Acute cognitive effects of interruptions to prolonged sitting with brief standing or physical activity breaks: a systematic review and three-level meta-analysis.

Abstract

Background: Prolonged sitting is strongly associated with impaired cognitive function. Although traditional exercise interventions have been shown to improve cognitive outcomes, their implementation is often limited by practical constraints. In contrast, introducing interruptions to prolonged sitting with brief bouts of standing or physical activity has emerged as a more feasible alternative. However, previous research has been dominated by qualitative reviews. Moreover, some quantitative studies have not adequately addressed effect-size dependency arising from multiple outcomes and time points within the same study, and quantitative evidence regarding specific cognitive domains and interruption-protocol parameters remains limited.

Methods: Following the PRISMA guidelines, this study systematically searched PubMed, Web of Science, the Cochrane Library, Embase, and Scopus for randomized crossover trials published up to January 2026 that examined the effects of brief standing or physical activity breaks during prolonged sitting on cognitive function. A three-level random-effects meta-analysis was conducted to pool effect sizes, with cluster-robust variance estimation used to account for effect-size dependency resulting from multiple outcomes and time points within the same study. In addition, subgroup and meta-regression analyses were performed to investigate potential moderating factors. Risk of bias was assessed using the Risk of Bias 2 tool, and the certainty of the evidence was evaluated according to the GRADE framework.

Results: A total of 21 randomized crossover trials involving 433 participants were included. Compared with prolonged sitting, sitting interruptions involving standing or physical activity were associated with improvements in executive function (k = 16 studies; Hedges' g = 0.18; 95% CI: 0.03 to 0.32; p = 0.016) and memory function (k = 10 studies; Hedges' g = 0.37; 95% CI: 0.13 to 0.61; p = 0.003). However, no clear evidence of improvement was found for global cognition (k = 2 studies; Hedges' g = 0.57; 95% CI: -0.20 to 1.34; p = 0.122), information processing (k = 4 studies; Hedges' g = 0.32; 95% CI: -0.21 to 0.86; p = 0.221), or attention (k = 5 studies; Hedges' g = - 0.08; 95% CI: -0.38 to 0.22; p = 0.575). The certainty of evidence was low for executive function, memory function, information processing, and attention, and very low for global cognition. Exploratory subgroup analyses suggested that cognitive benefits were more pronounced in older adults and in individuals with overweight or obesity. Interruptions involving walking showed relatively consistent beneficial effects, whereas low-intensity activity was associated with particularly marked improvements in memory function (p for subgroup difference < 0.05). Meta-regression indicated that a higher interruption frequency was associated with greater improvements in executive function, whereas improvements in memory function were associated with a lower interruption frequency and longer experimental exposure. Overall, however, the certainty of evidence for most outcomes was rated as low or very low.

Conclusions: Introducing brief standing or physical activity breaks during prolonged sitting may be associated with small acute improvements in executive function and memory function, although the certainty of evidence for these outcomes remains low. Evidence for global cognition, information processing, and attention remains insufficient and inconsistent, with very low certainty for global cognition. Observed differences across participant characteristics and interruption parameters should be interpreted as exploratory and are not sufficient to support definitive prescriptive recommendations. From a feasibility perspective, low-intensity walking may represent a practical option, but its relative efficacy requires confirmation in larger, higher-quality studies.

Trial registration: CRD420251273873; registered 26 December 2025.