Immersive motor-cognitive virtual reality training for cognitive frailty: a systematic review and meta-analysis of randomized controlled trials.

Abstract

<h4>Background</h4>Cognitive frailty-defined as the coexistence of physical frailty and mild cognitive impairment without dementia-has gained attention as a potentially reversible condition linked to functional decline, disability, and future dementia. Traditional motor-cognitive or physical training programs can be beneficial, yet they often suffer from low engagement and limited ecological relevance. Immersive virtual reality (VR) has emerged as a promising alternative because it provides interactive, multisensory environments capable of simultaneously stimulating cognitive and motor processes. Although several trials have evaluated VR in older adults with cognitive frailty, the overall effect remains uncertain. Recent meta-analyses have generally been broad in scope, combining heterogeneous populations or non-immersive VR systems, and no review has specifically focused on immersive motor-cognitive VR in individuals formally diagnosed with cognitive frailty.<h4>Objective</h4>To evaluate whether immersive motor-cognitive VR improves global cognition and physical frailty in adults with cognitive frailty.<h4>Methods</h4>Five databases were searched through March 09, 2026, for randomized controlled trials using immersive or semi-immersive motor-cognitive VR in adults diagnosed with cognitive frailty. Global cognition was the primary outcome and physical frailty the secondary. Pooled effect sizes were calculated using SMDs or MDs with 95% CIs. Risk of bias was assessed with Cochrane criteria, and certainty of evidence with GRADE.<h4>Results</h4>Three randomized controlled trials (<i>n</i> = 344) comparing VR-based interventions with non-VR control conditions demonstrated a significant improvement in global cognitive function (SMD = 0.50; 95% CI 0.14-0.85; <i>I</i> ² = 39%). Two trials (<i>n</i> = 278) that used whole-body VR reported reductions in frailty severity (MD = -0.26; 95% CI -0.47 to -0.04; <i>I</i> ² = 0%).<h4>Conclusion</h4>Immersive motor-cognitive VR may improve both cognitive function and frailty severity in adults with cognitive frailty. Evidence remains limited by the small number of trials and variation in VR systems and intervention protocols. Larger, high-quality studies are needed to confirm these findings.<h4>Systematic trial registration</h4>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251234169, PROSPERO database CRD420251234169.