JMIR Publications

ABSTRACT

Background:

Cognitive frailty, defined as the coexistence of physical frailty and mild cognitive impairment without dementia, is a reversible geriatric condition associated with functional decline, disability, and increased risk of dementia. Traditional motor-cognitive and physical training programs show benefits but are often limited by low engagement and poor ecological validity. Virtual reality (VR) offers an immersive and interactive platform that may enhance cognitive stimulation, physical activity, and daily living task performance. Several recent randomized controlled trials have explored VR interventions in adults with cognitive frailty, but their overall effectiveness remains unclear. However, existing meta-analyses provide limited evidence because they typically include heterogeneous populations (e.g., MCI or physical frailty alone) and non-immersive or low-engagement VR systems. To date, no review has specifically evaluated immersive motor–cognitive VR interventions in adults diagnosed with cognitive frailty using validated criteria.

Objective:

To assess the impact of immersive motor–cognitive VR training on cognition and physical frailty in adults with cognitive frailty.

Methods:

Five databases were searched up to November 14, 2025. Randomized controlled trials evaluating immersive or semi-immersive VR motor–cognitive interventions in adults with cognitive frailty were included. The primary outcome was global cognitive function, while secondary outcomes included physical frailty. Standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using RevMan 5.3. Risk of bias was assessed according to the Cochrane criteria, and the certainty of evidence was evaluated using the GRADE approach.

Results:

Three studies involving 344 participants were included in this meta-analysis comparing VR-based intervention versus non-VR (standard care) in older people. VR intervention was associated with a significant improvement in the global cognitive function compared with non-VR (SMD = 0.42; 95% CI 0.21 to 0.64; p = 0.0001; I² = 39%; moderate heterogeneity). Only two trials reported physical frailty outcomes and involved whole-body motor–cognitive VR; therefore, the third trial was excluded from this analysis. Two studies involving 278 participants were included in comparing VRMCT (Virtual Reality Motor-Cognitive Training) versus MCT (Motor-Cognitive Training) in older people. The VRMCT showed a significant improvement in the physical frailty (Mean Difference = –0.26; 95% CI –0.47 to –0.04; p = 0.02; I² = 0%; very low heterogeneity).

Conclusions:

Virtual reality-based rehabilitation appears to offer benefits for both cognitive and physical frailty severity in older adults when compared with conventional rehabilitation. Clinical Trial: CRD420251234169