The COgnitive and Physical Exercise to improve Outcomes after Surgery (COPE-iOS) study isg the hypothesis that a pragmatic program combining computerized cognitive training andhysical training throughout the perioperative period will improve long-term cognitive and disability outcomes in older surgical patients at high risk for decline. To accomplish these goals, the Investigators are randomizing 250 patients ≥60 years old undergoing elective majordiac surgery with expected hospitalization ≥3 days to a pragmatic comprehensiveg program (computerized cognitive training and supervised progressive physical) or to active control (control computer game, stretching exercises) for 2-4 weeksurgery and for 3 months after discharge. At baseline and after discharge, thevestigators will assess global cognition, activities of daily living, depression,dothelial and blood brain barrier function (blood biomarkers), and neuroimaging (anatomicald functional MRI). In this early stage trial, the Investigators will determine if certainubgroups benefit most, program aspects with greatest effect on outcomes, mechanisticwith outcomes, and additional exploratory analyses.