AbstractBackgroundNumerous studies have shown that aerobic and resistance exercises, including leisure time physical activity help to reduce the risk of cognitive decline. Recently potential of cognitive training using immersive virtual reality (VR) has been growing in the non‐pharmacological interventions for mild cognitive impairment (MCI). However, there are not enough studies comparing the impact of two different interventional approaches on cognition and brain function especially on MCI patients. Therefore, we investigated the effectiveness of two non‐pharmacological intervention using VR and aerobic‐and resistance physical exercise (PE) on cognitive and brain function of older adults with MCI.MethodThis study included 99 participants (70.8 ± 5.4) with MCI randomly assigned to PE, VR, and control group. The PE training consisted of aerobic and resistance exercise performed for 50 mins 5 times/week for 12 weeks. The immersive VR‐based cognitive training consisted of series of cognitive games. 24 sessions of VR training (three days/week) were performed, and each session was 100 mins long. Global cognitive function was measured with Mini‐Mental State Examination (MMSE) test. Resting‐state electroencephalography (EEG) of neural oscillatory activity in different frequency bands was measured. Physical function was measured with hand grip strength (HGS), gait speed and timed up and go test.ResultAfter the intervention period, VR significantly enhanced global cognition (p<0.045) and HGS (p<0.001) whereas PE significantly improved HGS (p<0.001) compared to baseline. One way Analysis of variance (ANOVA) of resting state EEG showed decreased theta/beta power ratio (TBR) (p<0.018) in the central region of the brain in PE group compared to the control group. Although not significant, VR group also showed decreased TBR compared to control group.ConclusionOur study findings suggest that VR based cognitive training enhances both global cognition and physical function of older adults with MCI. The decrease in resting state TBR in PE and VR group also indicated improved attention. Further studies should peruse the effect of VR exergaming intervention, a combination of PE and cognitive games, to yield peak benefits on MCI patients.