Effects of Aerobic Exercise and Computer-Based Cognitive Training on Cognition, Functional Independence, Quality of Life, and Salivary Cortisol Levels in Older Adults with Mild Cognitive Impairment: A Randomized Trial

Abdur Raheem Khan^1*Aafreen Aafreen¹Ashfaque Khan¹G. Shankar Ganesh²Monira I. Aldhahi³Mohammed M Alshehri⁴Mohammad Abu Shaphe⁴

• ¹Integral University, Lucknow, India
• ²Department of Physiotherapy, Composite Regional Centre for Skill Development, Rehabilitation, and Empowerment of Persons with Disabilities, Lucknow, Saudi Arabia
• ³Department of Rehabilitation Sciences, Princess Nourah bint Abdulrahman University (PNU), Riyadh, Saudi Arabia
• ⁴Physical Therapy Department, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia

Background: Mild Cognitive Impairment (MCI) represents an intermediate stage between normal aging and dementia, characterized by measurable cognitive decline without significant loss of functional independence. Non-pharmacological interventions, particularly aerobic exercise and cognitive training, have demonstrated potential benefits; however, their combined effects and underlying neurobiological mechanisms remain inadequately explored. Objective: To investigate the effects of aerobic exercise combined with computer-based cognitive training on cognitive function, functional independence, health-related quality of life, and salivary cortisol levels in older adults with MCI. Methods: This assessor-blinded, two-arm randomized controlled trial included 60 older adults (60–85 years) diagnosed with MCI. Participants were randomized to either an intervention group receiving aerobic exercise plus computer-based cognitive training (n=28) or an active comparison group receiving aerobic exercise with conventional cognitive training (n=28). Interventions were delivered over 12 weeks, with assessments conducted at baseline, post-intervention (12 weeks), and follow-up (16 weeks). Primary and secondary outcomes included the Montreal Cognitive Assessment (MOCA), Barthel Index (BI), Short Form-12 (SF-12), and salivary cortisol levels. Data were analysed using repeated measures ANOVA and Pearson correlation analysis. Results: Both groups demonstrated significant within-group improvements in cognitive function, functional independence, quality of life, and cortisol levels over time (p<0.05). The intervention group showed significantly greater improvement in MOCA scores at 16-weeks (p<0.05). Salivary cortisol levels differed significantly between groups at 12 weeks (p<0.05). A significant negative correlation between cortisol levels and cognitive performance was observed at follow-up in both groups. Conclusion: Combining aerobic exercise with cognitive training improves clinical outcomes in older adults with MCI and may influence stress-related neurobiological pathways. This multimodal approach represents a promising, non-pharmacological strategy for mitigating age-related cognitive decline.