Currently submitted to: Journal of Medical Internet Research
Date Submitted: Oct 1, 2026
Open Peer Review Period: Oct 6, 2026 - Dec 1, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Feasibility and Acceptability of Mixed Reality Cognitive and Physical Training and Multicomponent Exercise with Tai Chi in Older Adults With Cognitive Frailty: A Pilot Randomized Controlled Trial
ABSTRACT
Background:
Mixed reality–based combined cognitive and physical training (MR-CPT) may offer an innovative approach for older adults with cognitive frailty; however, its feasibility and acceptability in this population remain unexplored.
Objective:
This study examined the feasibility and acceptability of an 8-week MR-CPT intervention among older adults with cognitive frailty symptoms.
Methods:
Participants were randomized to an 8-week MR-CPT intervention or dose-matched multicomponent exercise +Tai Chi (ME + Tai Chi), attending sixteen 45-minute group sessions. Feasibility was assessed using recruitment, retention, intervention adherence, intervention engagement, and adverse events. Acceptability was evaluated using formative assessments of satisfaction with and perceived fit of the intervention components and post-intervention ratings of feasibility, acceptability, and appropriateness. Outcomes were summarized using descriptive statistics.
Results:
Of 39 individuals screened, 30 were eligible for the study (recruitment rate: 76.9%), and 24 completed the study (retention rate: 80.0%). MR-CPT participants achieved 92.8% session adherence, and achieved high levels of intervention engagement, with the mean task accuracy ranging from 83.72% to 98.30% and reaction time from 1.50 to 2.01 seconds across 16 sessions. Formative evaluation of acceptability indicated high satisfaction with (4.67 ± 0.54; 93.4%) and perceived fit of MR-CPT (4.30 ± 0.59; 86.0%) on a 5-point rating scale. Post-intervention evaluations showed high overall acceptability (4.97 ± 0.07; 99.4%), with similarly high ratings for the three subscales: acceptability (4.96 ± 0.14; 99.2%), appropriateness (5.00 ± 0.00; 100%), and feasibility (4.94 ± 0.11; 98.8%).
Conclusions:
The 8-week MR-CPT intervention was feasible and highly acceptable among older adults with cognitive frailty symptoms. These findings support further evaluation of MR-CPT in larger trials to determine its effectiveness for improving cognitive and physical function and its potential for broader implementation. Clinical Trial: ClincialTrials.gov (NCT07652996)
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