test scores alone. Immune\u2013inflammatory markers, blood\u2013brain barrier-related indicators, myokines, neurotrophic factors, and exercise-induced circulating factors are considered supportive endpoints because they may clarify broader biological responsiveness when selected according to a clear hypothesis. The review also considers how exercise modality, delivered dose, adherence, baseline fitness, vascular risk, cognitive status, sex, comorbidity, and recovery capacity may shape responder heterogeneity. The purpose of this review is to develop a mechanism-informed framework for interpreting exercise\u2013cognition studies in aging by aligning the delivered exercise stimulus, participant vulnerability, biological responsiveness, and cognitive or translational outcomes. Based on this synthesis, we propose a five-layer endpoint framework that positions cerebrovascular measures as primary mechanistic anchors and supportive biological markers as hypothesis-dependent contextual endpoints. Its distinct contribution is to integrate these elements within a single interpretive structure rather than considering exercise exposure, biological responses, participant characteristics, and cognitive outcomes as separate domains. Rather than serving as a clinical prescription model or formal reporting guideline, the framework is intended to improve hypothesis\u2013endpoint alignment and the mechanistic interpretation of exercise\u2013cognition studies in aging.<\/jats:p>","DOI":"10.3390\/life16081283","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:51:23Z","timestamp":1785772283000},"page":"1283","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moving Beyond Outcome-Based Exercise Studies in Cognitive Aging: A Mechanism-Informed Narrative Review of Cerebrovascular Anchors and Supportive Biological Endpoints"],"prefix":"10.3390","volume":"16","author":[{"given":"Zhigang","family":"Zhao","sequence":"first","affiliation":[{"name":"Physical Education Teaching and Training Department, Shanxi Institute of Technology, Yangquan 045000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Wang","sequence":"additional","affiliation":[{"name":"Sports Rehabilitation Department of Sports Teaching Department, Shanxi Medical University, Jinzhong 030604, China"},{"name":"Graduate Institute of Sports Training, University of Taipei, Taipei 111036, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Gao","sequence":"additional","affiliation":[{"name":"Physical Education Teaching and Training Department, Shanxi Institute of Technology, Yangquan 045000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2331-7927","authenticated-orcid":false,"given":"Chun-Hsien","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Putian University, Putian 351100, China"},{"name":"Department of Exercise and Health Promotion, Chinese Culture University, Taipei 111369, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2672","DOI":"10.1161\/STR.0b013e3182299496","article-title":"Vascular contributions to cognitive impairment and dementia: A statement for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"42","author":"Gorelick","year":"2011","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"H1","DOI":"10.1152\/ajpheart.00581.2016","article-title":"Functional vascular contributions to cognitive impairment and dementia: Mechanisms and consequences of cerebral autoregulatory dysfunction, endothelial impairment, and neurovascular uncoupling in aging","volume":"312","author":"Toth","year":"2017","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3326","DOI":"10.1016\/j.jacc.2019.04.034","article-title":"Vascular cognitive impairment and dementia: JACC Scientific Expert Panel","volume":"73","author":"Iadecola","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e035980","DOI":"10.1136\/bmjopen-2019-035980","article-title":"Outcomes tested in non-pharmacological interventions in mild cognitive impairment and mild dementia: A scoping review","volume":"10","author":"Couch","year":"2020","journal-title":"BMJ Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1136\/bjsports-2016-096587","article-title":"Exercise interventions for cognitive function in adults older than 50: A systematic review with meta-analysis","volume":"52","author":"Northey","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3017","DOI":"10.1073\/pnas.1015950108","article-title":"Exercise training increases size of hippocampus and improves memory","volume":"108","author":"Erickson","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1249\/MSS.0000000000001936","article-title":"Physical activity, cognition, and brain outcomes: A review of the 2018 Physical Activity Guidelines","volume":"51","author":"Erickson","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1177\/0271678X20957807","article-title":"Benefits of exercise training on cerebrovascular and cognitive function in ageing","volume":"41","author":"Bliss","year":"2021","journal-title":"J. Cereb. Blood Flow. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2245","DOI":"10.1212\/WNL.0000000000009478","article-title":"Aerobic exercise improves cognition and cerebrovascular regulation in older adults","volume":"94","author":"Guadagni","year":"2020","journal-title":"Neurology"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bliss, E.S., Wong, R.H.X., Howe, P.R.C., and Mills, D.E. (2022). The effects of aerobic exercise training on cerebrovascular and cognitive function in sedentary, obese, older adults. Front. Aging Neurosci., 14.","DOI":"10.3389\/fnagi.2022.892343"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"glaf133","DOI":"10.1093\/gerona\/glaf133","article-title":"Exercise and cognitive aging: A meta-analysis of macrovascular cerebral blood flow and cognitive function in older adults","volume":"80","author":"Li","year":"2025","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1210\/endrev\/bnaa016","article-title":"Muscle\u2013organ crosstalk: The emerging roles of myokines","volume":"41","author":"Severinsen","year":"2020","journal-title":"Endocr. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"107166","DOI":"10.1016\/j.nbd.2025.107166","article-title":"Exercise and the blood\u2013brain barrier: Mechanistic insights and therapeutic implications","volume":"217","author":"Sun","year":"2025","journal-title":"Neurobiol. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gao, X., Chen, C., and Yang, J. (2024). Unlocking the potential of exercise: Harnessing myokines to delay musculoskeletal aging and improve cognitive health. Front. Physiol., 15.","DOI":"10.3389\/fphys.2024.1338875"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"g1687","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: Template for Intervention Description and Replication (TIDieR) checklist and guide","volume":"348","author":"Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1136\/bjsports-2016-096651","article-title":"Consensus on Exercise Reporting Template (CERT): Explanation and elaboration statement","volume":"50","author":"Slade","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1249\/MSS.0b013e318213fefb","article-title":"Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise","volume":"43","author":"Garber","year":"2011","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1152\/japplphysiol.00714.2014","article-title":"Individual response to exercise training: A statistical perspective","volume":"118","author":"Hecksteden","year":"2015","journal-title":"J. Appl. Physiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3233\/BPL-180067","article-title":"Exercise and the aging brain: Considerations for sex differences","volume":"4","author":"Barha","year":"2018","journal-title":"Brain Plast."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1471-1842.2009.00848.x","article-title":"A typology of reviews: An analysis of 14 review types and associated methodologies","volume":"26","author":"Grant","year":"2009","journal-title":"Health Inf. Libr. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jbusres.2019.07.039","article-title":"Literature review as a research methodology: An overview and guidelines","volume":"104","author":"Snyder","year":"2019","journal-title":"J. Bus. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"112768","DOI":"10.1016\/j.exger.2025.112768","article-title":"Comparative efficacy of exercise interventions for cognitive health in older adults: A network meta-analysis","volume":"206","author":"Zhang","year":"2025","journal-title":"Exp. Gerontol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"104912","DOI":"10.1016\/j.ijnurstu.2024.104912","article-title":"Effects of aerobic exercise on executive function of healthy middle-aged and older adults: A systematic review and meta-analysis","volume":"160","author":"Ye","year":"2024","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1038\/s41562-020-0851-8","article-title":"Systematic review and meta-analysis investigating moderators of long-term effects of exercise on cognition in healthy individuals","volume":"4","author":"Ludyga","year":"2020","journal-title":"Nat. Hum. Behav."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1080\/13854046.2012.680913","article-title":"Scoring higher the second time around: Meta-analyses of practice effects in neuropsychological assessment","volume":"26","author":"Calamia","year":"2012","journal-title":"Clin. Neuropsychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.tics.2013.08.001","article-title":"Bridging animal and human models of exercise-induced brain plasticity","volume":"17","author":"Voss","year":"2013","journal-title":"Trends Cogn. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.tins.2020.04.010","article-title":"Effects of exercise on brain and cognition across age groups and health states","volume":"43","author":"Stillman","year":"2020","journal-title":"Trends Neurosci."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Bonafiglia, J.T., Preobrazenski, N., and Gurd, B.J. (2021). A systematic review examining the approaches used to estimate interindividual differences in trainability and classify individual responses to exercise training. Front. Physiol., 12.","DOI":"10.3389\/fphys.2021.665044"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1113\/jphysiol.2013.268953","article-title":"Integrative regulation of human brain blood flow","volume":"592","author":"Willie","year":"2014","journal-title":"J. Physiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1111\/jnc.14234","article-title":"Cerebral blood flow in normal aging adults: Cardiovascular determinants, clinical implications, and aerobic fitness","volume":"144","author":"Tarumi","year":"2018","journal-title":"J. Neurochem."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1038\/jcbfm.2014.44","article-title":"Cerebral hemodynamics in normal aging: Central artery stiffness, wave reflection, and pressure pulsatility","volume":"34","author":"Tarumi","year":"2014","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1007\/s00421-023-05154-y","article-title":"The benefits of regular aerobic exercise training on cerebrovascular function and cognition in older adults","volume":"123","author":"Bliss","year":"2023","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"671","DOI":"10.3233\/JAD-180728","article-title":"Resting cerebral blood flow after exercise training in mild cognitive impairment","volume":"67","author":"Alfini","year":"2019","journal-title":"J. Alzheimers Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Prudente, T.P., Oliva, H.N.P., Oliva, I.O., Mezaiko, E., and Monteiro-Junior, R.S. (2023). Effects of physical exercise on cerebral blood velocity in older adults: A systematic review and meta-analysis. Behav. Sci., 13.","DOI":"10.3390\/bs13100847"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.neuroimage.2018.03.047","article-title":"Cerebrovascular reactivity (CVR) MRI with CO2 challenge: A technical review","volume":"187","author":"Liu","year":"2019","journal-title":"NeuroImage"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Chen, J.J. (2018). Cerebrovascular-reactivity mapping using MRI: Considerations for Alzheimer\u2019s disease. Front. Aging Neurosci., 10.","DOI":"10.3389\/fnagi.2018.00170"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1113\/EP092060","article-title":"Physiological influences on neurovascular coupling: A systematic review of multimodal imaging approaches and recommendations for future study designs","volume":"110","author":"Burma","year":"2025","journal-title":"Exp. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1161\/HYPERTENSIONAHA.119.14307","article-title":"Associations of arterial stiffness with cognitive performance, and the role of microvascular dysfunction: The Maastricht Study","volume":"75","author":"Rensma","year":"2020","journal-title":"Hypertension"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e13718","DOI":"10.1111\/psyp.13718","article-title":"Age-related alterations in the cerebrovasculature affect neurovascular coupling and BOLD fMRI responses: Insights from animal models of aging","volume":"58","author":"Yabluchanskiy","year":"2021","journal-title":"Psychophysiology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"111431","DOI":"10.1016\/j.mad.2021.111431","article-title":"The role of physical exercise in modulating peripheral inflammatory and neurotrophic biomarkers in older adults: A systematic review and meta-analysis","volume":"194","author":"Titus","year":"2021","journal-title":"Mech. Ageing Dev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"156303","DOI":"10.1016\/j.cyto.2023.156303","article-title":"Influence of different modes of exercise training on inflammatory markers in older adults with and without chronic diseases: A systematic review and meta-analysis","volume":"169","author":"Khalafi","year":"2023","journal-title":"Cytokine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1111\/j.1532-5415.2004.52307.x","article-title":"Physical activity, exercise, and inflammatory markers in older adults: Findings from the Health, Aging and Body Composition Study","volume":"52","author":"Colbert","year":"2004","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s12974-023-02753-6","article-title":"Exercise suppresses neuroinflammation for alleviating Alzheimer\u2019s disease","volume":"20","author":"Wang","year":"2023","journal-title":"J. Neuroinflamm."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.cmet.2013.09.008","article-title":"Exercise induces hippocampal BDNF through a PGC-1\u03b1\/FNDC5 pathway","volume":"18","author":"Wrann","year":"2013","journal-title":"Cell Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.cmet.2016.05.025","article-title":"Running-induced systemic cathepsin B secretion is associated with memory function","volume":"24","author":"Moon","year":"2016","journal-title":"Cell Metab."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Vints, W.A.J., G\u00f6k\u00e7e, E., Langeard, A., Pavlova, I., \u00c7evik, \u00d6.S., Ziaaldini, M.M., Todri, J., Lena, O., Sakkas, G.K., and Jak, S. (2023). Myokines as mediators of exercise-induced cognitive changes in older adults: Protocol for a comprehensive living systematic review and meta-analysis. Front. Aging Neurosci., 15.","DOI":"10.3389\/fnagi.2023.1213057"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1126\/science.aaw2622","article-title":"Blood factors transfer beneficial effects of exercise on neurogenesis and cognition to the aged brain","volume":"369","author":"Horowitz","year":"2020","journal-title":"Science"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1038\/s41586-021-04183-x","article-title":"Exercise plasma boosts memory and dampens brain inflammation via clusterin","volume":"600","author":"Khoury","year":"2021","journal-title":"Nature"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Sanders, L.M.J., Hortob\u00e1gyi, T., la Bastide-van Gemert, S., van der Zee, E.A., and van Heuvelen, M.J.G. (2019). Dose-response relationship between exercise and cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0210036"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Xu, L., Gu, H., Cai, X., Zhang, Y., Hou, X., Yu, J., and Sun, T. (2023). The effects of exercise for cognitive function in older adults: A systematic review and meta-analysis of randomized controlled trials. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021088"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1080\/13607863.2020.1857691","article-title":"Resistance training improves cognitive function in older adults with different cognitive status: A systematic review and meta-analysis","volume":"26","author":"Marzetti","year":"2022","journal-title":"Aging Ment. Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1001\/archinternmed.2009.494","article-title":"Resistance training and executive functions: A 12-month randomized controlled trial","volume":"170","author":"Nagamatsu","year":"2010","journal-title":"Arch. Intern. Med."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Venegas-Sanabria, L.C., Cavero-Redondo, I., Mart\u00ednez-Vizcaino, V., Cano-Gutierrez, C.A., and \u00c1lvarez-Bueno, C. (2022). Effect of multicomponent exercise in cognitive impairment: A systematic review and meta-analysis. BMC Geriatr., 22.","DOI":"10.1186\/s12877-022-03302-1"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1186\/s13690-024-01441-y","article-title":"The effectiveness of multicomponent exercise in older adults with cognitive frailty: A systematic review and meta-analysis","volume":"82","author":"Luo","year":"2024","journal-title":"Arch. Public Health"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Park, M., Song, R., Ju, K., Shin, J.C., Seo, J., Fan, X., Gao, X., Ryu, A., and Li, Y. (2023). Effects of Tai Chi and Qigong on cognitive and physical functions in older adults: Systematic review, meta-analysis, and meta-regression of randomized clinical trials. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-04070-2"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1212\/WNL.0000000000003332","article-title":"Aerobic exercise and vascular cognitive impairment: A randomized controlled trial","volume":"87","author":"Best","year":"2016","journal-title":"Neurology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"19974","DOI":"10.1038\/s41598-021-99249-1","article-title":"Cardiovascular risk moderates the effect of aerobic exercise on executive functions in older adults with subcortical ischemic vascular cognitive impairment","volume":"11","author":"Barha","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1001\/archneurol.2009.307","article-title":"Effects of aerobic exercise on mild cognitive impairment: A controlled trial","volume":"67","author":"Baker","year":"2010","journal-title":"Arch. Neurol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1001\/jama.300.9.1027","article-title":"Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: A randomized trial","volume":"300","author":"Lautenschlager","year":"2008","journal-title":"JAMA"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"101139","DOI":"10.1016\/j.pmedr.2020.101139","article-title":"Adherence to exercise interventions in older people with mild cognitive impairment and dementia: A systematic review and meta-analysis","volume":"19","author":"Bosco","year":"2020","journal-title":"Prev. Med. Rep."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Collado-Mateo, D., Lav\u00edn-P\u00e9rez, A.M., Pe\u00f1acoba, C., Del Coso, J., Leyton-Rom\u00e1n, M., Luque-Casado, A., Gasque, P., Fern\u00e1ndez-del-Olmo, M.\u00c1., and Amado-Alonso, D. (2021). Key factors associated with adherence to physical exercise in patients with chronic diseases and older adults: An umbrella review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18042023"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"a1655","DOI":"10.1136\/bmj.a1655","article-title":"Developing and evaluating complex interventions: The new Medical Research Council guidance","volume":"337","author":"Craig","year":"2008","journal-title":"BMJ"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"h1258","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"Moore","year":"2015","journal-title":"BMJ"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"n2061","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/8\/1283\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:40:52Z","timestamp":1785991252000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/8\/1283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":64,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["life16081283"],"URL":"https:\/\/doi.org\/10.3390\/life16081283","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]}}}