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

The intervention significantly increased the proportion of participants meeting all applicable physical activity guidelines.

• At baseline, only 3 of 55 (6%) participants met all applicable PA guidelines.
• Post-intervention, 24 of 55 (44%) participants met all applicable PA guidelines (P<.001).
• Participants were at least 8 times more likely to meet age-appropriate guidelines for aerobic, strength, and balance activities after the intervention.

The intervention demonstrated high retention and acceptability among participants.

• The retention rate was 95% (completion rate).
• Feedback indicated 98% of participants found the program useful.
• The intervention was delivered as a pilot individual 12-week online home-based PA program with fortnightly online coaching.

Dementia risk was significantly reduced following the intervention.

• Dementia risk reduction had an effect size of d=-0.32 (P=.008).
• Participants were aged 45-80 years with subjective cognitive decline or mild cognitive impairment.
• The sample consisted of 55 participants (46 females/9 males; mean age 62.2, SD 7.6 years).

Reductions in depression, anxiety, and stress scores were large and clinically meaningful.

• Effect size for depression reduction was d=-1.31 (P<.001).
• Effect size for anxiety reduction was d=-0.89 (P<.001).
• Effect size for stress reduction was d=-1.18 (P<.001).
• All participants had mild to moderate symptoms of depression or anxiety at baseline.

Over half of the cohort transitioned to a higher stage of change for physical activity post-intervention.

• 27 of 55 participants transitioned to a higher stage of change at post-intervention.
• This represents more than half of the enrolled cohort.
• Stage of change was one of the measured outcomes alongside PA levels, mental health symptoms, and dementia risk.

Improvements in action planning and positive outcome expectancies were identified as potential cognitive mechanisms of change.

• Action planning improved with an effect size of d=0.66 (P<.001).
• Positive outcome expectancies improved with an effect size of d=0.33 (P=.01).
• These improvements were described as bridging the PA intention-behavior gap, reflecting the Capability, Opportunity, and Motivation Behavior (COM-B) model underlying the intervention design.

Safety was successfully monitored remotely using an online clinical panel alert system.

• Safety was monitored by a clinical panel via email using a system of alerts.
• The intervention was home-based and delivered online.
• The intervention was described as safe based on the monitoring outcomes.

The study population had co-occurring cognitive concerns and mental health symptoms, which represent a high-risk group for dementia with previously documented lower adherence to PA interventions.

• Participants were required to have subjective cognitive decline or mild cognitive impairment and mild to moderate symptoms of depression or anxiety.
• Eligible participants were aged 45-80 years.
• The authors note that clinical trials have shown lower adherence to PA interventions in high-risk groups and that there is a sparsity of interventions tailored to their unique behavior change needs.
• The EXCEL (Exercise for Cognitive Health) phase 1 previously developed a model to understand the needs of this population and identified tailoring requirements.

The individually tailored PA programs combined aerobic and strength physical activity, plus balance training as indicated.

• Programs were prescribed individually and tailored to each participant.
• The intervention included aerobic PA, strength PA, and balance training as indicated.
• The intervention was 12 weeks in duration with fortnightly online coaching sessions.
• The program was home-based and delivered online.