Factors Influencing Long-Term Physical Activity Maintenance: A Qualitative Evaluation of a Physical Activity Program for Inactive Older Adults at Risk of Cognitive Decline: The INDIGO Follow-Up Study

Article type: Research Article

Authors: Chong, Terence W.H.^{a; b; c; *} | Curran, Eleanor^{a; b; c} | Southam, Jenny^a | Cox, Kay L.^d | Bryant, Christina^e | Goh, Anita M.Y.^{f; g} | You, Emily^a | Ellis, Kathryn A.^{a; e} | Lautenschlager, Nicola T.^{a; b; c}

Affiliations: [a] Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia | [b] St Vincent’s Hospital Melbourne, Fitzroy, Australia | [c] North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia | [d] Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia | [e] Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia | [f] National Ageing Research Institute, Parkville, Australia | [g] Department of Psychiatry, The University of Melbourne, Parkville, Australia

Correspondence: [*] Correspondence to: Dr. Terence W.H. Chong, Department of Psychiatry, The University of Melbourne and St Vincent’s Hospital Melbourne, St George’s Campus, St Vincent’s Hospital Melbourne, 283 Cotham Road, Kew, Victoria 3101, Australia. Tel.: +61 3 9231 8485; Fax: +61 3 9231 8477; E-mail: twhc@unimelb.edu.au.

Abstract: Background:Physical inactivity is a modifiable risk factor for dementia, but there remains a research translation gap in effective physical activity (PA) implementation, particularly in the longer-term. The INDIGO trial investigated the effectiveness of a six-month PA intervention for inactive older adults at risk of cognitive decline with subjective cognitive decline or mild cognitive impairment. Objective:This follow-up study aimed to collect feedback from INDIGO participants about their experience of involvement in the trial, including barriers and enablers to longer-term maintenance of PA. Methods:A qualitative study using semi-structured individual interviews was conducted and transcripts analyzed thematically. All INDIGO trial completers were invited, with 29 participating (follow-up period 27–66 months post-baseline). Results:At long-term follow-up, participants described INDIGO trial participation as beneficial. The theme of “Motivation” (subthemes: structure and accountability, knowledge and expected benefits, preferences and motivation, tools) followed by “Situation” (subthemes: environment and time, social aspects, aging and physical health) appeared to be critical to PA “Action". Most participants had a positive view of goal-setting and peer mentoring/support, but there was some polarization of opinion. Key factors to longer-term “Maintenance” of PA were self-efficacy and perceived benefits, habit formation, and for some participants, enjoyment. Conclusion: PA interventions for older adults at risk of cognitive decline should include behavior change techniques tailored to the individual. Effective techniques should focus on “Motivation” (particularly structure and accountability) and “Situation” factors relevant to individuals with the aim of developing self-efficacy, habit formation, and enjoyment to increase the likelihood of longer-term PA maintenance.

Keywords: Cognition, exercise, goal setting, late-life, older adults, peer mentors, physical activity

DOI: 10.3233/JAD-220202

Journal: Journal of Alzheimer's Disease, vol. 89, no. 3, pp. 1025-1037, 2022