Designing EXercise for Cognitive hEalth in depression and anxiety: the EXCEL study

Abstract

AbstractBackgroundPhysical inactivity significantly contributes to chronic disease burden, including increasing dementia risk. Physical activity (PA) can benefit cognitive health for groups at high‐risk of dementia, such as people experiencing cognitive concerns (including mild cognitive impairment and subjective cognitive decline), and mental health symptoms. However, understanding how to best enable people with co‐occurring cognitive and mental health concerns to increase PA for dementia risk reduction (DRR) remains challenging for researchers, resulting in lower adherence in clinical trials and limiting the impact of implementation in clinical practice. The EXCEL PA implementation study incorporated design approaches from behavioral science that were novel to DRR, to improve intervention tailoring and engagement. We report findings from the first phase of EXCEL, which aimed to understand PA behavior change needs in this population and identify unique intervention tailoring requirements to enable more effective engagement.MethodThe study used the Capability, Opportunity and Motivation (COM‐B) model of behavior change as an organizing framework. Middle‐aged and older people (aged 45 – 85 years) experiencing subjective cognitive decline (SCD) or mild cognitive impairment (MCI) and mild‐moderate depression or anxiety were interviewed. Themes from semi‐structured interviews examining PA and DRR perspectives were triangulated with findings from published PA intervention trials to identify convergent and complementary themes. Integrated findings were mapped to the study framework to develop a specified, contextualized model of key factors influencing PA behavior change and matched intervention approaches.ResultData from 21 interviews and 24 relevant papers were included. Identified areas requiring behavior change support in the target population that have not been emphasized in theory or previous interventions included:• Emotional regulation• Turning intentions into action despite distractions or barriers• Confidence in existing skills, including to overcome barriers and regulate emotionThese aligned with and extended COM‐B and provided a model to guide the EXCEL intervention.ConclusionThis novel model used behavioral science methods to tailor an intervention for people experiencing cognitive concerns and depression or anxiety, supporting improved PA engagement and impact for an at‐risk population (see Ellis et al. AAIC‐23, submitted, for trial results).