Effects of brain endurance training on cognitive function, physical performance and perceived exertion in healthy adults: a systematic review and three-level meta-analysis

Background Mental fatigue impairs cognitive function and physical performance in healthy adults. Brain endurance training (BET) has emerged as a strategy to enhance resistance to mental fatigue and improve both cognitive and physical outcomes; however, its effects have not been comprehensively synthesized. Objective To systematically assess the effects of BET on cognitive function, physical performance, and perceived exertion in healthy adults. Methods Searches were conducted in PubMed, Web of Science, Embase, Cochrane Library, and SPORTDiscus on September 9, 2025. Data (mean ± standard deviation and sample size) were extracted, and pooled effects were calculated as Hedges’g using random-effects meta-analysis models. Subgroup and meta-regression analyses were performed to explore potential moderators. Results Eleven studies (13 trials; n=441 participants) were included. BET significantly improved cognitive function (g = 0.64, 95% CI [0.24, 1.04], P = 0.006) and physical performance (g = 0.48, 95% CI [0.33, 0.62], p<0.001), whereas no statistically significant effect was observed for perceived exertion (g = −0.01, 95% CI [−0.25, 0.23]). Effects on cognitive function and physical performance appeared larger under mental-fatigue than non-fatigued testing conditions. Evidence for other potential moderators was inconclusive, and intervention duration was not significantly associated with any outcome. The certainty of evidence was low for cognitive function and physical performance and moderate for perceived exertion. Conclusion BET was associated with improvements in cognitive function and physical performance in healthy adults, with effects appearing larger under mental-fatigue testing conditions. BET had no statistically significant effect on perceived exertion. Given the limited number of studies and low certainty of evidence for the primary performance outcomes, these findings should be interpreted cautiously.