Effects of immersive leisure-based virtual reality cognitive training on cognitive and physical function in community-based older adults: A randomized controlled trial

Background: Older adults are at risk of developing cognitive impairments, and cognitive training is commonly used to enhance cognitive function in this population. The effectiveness of cognitive training is further optimized with the integration of leisure-based activities, such as horticultural therapy. However, to the best of our knowledge, there is a lack of studies examining the effect of integrating virtual reality (VR) with leisure-based activities to provide real-world experiences and enhance cognitive outcomes in older adults. Furthermore, while immersive VR cognitive training has demonstrated effectiveness in enhancing multiple cognitive domains, methodological limitations-such as the absence of control groups or the use of passive controls-hinder the ability to draw conclusive conclusions regarding its comparative effectiveness. Objective: This study conducted immersive leisure-based VR cognitive training in community-dwelling older adults to investigate its effectiveness on cognitive and physical functions. We employed an active control group in which participants received well-arranged leisure activities without focusing on cognitive components. Methods: This cluster randomized controlled trial was conducted in the community facilities in northern Taiwan between 2022 and 2023. The VR cognitive training group received simulated gardening activities, such as planting, fertilizing, and harvesting, and tasks involving cognitive challenges, such as producing plant essential oils, for 60 min daily, 2 days per week, for 8 weeks. The control group received non-cognitive training. The outcomes evaluated were cognitive function assessed by Montreal Cognitive Assessment (MoCA), immediate memory assessed by Wechsler Memory Scale (WMS)-Word List, working memory and mental flexibility assessed by WMS-Digit Span Forward, WMS-Digit Span Backward, and WMG-Digit Span Sequencing (DSS), and physical function assessed by the Timed Up and Go (TUG) test. Results: The study recruited 137 older adults. After VR cognitive training, higher significant improvements were seen in MoCA (p < 0.001), WMS-DSS (p = 0.015), and TUG (0.008*) compared with the control group. Conclusions: This study is the first to examine the effects of fully immersive, leisure-based VR cognitive training on cognitive and physical function in community-dwelling older adults, highlighting its potential as a promising tool for promoting health compared to the non-cognitive training commonly used in community facilities.