BACKGROUND AND PURPOSE: The global prevalence of Alzheimer's disease (AD) in the elderly is rising, and exercise is increasingly used as a non-pharmacological intervention. However, the most effective exercise modality for improving quality of life, alleviating depression, and reducing neuropsychiatric symptoms in AD patients remains unclear. This study aims to identify the optimal exercise modality for addressing these symptoms through a network meta-analysis. METHODS: As of November 2024, we conducted a comprehensive search across six databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. This study included only randomized controlled trials (RCTs), with study durations ranging from 2 to 24 weeks, primarily set in clinical or community environments. Following the PRISMA-NMA guidelines, we conducted statistical analysis using the "gemtc" package in R and assessed evidence quality via the CINeMA online platform. RESULTS: A network meta-analysis of 29 RCTs with 1507 participants showed that for global cognition, Aerobic exercise (AE) [MD = 2.83, 95 % CI (0.66, 4.85)] ranked first with 79.5 % probability
for quality of daily life, Resistance Training (RT) [SMD = 0.96, 95 % CI (-0.14, 2.07)] ranked first with 83.7 %
for depression, Physical Activity Program (PAP) [SMD = -3.76, 95 % CI (-7.06, -0.47)] ranked first with 96.0 %
and for neuropsychiatric inventory outcomes, AE [SMD = -2.35, 95 % CI (-5.95, 1.06)] ranked first with 71.1 %. CONCLUSIONS: Based on the findings from retrospective studies, aerobic exercise may be an effective intervention for improving overall cognition and quality of life in individuals aged 60 and above with Alzheimer's disease.