Tailored Online Physical Activity Coaching for Middle-Aged and Older Adults With Cognitive and Mental Health Concerns: Single-Arm Pre-Post Intervention Study

Background: Low levels of physical activity (PA) increase dementia risk, and for middle-aged and older adults with co-occurring cognitive concerns and mental health symptoms, dementia risk increases further. Despite clinical trials showing lower adherence to PA interventions in high-risk groups, there is a sparsity of interventions tailored to support unique behavior change needs. In EXCEL (Exercise for Cognitive Health) phase 1, we developed a model to understand the needs of this population and identified tailoring requirements to enhance engagement. Here we report the findings of a pilot online intervention designed to support middle-aged and older adults with subjective cognitive decline or mild cognitive impairment and mild to moderate symptoms of depression or anxiety to meet PA guidelines. Objective: We aimed to measure (1) efficacy of the intervention in promoting adoption of PA in line with national guidelines, (2) acceptability, feasibility, and safety of the intervention, (3) changes to dementia risk, PA levels, mental health symptoms, and stages of change, and (4) changes in potential cognitive mechanisms of change. Methods: A pilot individual 12-week online home-based PA intervention. Participants aged 45-80 years, experiencing both cognitive and mild-to-moderate anxiety and depression symptoms, were prescribed individually tailored PA programs combining aerobic and strength PA, plus balance training as indicated, with fortnightly online coaching. Results: A total of 55 participants were enrolled (46 females/9 males; mean age 62.2, SD 7.6 y). The intervention was effective; at baseline, only 3 of 55 (6%) participants met all applicable PA guidelines, compared to 24 of 55 (44%) participants post intervention (P