Sage Journals: Discover world-class research

Abstract

Background

Physical activity is crucial for preventing cognitive decline in elders with mild cognitive impairment (MCI) or dementia, but increasing it in this group poses challenges.

Objective

To summarize and update barriers and facilitators to physical activity using the COM-B (Capability-Opportunity-Motivation-Behavior) model, and examine variations across settings, cognitive levels, and stakeholders’ perspectives.

Methods

Eight databases (PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, China National Knowledge Network, Wanfang Data and VIP) were searched from inception to January 20, 2024. Barriers and facilitators were analyzed using directed content analysis based on the COM-B model.

Results

From 33 studies, 18 barriers and 15 facilitators were identified, spanning all COM-B domains, with variations across settings, cognitive levels, and stakeholders’ perspectives.

Conclusion

The findings provide a foundation for developing tailored physical activity promotion strategies for older adults with MCI/dementia, which should be differentiated based on residential settings, cognitive impairment levels, and stakeholders involved.

Keywords

barriers facilitators physical activity dementia mild cognitive impairment COM-B model

Introduction

Dementia is a prevalent chronic condition affecting 55 million people globally, with particularly high prevalence among older adults.¹ Mild cognitive impairment (MCI) is often considered as an intermediate state between normal cognitive status in aging and early dementia,² and is a key stage in the prevention of dementia. Given that pharmacological interventions may cause side effects and their effectiveness remains to be fully evaluated, non-pharmacological interventions are receiving growing attention in the prevention and management of dementia in recent years.¹

Physical activity is defined as any bodily movement produced by skeletal muscles that results in the expenditure of energy.³ It has been widely proved to be effective in improving cognitive function and slowing cognitive decline.⁴ However, older adults with MCI/dementia often have a low level of physical activity and poor activity compliance. This may be attributed to cognitive decline, which can impair the ability to comprehend, remember, and execute instructions; reduce motivation and the capacity for behavioral change; and is frequently accompanied by declines in physical function.^5,6 Systematically identifying the facilitators and barriers to physical activity participation in older adults with MCI and dementia can help develop scientific and effective management strategies to promote the physical activity participation in older adults with MCI/dementia, and the COM-B (Capability-Opportunity-Motivation-Behavior) model is a suitable framework for identifying the facilitators and barriers.

The COM-B model is a theoretical framework proposed by Michie et al.,⁷ and it is the core element of the Behavior Change Wheel (BCW) for understanding behaviors. Synthesized from 19 theories, this model is comprehensive and integrative. Additionally, it can be used in the beginning of a bottom-up strategy for designing interventions focused on behavior change. According to COM-B, physical activity participation in older adults with MCI/dementia is influenced by three core elements: capability, opportunity, and motivation, which may function independently or in combination.⁷ For example, opportunities and capability can both influence motivation, and implementing a certain behavior can change capability, motivation, and opportunity in turn. There have been reviews using the COM-B model to summarize the facilitators and barriers to physical activity participation and exercise adherence in the general older population, and have shown satisfactory results.^8,9

Scholars have also paid attention to and summarized the facilitators and barriers to physical activity participation in this special population, that is, the older adults with MCI and dementia. However, the original studies included in the latest review are as of 2019,¹⁰ and a large number of new relevant original studies have appeared in recent years, so the evidence needs to be updated. In addition, factors influencing physical activity vary across different living environments and levels of cognitive impairment among older adults. For instance, physical activity levels in community-dwelling older adults may be influenced by determinants such as educational attainment and smoking habits. Conversely, physical activity levels among older adults residing in care facilities may be more affected by factors like reduced household chores and financial problem.^11,12 Compared to individuals with MCI, older adults with dementia exhibit more severe cognitive impairment (such as executive function), greater decline in activities of daily living (ADLs), and have significantly prolonged sedentary time.¹³ All of these can lead to differences in the factors influencing physical activity participation. Furthermore, different stakeholders prioritize distinct factors influencing physical activity.¹⁴ For example, older adults with MCI/dementia place greater emphasis on health benefits and affective experiences. Informal caregivers not only focus on health benefits but also pay attention to the activity environment and the characteristics of the staff. Physiotherapy experts focus predominantly on physical state of older adults.¹⁴ However, current reviews summarizing the facilitators and barriers to physical activity participation among older adults with MCI/dementia have overlooked heterogeneity attributable to living environments, cognitive impairment severity, and multi-stakeholder perspectives.

Therefore, the objectives of this review are as follows. First, summarize and update the facilitators and barriers to physical activity in older adults with MCI/dementia based on the COM-B model. Second, analyze the differences in the facilitators and barriers to physical activity participation in older adults with MCI/dementia across different residential settings, different levels of cognitive impairment, and different stakeholders’ perspectives. This study can assist healthcare professionals in identifying key determinants of physical activity and tailoring strategies for older adults with MCI/dementia, thereby providing a practical and evidence-based foundation for promoting physical activity participation in this population.

Methods

This systematic review is reported according to the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.¹⁵ The review protocol has been registered in PROSPERO (CRD42024503022).

Search Strategy

The search period extended from the inception of the databases to January 20, 2024. Search terms encompassed key words related to cognitive disorder (eg, cognitive dysfunction, dementia, Alzheimer disease), words related to various physical activity (eg, exercise, sports, physical exertion) and the words related to influence factor (eg, barrier*, facilitat*, motivat*). We searched eight databases, including PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, China National Knowledge Network, Wanfang Data and VIP. For specific search strategies, refer to Supplemental Material 1. In addition, references lists to the included studies and relevant reviews were retrieved to avoid omissions.

Eligibility Criteria and Study Selection

The inclusion criteria included the following: (1) participants: older adults with MCI/dementia, their caregivers, therapists, or other stakeholders; (2) intervention: any form of physical activity; (3) context: residing in community or care facilities (including nursing homes, hospital day centers and rehabilitation wards); (4) outcomes/aims: facilitators or barriers to the participation in any form of physical activity among older adults with MCI/dementia; (5) language was limited to English and Chinese.

Studies that met any of the following criteria were excluded: (1) conference abstracts, letters, research protocols, and dissertations; (2) physical activity was only part of various forms of activities; (3) older adults with MCI/dementia were only a subset of participants and were not analyzed separately; (4) full text was not available.

After deduplication of the retrieval results, two researchers independently screened and evaluated the title, abstract, and full text of each document according to the above criteria. Disagreements were resolved by consulting the third researcher.

Methodological Quality Assessment

Two researchers independently assessed the quality of the included studies. The Joanna Briggs Institute (JBI) Literature Critical Appraisal Tool¹⁶ was used to assess the quality of the quantitative and qualitative studies. Specific assessment items were selected based on the corresponding study design. The overall quality of one study was expressed by the percentage of “yes” responses, with 60% and 80% as the cut-off values to distinguish low, medium and high quality.¹⁷ The Mixed Methods Assessment Tool (MMAT)¹⁸ was used to assess mixed methods studies. When more than 50% of the items were responded with “yes”, the study was considered high quality.¹⁹ Any disagreements that arose during the methodological quality assessment were resolved by consulting the third researcher.

Data Extraction

The following information of the included studies were extracted: the first author and year, country, study design, setting, sample characteristics (sample size, diagnosis, age, gender), physical activity information, barriers and facilitators to physical activity participation. Data extraction was carried out by one researcher and checked by a second researcher, using predefined extraction templates.

Synthesis Methods

Barriers and facilitators to physical activity participation were integrated using the directed content analysis.²⁰ First, six themes (physical capability, psychological capability, reflective motivation, automatic motivation, physical opportunity and social opportunity) were pre-defined based on the COM-B model. Second, based on the definition of the themes, the findings were coded by two researchers independently. During the analysis, any codes that did not align with the six predefined themes were used to generate new themes. Finally, the codes under each theme were grouped based on relevance and then conceptualized into sub-themes.

In addition, to increase the precision and applicability of the results, subgroup analyses were conducted according to the type of residential setting, levels of cognitive impairment and the perspectives of different stakeholders.

Evidence Quality Assessment

Evidence from quantitative studies was assessed using the GRADE approach.²¹ Evidence from qualitative studies was evaluated using the GRADE-CERQual approach.²² The strength of synthesized evidence from both qualitative and quantitative sources was assessed based on the risk of bias, the consistency, quantity, and impact of the findings across studies.²³

Results

Study Selection

A total of 8555 articles were retrieved. After deduplication and title, abstract, and full-text screening, 33 studies were eligible for inclusion in the systematic review. Supplemental materials 2 shows all included original studies. Figure 1 summarizes the study selection process.

Figure 1.

Study selection flowchart

Study Characteristics

Of the included studies, 21 were qualitative, 6 were quantitative, and 6 were mixed methods study design. There were a total of 1512 participants, including 1013 participants with MCI/dementia (n = 30), 416 informal caregivers (n = 16), and 83 staff members (n = 7). The study populations were from the United Kingdom (n = 7), China (n = 5), the Netherlands (n = 5), the United States (n = 4), Belgium (n = 2), Canada (n = 2), Norway (n = 2), Thailand (n = 1), Austria (n = 1), Portugal (n = 1), Australia (n = 1), Switzerland (n = 1) and Sweden (n = 1). Articles published from 2009 to 2023. The residential settings in 24 studies were communities, and others were care facilities (n = 9). 19 studies were specific to people with dementia and 5 studies were specific to people with MCI. The specific types of physical activity included household, leisure (including exercises), and occupational activities. Activity intensity was categorized as low, moderate, and vigorous. The forms of participation encompassed group-based, home-based, and technology-based interventions. Details of the study characteristics are shown in Table 1.

Table 1.

Characteristics of the Included Studies

The first author, year	Country	Setting	Study design	Sample characteristics	Physical activity information
Borges-Machado, 2023	Portugal	Community	Qualitative study	Target population: People living with dementia/NCD or MCI/minor NCD	Balance and coordination, upper-and-lower body muscle strength, and aerobic endurance
				Interviewee: Caregivers (n = 20)	Light-to-moderate intensity
				Age (y): 74 ± 5.46	Group-based intervention
				Female: 75%	Group-based intervention
Di Lorito, 2023	United Kingdom	Community	Qualitative study	Target population: People living with MCI or dementia	Physical exercise, functional activities
				Interviewee: People living with MCI or dementia (control: n = 12, intervention: n = 32), therapists (n = 26), caregivers (n = 39)	Moderate intensity
				Mean age (y): 79	Group-based intervention
				Female: Unclear	Group-based intervention
Drazich, 2023	United States	Hospital	Cross-sectional study	Target population: Patients with dementia (of any type) (n = 79)	Physical activity
				Age (y): 82.86 ± 7.69	Low, moderate and vigorous intensity
				Female: 63.3%	Low, moderate and vigorous intensity
Park, 2023	United States	Community	Qualitative study	Target population: People living with dementia	Chair yoga
				Interviewee: People living with dementia (n = 8), caregivers (n = 9)	Low-to-moderate intensity
				Age (y): 68-96	Home-based intervention
				Female: 37.5%	Home-based intervention
Portegijs, 2023	Netherlands	Care facilities	Mixed method study	Target population/Interviewee: People living with dementia (n = 76)	Daily activity (standing, walking, other activities)
				Age (y): 82.4 ± 12.0	Low-intensity
				Female: 64%	Low-intensity
Van Santen, 2023	Netherlands	Community	Mixed method study	Target population: People living with dementia	Exergaming: Ride on a bicycle
				Interviewee: People living with dementia (n = 73), their caregivers and staff (n = 2)	Low-to-moderate intensity
				Age (y): 79 ± 6	Group-based intervention
				Female: 49%	Group-based intervention
Guo, 2022	China	Community	Qualitative study	Target population/interviewee: People living with VaMCI (n = 15)	Aerobic physical activity
				Age (y): 78-80
				Female: 53.3%
Huang, 2022	China	Community	Mixed method study	Target population/interviewee: People living with MCI (n = 3) and AD (n = 11)	Aerobic exercise; resistance exercise
				Age (y): Aerobic group: 72.6 ± 8.8, resistance group: 69.3 ± 7.5	Moderate intensity
				Female: 50%	Home-based intervention
Li, 2022	China	Community	Cross-sectional study	Target population: People living with dementia	Household activities: Washing dishes
				Interviewee: Caregivers of people with AD (n = 79) and other dementia types (n = 61)	Leisure activities: Walking outdoors, and endurance exercise
				Age (y): 78 ± 8.0	Occupational activities: Participating in paid or voluntary work
				Female: 49.54%	Low, moderate, vigorous intensity
				Female: 49.54%	Home-based intervention
Ma, 2022	China	Community	Cross-sectional study	Target population: People living with MCI (n = 87)	Physical activity
				Age (y): ≥60
				Female: 41.38%
Swinnen, 2022	Belgium	Care facilities	Qualitative study	Target population/Interviewee: People living with major neurocognitive disorder (n = 31)	Standing balance exergaming project
				Age (y): 67-93	Technology-based intervention
				Female: 77.4%	Technology-based intervention
Di Lorito, 2021	United Kingdom	Community	Qualitative study	Target population: People living with dementia	Balance and coordination, upper-and-lower body muscle strength, and aerobic endurance
				Interviewee: People living with dementia (n = 24), caregivers (n = 19), professionals (n = 15)	Low-to-moderate intensity
				Age (y): 67-95	Group-based intervention
				Female: 42%	Group-based intervention
Farina, 2021	United Kingdom	Community	Qualitative study	Target population/Interviewee: People living with AD (n = 9) and other types of dementia (n = 6), caregivers (n = 15)	Occupational, sports, and household activities
				Age (y): 77.3 ± 5.77	Home-based intervention
				Female: 33.3%	Home-based intervention
Gebhard, 2021	Austria	Care facilities	Qualitative study	Target population/Interviewee: People living with mild dementia (n = 5) and moderate dementia (n = 5)	Walking, gardening, swimming, exercise, hiking, winter sports, cycling, housework, physical activity in a professional environment, dancing
				Age (y): 84.9 ± 4.91	Group-based intervention
				Female: 80%	Group-based intervention
Swinnen, 2021	Belgium	Care facilities	Mixed method study	Target population/Interviewee: People living with major neurocognitive disorder (n = 22)	Exergaming: Strength training, balance training, and cognitive training
				Age (y): 70-95	Technology-based intervention
				Female: 81.8%	Technology-based intervention
Wang, 2021	China	Care facilities	Qualitative study	Target population/Interviewee: People living with MCI (n = 13)	Chinese square dancing
				Age (y): 69 - 88	Moderate intensity
				Female: 76.92%	Group-based intervention
Bechard, 2020	Canada	Community	Qualitative study	Target population: People living with MCI and AD	Physical activity
				Interviewee: People living with MCI (n = 6) and AD (n = 4), caregivers (n = 10)	Moderate-to-vigorous intensity
				Age (y): 74.4 ± 7.5	Home-based intervention
				Female: 60%
Di Lorito, 2020	United Kingdom	Community	Qualitative study	Target population: People living with dementia	Exercise, activities of daily living, and dual tasks (physical and cognitive exercises)
				Interviewee: People living with dementia except Lewy body dementia (n = 20), caregivers (n = 20)	Low-to-moderate intensity
				Age (y): 70-90	Home-based intervention
				Female: 10%
Fischbacher, 2020	Switzerland	Community	Randomized controlled trial	Target population: People living with MCI(n = 6) and mild dementia (n = 12)	Dalcroze eurhythmics program: Different courses of motion, sometimes in combination with the handling of objects (eg, a ball or claves)
				Age (y): 76.4 ± 4.5	Group-based intervention
				Female: 61.1%
Hobson, 2020	Canada	Community	Qualitative study	Target population: People living with MCI and dementia	Dementia-related community activity
				Interviewee: People living with MCI(n = 5) and dementia (n = 5), caregivers (n = 7)	Low and moderate intensity
				Age (y): 75.3 ± 6.5	Group-based intervention
				Female: 30%	Group-based intervention
Karssemeijer, 2020	Netherlands	Community	Qualitative study	Target population: People living with dementia	Cognitive-aerobic training
				Interviewee: People living with dementia (n = 20), informal caregivers (n = 20) and physiotherapists (n = 15)	Low intensity
				Age (y): 79 ± 5.4
				Female: 25%
Taraldsen, 2020	Norway	Community	Qualitative study	Target population: People living with MCI and dementia	Group exercises for warm-up endurance, muscle strength, balance and cooling down
				Interviewee: People living with MCI (n = 1) and dementia (n = 3), caregivers (n = 4), volunteers (n = 4) and physiotherapists (n = 2)	Group-based intervention
				Age (y): 70-85
				Female: 50%
Van der Wardt, 2020	United Kingdom	Community	Qualitative study	Target population: People living with MCI or dementia	Individually tailored strength, balance and dual task training programs
				Interviewee: People living with MCI or dementia (n = 6), caregivers (n = 3), professional (n = 4)	Home-based intervention
				Age (y): 63-86
				Female: Unclear
Hancox, 2019	United Kingdom	Community	Mixed method study	Target population: People living with MCI or early dementia	Home-based strength and balance exercises
				Interviewee: People living with MCI (n = 1) or early dementia (n = 19), informal caregivers (n = 19)	Moderate and high intensity
				Age (y): 79 ± 5.4	Home-based intervention
				Female: 20%	Home-based intervention
Lindelöf, 2017	Sweden	Care facilities	Qualitative study	Target population/Interviewee: People living with AD (n = 8) and other dementia types (n = 13)	Functional exercise program
				Age (y): 74-96	High intensity
				Female: 71%	Group-based intervention
Karuncharernpanit, 2016	Thailand	Community	Qualitative study	Target population: People living with dementia	Daily activities and formal exercise
				Interviewee: People living with AD (n = 8), caregivers (n = 8), professional (n = 9)	Home-based intervention
				Age (y): 64-81
				Female: 75%
McDuff, 2015	United Kingdom	Community	Qualitative study	Target population/Interviewee: People living with dementia (n = 12)	Walking, exercise classes, housework, gardening and swimming
				Age (y): 65-86
				Female: 50%
Olsen, 2015	Norway	Care facilities	Qualitative study	Target population/Interviewee: People living with dementia (n = 8)	Functional exercise program
				Age (y): 69-96	High intensity
				Female: 87.5%	Group-based intervention
Suttanon, 2012	Australia	Community	Qualitative study	Target population: People living with AD	Home-based balanced exercise program
				Interviewee: People living with AD (n = 10), caregivers (n = 9)	Home-based intervention
				Age (y): 81.6 ± 5.2
				Female: 70%
Tak, 2012	Netherlands	Community	Randomized controlled trial	Target population: People living with MCI (n = 179)	Aerobic walking program
				Age (y): 75.1 ± 2.9	Moderate intensity
				Female: 44%	Group-based intervention
Yu, 2011	United States	Community	Mixed method study	Target population/Interviewee: People living with AD (n = 4)	Aerobic training
				Age (y): 61-82	Moderate intensity
				Female: 0%	Group-based intervention
Galik, 2009	United States	Care facilities	Qualitative study	Target population: People living with moderate to severe cognitive impairment	Restorative care activities
				Interviewee: Caregivers (n = 7)	Group-based intervention
				Age (y): Unclear
				Female: Unclear
Van Uffelen, 2009	Netherlands	Community	Randomized controlled trial	Target population: People living with MCI (n = 152)	Walking program
				Age (y): Intervention group: 75 ± 2.9, control group: 75 ± 2.8	Moderate intensity
				Female: Intervention group: 52%, control group: 36%	Group-based intervention

Note. NCD, neurocognitive disorder; MCI, mild cognitive impairment; VaMCI, vascular mild cognitive impairment; AD, Alzheimer’s disease.

Age data in Table 1 pertains exclusively to the target population.

Methodological Quality

The percentage of “yes” ranged from 60% to 87.5%. 8 studies were of high quality, and 25 studies were of moderate quality, See Supplemental materials 3 for details.

Facilitators and Barriers to Physical Activity Participation in Older Adults With MCI/Dementia

Under the guidance of COM-B framework, 33 sub-themes were identified, including 18 barriers and 15 facilitators. No new themes beyond the COM-B framework were identified. The details of the themes, sub-themes and codes are presented in Table 2. The supplemental Figure 1 presents the factors in a more intuitive way.

Table 2.

Barriers and Facilitators Derived From Studies

Themes	Sub-themes	Codes (the first author, year)
Physical capability	Barriers
	Physical mobility limitations	Illness (Di Lorito, 2023; Ma, 2022; Gebhard, 2021; Fischbacher, 2020; Karssemeijer, 2020; Van der Wardt, 2020; McDuff, 2015; Van Uffelen, 2009)
		Pain (Guo, 2022; Gebhard, 2021; Di Lorito, 2020; McDuff, 2015)
		History or current status of injury/operation (Di Lorito, 2023; Guo, 2022; Di Lorito, 2021; Farina, 2021; Gebhard, 2021; Di Lorito, 2020; Suttanon, 2012; Tak, 2012; Van Uffelen, 2009)
		Side effect of medications (Di Lorito, 2023; Di Lorito, 2020; Galik, 2009)
		Poor general physical status (Huang, 2022): Feeling tired (Wang, 2021; Karssemeijer, 2020; McDuff, 2015; Tak, 2012), physical frailty (di Lorito, 2021)
		Advanced age (Ma, 2022; Bechard, 2020)
	Facilitators
	Good mobility	Execute and maintain physical activity (Drazich, 2023; Gebhard, 2021; Hobson, 2020)
Psychological capability	Barriers
	Cognitive deficits	Difficulties in understanding (Borges-Machado, 2023)
		Forgetfulness (Di Lorito, 2023; Guo, 2022; Farina, 2021; Gebhard, 2021; Wang, 2021; Bechard, 2020; Fischbacher, 2020; Van der Wardt, 2020; Hancox, 2019; Karuncharernpanit, 2016; McDuff, 2015)
		Lack of attention (Park, 2023; Bechard, 2020)
		Inability to self-direct (Bechard, 2020)
		Lack of the ability to access and use digital support (Di Lorito, 2021)
		Communication breakdown (Gebhard, 2021; Galik, 2009)
	Behavioral and psychological symptoms	Apathy (Di Lorito, 2023; Li, 2022; Bechard, 2020)
		Agitation (Di Lorito, 2020; Galik, 2009)
		Psychomotor alterations (Li, 2022)
		Negative emotions (e.g., anxiety) (Gebhard, 2021; Karssemeijer, 2020; Galik, 2009)
		Poor mental status (Huang, 2022; Karssemeijer, 2020)
		Personality misfit (e.g., need of peace, Less sociable and shyness to exercise in front of others) (Gebhard, 2021, Di Lorito, 2020)
	Inadequate knowledge of physical activity	Lack of understanding of the benefits of physical activity (Guo, 2022)
	Inadequate knowledge of physical activity	Lack of understanding of the meaning of physical activity (Hancox, 2019)
	Mental illness	Pre-existing psychological morbidity (Di Lorito, 2021; Van der Wardt, 2020)
	Lack of behavioral regulation ability	Unhealthy lifestyles (Ma, 2022; Di Lorito, 2020)
	Facilitators
	Memory support	Prompts/cues from clinicians, carer and/or pictures of exercises (Park, 2023; Van der Wardt, 2020; Hancox, 2019)
	Physical activity management skills	Participation in the decision-making process (Guo, 2022; Di Lorito, 2020; Karssemeijer, 2020)
		Communication associated with physical activity (Gebhard, 2021)
		Good self-management skills (e.g., time management skills, internal discipline, Adaptability to schedule changes) (Bechard, 2020)
	Adequate knowledge of physical activity	Be aware of some cognitive benefits associated with physical activity (Bechard, 2020)
Automatic motivation	Barriers
	Lack of activity attractiveness	Lack of interest (Borges-Machado, 2023; Fischbacher, 2020; Karssemeijer, 2020; McDuff, 2015; Tak, 2012; Van Uffelen, 2009)
		Exercise better or worse than others (Gebhard, 2021)
		Dislike online forms of exercise (Park, 2023)
		Dislike structured exercise (Gebhard, 2021; Hancox, 2019; Suttanon, 2012)
	Facilitators
	Positive feelings	Enjoyment (Borges-Machado, 2023; Farina, 2021; Gebhard, 2021; Swinnen, 2021; Di Lorito, 2020; Karssemeijer, 2020; Van der Wardt, 2020; Yu, 2011)
		Pleasant (Borges-Machado, 2023; Huang, 2022; Swinnen, 2022; Farina, 2021; Gebhard, 2021; di Lorito, 2020; Karssemeijer, 2020; Lindelöf, 2017; Yu, 2011)
		Free (Karssemeijer, 2020)
	Lifestyle habits conducive to physical activity	Forming exercise habits (Borges-Machado, 2023; Van Santen, 2023; Wang, 2021; Van der Wardt, 2020; Hancox, 2019)
	Adequacy of activity attractiveness	Demand for attractive activities (Borges-Machado, 2023)
		The sense of competitiveness (Farina, 2021; Di Lorito, 2020)
		The desire for physical activity (Gebhard, 2021; Bechard, 2020)
		Preference (Van Santen, 2023; Swinnen, 2021; Van der Wardt, 2020; Suttanon, 2012)
Reflective motivation	Barriers
	Perception of potential risk	Fear of injury (Gebhard, 2021; Di Lorito, 2020; Galik, 2009)
		Fear of falling (Gebhard, 2021; Di Lorito, 2020; Van der Wardt, 2020)
		Fear of getting lost (Karuncharernpanit, 2016)
	Low self-efficacy	Lack of confidence to complete physical activities (Gebhard, 2021; Bechard, 2020; Di Lorito, 2020; Van der Wardt, 2020)
	Negative physical activity experiences	The feeling of sweating during exercise (Guo, 2022; Gebhard, 2021; Bechard, 2020)
		Fatigue and muscle soreness after exercise (Bechard, 2020)
		Boredom with prescriptive exercises (Hancox, 2019)
	The gap between ideal and perceived benefits of physical activity	Unrealistic or unachievable expectations (Di Lorito, 2023; Di Lorito, 2020; Tak, 2012)
		Be unable to feel the benefits of physical activity (Bechard, 2020; Hancox, 2019)
	Facilitators
	Positive physical activity experiences/negative inactivity experiences (Van Santen, 2023; Guo, 2022; Bechard, 2020; Di Lorito, 2020; Hancox, 2019; Olsen, 2015)	Previous physical activity habits (Karssemeijer, 2020; Lindelöf, 2017; Yu, 2011)
		Perceive the benefits on physical and mental health (Borges-Machado, 2023; Di Lorito, 2023; Huang, 2022; Wang, 2021; Karssemeijer, 2020; Hancox, 2019; Suttanon, 2012; Yu, 2011)
		Perception of progress (Di Lorito, 2020)
	Motivation from established goals	Physical and mental health promotion (Di Lorito, 2023; Bechard, 2020; Di Lorito, 2020; Hancox, 2019; Yu, 2011)
	Motivation from established goals	Meeting new people (Borges-Machado, 2023; Farina, 2021; Di Lorito, 2020; Hobson, 2020; Taraldsen, 2020)
	Strong beliefs of physical activity participation	Believe in the benefits of exercise (Huang, 2022; Farina, 2021; Hobson, 2020; Hancox, 2019; Yu, 2011)
		Participants’ sense of commitment (Suttanon, 2012; Yu, 2011)
		Acceptance of long-term physical activity participation (Swinnen, 2021)
Physical opportunity	Barriers
	Unfavorable physical activity environments	Inappropriate outdoor environments design (Van Santen, 2023; Gebhard, 2021; Di Lorito, 2020; Van der Wardt, 2020; McDuff, 2015; Tak, 2012)
		Poor weather (McDuff, 2015; Suttanon, 2012; Van Uffelen, 2009)
		Limitations of the environment related to the illness (Borges-Machado, 2023; Di Lorito, 2023; Drazich, 2023; Di Lorito, 2021)
		Space and freedom limitations (Borges-Machado, 2023; Di Lorito, 2023; Guo, 2022; Gebhard, 2021)
		Less physically active nursing home environment (Olsen, 2015)
	Time conflicts	Competing priorities (Wang, 2021; Fischbacher, 2020; Van der Wardt, 2020; Suttanon, 2012; Tak, 2012; Yu, 2011)
	Inappropriate organizational characteristics of physical activity	Music restrictions (Borges-Machado, 2023; Gebhard, 2021)
		No fixed activity plan (Van Santen, 2023; Hancox, 2019)
		Inappropriate duration of activities (Wang, 2021)
		Inappropriate intensity of activities (Tak, 2012)
	Unfavorable material or human resources	The limitations from the mobility aid (Gebhard, 2021)
		The limitations from the finances (Van der Wardt, 2020)
		The limitations from the transportation (Yu, 2011)
		Limited availability of staff (Van Santen, 2023)
		Limited availability of equipment (Van Santen, 2023)
	Facilitators
	Appropriate organizational characteristics of physical activity	Tailored physical activities (Di Lorito, 2023; Swinnen, 2022; Bechard, 2020; Di Lorito, 2020; Hobson, 2020; Van der Wardt, 2020)
		Flexible scheduling (Van Santen, 2023; Karssemeijer, 2020; Van der Wardt, 2020; Hancox, 2019; Galik, 2009)
		Appropriate materials intensity, duration, and modality of physical activities (Borges-Machado, 2023; Huang, 2022; Swinnen, 2022; Swinnen, 2021; Wang, 2021; Taraldsen, 2020; Van der Wardt, 2020; Suttanon, 2012; Galik, 2009)
	Favorable physical activity environments	Comfortable and safe activity environment (Drazich, 2023; Park, 2023; Portegijs, 2023; Guo, 2022; Huang, 2022; Di Lorito, 2021; Hobson, 2020)
		Outdoors (Gebhard, 2021; Di Lorito, 2020; Karssemeijer, 2020)
		Good weather (Karssemeijer, 2020)
	Favorable material resources	Convenient infrastructure (Hobson, 2020): Accessible information channels for activity benefits (Di Lorito, 2023; Bechard, 2020), good technical support (Van Santen, 2023), convenient equipment support (Van Santen, 2023; Guo, 2022; Bechard, 2020)
		Supportive care (Bechard, 2020)
		Mobility aid support (Gebhard, 2021)
Social opportunity	Barriers
	Lack of support from relevant persons (Di Lorito, 2023; Guo, 2022; Gebhard, 2021)	Insufficient time and energy on the part of caregivers (Di Lorito, 2023; Huang, 2022; Bechard, 2020; Hancox, 2019; Suttanon, 2012)
		Lack of knowledge among staff (Van Santen, 2023)
		Lack of relevant persons understanding of cognitive impairment (Guo, 2022; Bechard, 2020)
		Concerns about activity-related adverse events (Di Lorito, 2023; Li, 2022; Di Lorito, 2020; Karuncharernpanit, 2016; McDuff, 2015)
		Poor relationships with professionals (Di Lorito, 2020)
	Over-support from relevant persons (Van der Wardt, 2020; Hancox, 2019)	Participants’ over-reliance (Di Lorito, 2023; Huang, 2022; Bechard, 2020)
	Negative or pressure-inducing external evaluative factors	Negative comments on the patient's physical activity (Gebhard, 2021)
		High expectations for clinicians (Hancox, 2019)
		Negative comments about inappropriate dress (Karuncharernpanit, 2016)
	Facilitators
	Explicit support from relevant persons	Encouragement (Borges-Machado, 2023; Di Lorito, 2023; Park, 2023; Van Santen, 2023; Guo, 2022; Huang, 2022; Farina, 2021; Gebhard, 2021; Bechard, 2020; Di Lorito, 2020; Hobson, 2020; Karssemeijer, 2020; Van der Wardt, 2020; Hancox, 2019; Lindelöf, 2017; Suttanon, 2012; Yu, 2011; Galik, 2009)
		Supervision (Van Santen, 2023; Wang, 2021; Bechard, 2020; Hancox, 2019; Suttanon, 2012)
		Guidance (Park, 2023; Swinnen, 2022; Wang, 2021; Galik, 2009)
		Advice (Di Lorito, 2023; Di Lorito, 2020; Hobson, 2020)
		Conditional support (Farina, 2021; Bechard, 2020)
		Group support (Wang, 2021; Bechard, 2020; Hobson, 2020; Taraldsen, 2020; Lindelöf, 2017)
		Leadership support (Karssemeijer, 2020)
		Role model support (Olsen, 2015)
	Implicit support from relevant persons	The younger demographic characteristics of staff (Wang, 2021)
		Professionalism (Di Lorito, 2023; Van Santen, 2023; Di Lorito, 2020; Karssemeijer, 2020; Olsen, 2015; Suttanon, 2012)
		Exercise with people they identify with (Guo, 2022; Gebhard, 2021; Bechard, 2020; Hobson, 2020; Suttanon, 2012; Galik, 2009)
		Belief in the benefits of exercise (Borges-Machado, 2023; Hancox, 2019)
		Understanding of patient preferences (Galik, 2009; Van Uffelen, 2009)
		Good relationship with relevant persons (Borges-Machado, 2023; Di Lorito, 2023; Bechard, 2020; di Lorito, 2020; Hancox, 2019; Olsen 2015)

Physical Capability

18 studies reported barriers related to physical capability, all categorized as physical mobility limitations. Regarding facilitators related to physical capability, 3 studies reported good mobility. Specific codes are presented in Table 2.

Psychological Capability

20 studies reported barriers related to psychological capability, including cognitive deficits (n = 15), behavioral and psychological symptoms (n = 8), inadequate knowledge of physical activity (n = 2), mental illness (n = 2) and lack of behavioral regulation ability (n = 2). 8 studies reported facilitators related to psychological capability, including memory support (n = 3), physical activity management skills (n = 5) and adequate knowledge of physical activity (n = 1). Specific codes are presented in Table 2.

Automatic Motivation

10 studies reported barriers related to automatic motivation, all categorized as lack of activity attractiveness. 16 studies reported facilitators related to automatic motivation, including positive feelings (n = 11), lifestyle habits conducive to physical activity (n = 5), and adequacy of activity attractiveness (n = 9). Specific codes are presented in Table 2.

Reflective Motivation

10 studies reported barriers related to reflective motivation, including perception of potential risk (n = 5), low self-efficacy (n = 4), negative physical activity experiences (n = 4), and the gap between ideal and perceived benefits of physical activity (n = 5). 18 studies reported facilitators related to reflective motivation, including positive physical activity experiences/negative inactivity experiences (n = 14), motivation from established goals (n = 9), and strong beliefs of physical activity participation (n = 7). Specific codes are presented in Table 2.

Physical Opportunity

18 studies reported barriers related to physical opportunity, including unfavorable physical activity environments (n = 14), time conflicts (n = 6), inappropriate organizational characteristics of physical activity (n = 6) and unfavorable material or human resources (n = 4). 22 studies reported facilitators related to physical opportunity, including appropriate organizational characteristics of physical activity (n = 16), favorable physical activity environments (n = 10) and favorable material resources (n = 6). Specific codes are presented in Table 2.

Social Opportunity

13 studies reported barriers related to social opportunity, including lack of support from relevant persons (n = 12), over-support from relevant persons (n = 5), and negative or pressure-inducing external evaluative factors (n = 3). 23 studies reported facilitators related to social opportunity, including explicit support from relevant persons (n = 22) and implicit support from relevant persons (n = 15). Specific codes are presented in Table 2.

Subgroup Analysis

Subgroup analyses revealed differences in the facilitators and barriers to physical activity participation among older adults with MCI/dementia across different residential settings, levels of cognitive impairment, and stakeholders’ perspectives, as detailed in Tables 3 –5.

Table 3.

Subgroup Analysis Based on Different Residential Settings

	Community		Care facilities
Barriers
C	Lack of behavioral regulation ability	Unhealthy lifestyles
M	The gap between ideal and perceived benefits of physical activity	Unrealistic or unachievable expectations
		Be unable to feel the benefits of physical activity
	Lack of activity attractiveness	Dislike online forms of exercise
O	Lack of support from relevant persons	Lack of knowledge among staff	Unfavorable physical activity environments	Less physically active nursing home environment
O	Lack of support from relevant persons	Lack of knowledge among staff	Unfavorable material or human resources	The limitations from the mobility aid
Facilitators
C	Physical activity management skills	Good self-management skills (eg, time management skills, internal discipline, adaptability to schedule changes)
M	Adequacy of activity attractiveness	Demand for attractive activities
M	Motivation from established goals	Meeting new people
O	Favorable material resources	Convenient infrastructure	Favorable material resources	Mobility aid support
		Supportive care	Explicit support from relevant persons	Role model support
		Supportive care	Implicit support from relevant persons	The younger demographic characteristics of staff

Note. The common facilitators and barriers to physical activity among older adults living in communities and care facilities were not presented.

Table 4.

Subgroup Analysis Based on Different Levels of Cognitive Impairment

	Dementia		MCI
Barriers
C	Behavioral and psychological symptoms	Agitation
		Psychomotor alterations
		Personality misfit (eg, need of peace, less sociable and shyness to exercise in front of others)
	Cognitive deficits	Communication breakdown
O	Lack of support from relevant persons	Lack of knowledge among staff
	Lack of support from relevant persons	Poor relationships with professionals
	Negative or pressure-inducing external evaluative factors	Negative comments on the patient’s physical activity
Facilitators
C	Physical activity management skills	Communication associated with physical activity
O	Explicit support from relevant persons	Role model support	Implicit support from relevant persons	The younger demographic characteristics of staff

Note. Based on our results and prior reviews,^24-26 the common facilitators and barriers to physical activity among older adults with MCI/dementia were not presented.

Table 5.

Subgroup Analysis Based on Different Stakeholders’ Perspectives

	People living with MCI or dementia		Informal caregivers		Staff
Barriers
C	Inadequate knowledge of physical activity	Lack of understanding of the benefits of physical activity	Cognitive deficits	Difficulties in understanding	Cognitive deficits	Lack of the ability to access and use digital support
	Lack of behavioral regulation ability	Unhealthy lifestyles		Lack of attention
	Behavioral and psychological symptoms	Personality misfit (eg, need of peace, Less sociable and shyness to exercise in front of others)		Inability to self-direct
	Behavioral and psychological symptoms		Behavioral and psychological symptoms	Psychomotor alterations
M	The gap between ideal and perceived benefits of physical activity	Unrealistic or unachievable expectations
	Negative physical activity experiences	The feeling of sweating during exercise
		Fatigue and muscle soreness after exercise
		Boredom with prescriptive exercises
	Low self-efficacy	Lack of confidence to complete physical activities
O	Unfavorable material or human resources	The limitations from the mobility aid
	Unfavorable material or human resources	The limitations from the transportation
	Inappropriate organizational characteristics of physical activity	Inappropriate duration of activities
		Inappropriate intensity of activities
	Unfavorable physical activity environments	Less physically active nursing home environment
	Unfavorable physical activity environments	Poor weather
	Negative or pressure-inducing external evaluative factors	Negative comments on the patient’s physical activity
	Negative or pressure-inducing external evaluative factors	High expectations for clinicians
Facilitators
C	Physical activity management skills	Communication associated with physical activity
C	Physical activity management skills	Good self-management skills (eg, time management skills, internal discipline, Adaptability to schedule changes)
M	Adequacy of activity attractiveness	The sense of competitiveness	Adequacy of activity attractiveness	Demand for attractive activities
M	Adequacy of activity attractiveness	The desire for physical activity	Adequacy of activity attractiveness	Demand for attractive activities
O	Favorable material resources	Mobility aid support	Implicit support from relevant persons	Belief in the benefits of exercise
	Explicit support from relevant persons	Role model support
	Implicit support from relevant persons	The younger demographic characteristics of staff

Note. The common facilitators and barriers to physical activity participation among older adults with MCI/dementia across different stakeholders’ perspectives were not presented.

Certainty of Evidence

Of the 33 factors finally identified, 4 were of strong certainty and 29 were of moderate certainty (Details are shown in Supplemental materials 4, 5).

Discussion

Interpretation of Main Results

This systematic review comprehensively collated facilitators and barriers to physical activity participation in older adults with MCI/dementia based on the six domains of COM-B. The results indicate that the facilitators and barriers comprehensively involve the six domains of COM-B. In addition, the findings revealed variations across different residential settings types, levels of cognitive impairment, and stakeholders’ perspectives.

Compared with the recent umbrella review that identified 31 barriers and facilitators based the Theoretical Domain Framework (TDF),¹⁰ This review further incorporated 23 recently published original studies, which accounted for 69.7% of the total number of studies included. In line with the umbrella review, it also found that the following four factors were most widely reported, namely explicit support from relevant persons, physical mobility limitations, appropriate organizational characteristics of physical activity, and unfavorable physical activity environments. The active participation of physical activity is directly related to environmental resources and social support, which runs through the whole process of starting and maintaining physical activity behavior.²⁷ Various physical mobility limitations often significantly alter the perception of physical activity in older adults,⁹ so there is a need to provide personalized physical activity program guidance tailored to the physical status of older adults.

In addition, this review found some new barriers, including lack of behavioral regulation, low self-efficacy, the gap between ideal and perceived benefits of physical activity, and negative or pressure-inducing external evaluative factors. Behavioral regulation ability is the key to change from action decision making to actual behavior adoption, and it plays an important role in the process of behavior change.^28,29 Therefore, the fundamental reason why unhealthy lifestyles hinder physical activity may be the lack of behavioral regulation ability. In older adults with MCI or dementia, the decline in cognitive function can lead to impaired executive function,¹ making it difficult for them to develop appropriate activity plans. This decline in psychological capability directly limits an individual’s ability to translate activity intentions into structured and sustained actions. From a neurological perspective, this may be linked to functional impairments in brain regions associated with cognitive control and memory, such as the prefrontal cortex and hippocampus,^30,31 which hinder patients from forming and maintaining new behavior patterns that require cognitive effort.¹ Therefore, increasing participation in physical activity requires the support of cognitive-assistive strategies—such as simplified instructions and visual cues—to enhance their practical capability for behavioral execution.

In terms of low self-efficacy, it may lead to avoidance behaviors due to fear of failure or injury, such as refraining from going out, declining participation in group exercises, or even completely ceasing activities.⁹ Older adults with MCI and dementia face confidence challenges due to loss of cognitive function. Hence, the negative impact of decreased self-efficacy on their physical activity participation may be greater than that in older adults with normal cognition.³² In addition, there is already evidence showing that self-efficacy is positively correlated with both cognitive function and physical activity levels.³³ It interacts with the aforementioned psychological capability deficits and social negative evaluations, forming a vicious cycle: insufficient capability leads to experiences of failure, which lower self-efficacy⁹ and may invite negative evaluations; such evaluations further undermine confidence and motivation, ultimately reinforcing sedentary behavioral patterns. The implication is that intervention strategies must include components to build mastery and confidence, such as graded tasks and positive feedback.

The gap between ideal and perceived benefits of physical activity is an important barrier. This is consistent with the results of Yu et al³⁴ The possible explanation for this is that dementia is a degenerative disorders, where even physical activity-induced cognitive improvements may be difficult to detect, or it may also be due to too little exercise or lack of self-comparison.³⁴ Furthermore, immediate negative feedback, such as physical discomfort or poorly designed activities, may further exacerbate this cognitive discrepancy. Such negative experiences could dominate behavioral decision-making by enhancing activity in brain regions like the insula, which is responsible for interoception and aversion processing, thereby overwhelming the prefrontal cortex-driven rational cost-benefit analysis and hindering the translation of reflective motivation into action.³⁵ Future interventions should focus on highlighting the immediate, perceptible positive benefits of physical activity, such as through the use of real-time feedback tools.

In terms of negative or pressure-inducing external evaluative factors, people are often affected by the past (cognitive normal period) and present “identity” of people living with dementia, and hold too high or too low expectations.³⁶ Too high expectations may cause negative emotions such as fear of disappointment, and too low expectations may cause stigma, which could reduce the physical activity participation. More importantly, these external evaluative pressures often directly undermine the autonomy of older adults in their daily activities. According to Self-Determination Theory, such impairment of basic psychological needs (such as autonomy) can further reduce their intrinsic motivation, and may even lead them to actively withdraw from social activities.³⁶ Therefore, when implementing promotion strategies, a focus can be placed on peer support programs. Specifically, it involves introducing older adult volunteers with similar experiences to serve as role models and foster a sense of identification, thereby counteracting the internalization of negative evaluations.

The findings of this study and the existing evidence discussed above are basically consistent with the assumptions of the COM-B model regarding the relationships among C, O, M, and B. That is, capability, opportunity, and motivation not only directly influence physical activity behavior individually, but capability and opportunity also indirectly affect physical activity behavior by influencing motivation. Furthermore, physical activity behavior in turn influences C, O, M. The repeated practice of a behavior is inherently a process of capability refinement. For instance, regular and consistent exercise can enhance cognitive functions such as memory (a psychological capability).³⁷ The authentic experiences derived from behavioral outcomes profoundly influence motivation. When physical activity yields sustained satisfaction and habits are established, it can enhance an individual’s autonomous motivation.⁹ Additionally, engaging in the behavior may motivate individuals to actively seek environments consistent with that behavior, such as familiar community settings,⁹ while also potentially attracting social support and resources from others, thereby further reinforcing and expanding existing opportunity structures. Conversely, the cessation of behavior may lead to the contraction of related opportunities. In the future, further research and validation are needed to elucidate the specific interactions among capability, opportunity, motivation, and physical activity behavior in older adults with MCI.

Interestingly, this review further observed differences in the facilitators and barriers to physical activity participation among older adults with MCI/dementia across different residential settings, levels of cognitive impairment, and stakeholders’ perspectives. In community settings, the emphasis is on the appeal of activities, involving benefits and preferences. In care facilities settings, the emphasis shifts to the influence of the staff (such as responsibilities) and environmental design of care facilities. This difference may be due to that care facilities usually have adequate and better-qualified professionals specializing in older adults, regularly organized activities, and centralized management, and the groups that live together are relatively stable and are prone to being influenced by others.³⁸ Conversely, the community setting offers greater autonomy, and the environments are more open and infrastructure-rich.³⁹ Therefore, physical activities need to be more attractive. In older adults with dementia, cognitive function performance, external influences, and support systems are important influencing factors of physical activity; whereas those with MCI emphasize staff characteristics. This differentiation may be attributed to the fact that dementia causes more severe cognitive impairment,¹ requires greater support, and is also more severely affected by social stigma.⁴⁰ While older adults with MCI preserve their functional independence and desire more positive environments. Regarding the perspectives of different stakeholders, older adults with MCI/dementia focus on internal/external activity conditions and motivation for activities. It is noteworthy that this population’s dependence on environmental support stems from increasing cognitive impairment, while cognitive decline also diminishes their ability to adapt to the environment.⁴¹ Informal caregivers concentrate on their own beliefs about physical activity; and staff members focus on factors related to their work practices, such as the ability of participants to access and use digital support. Therefore, different stakeholder groups may uniquely consider the factors most relevant to themselves.

Strengths and Limitations

Based on the COM-B model, our systematic review provides a systematic analysis of the factors that promote and hinder physical activity in older adults with MCI/dementia by integrating the latest research results, and found several new meaningful factors compared with the previous reviews. This review also analyzed differences in these factors by types of residential settings, levels of cognitive impairment, and stakeholder perspectives. Despite these advantages, there are some potential limitations in this review. First, the majority of participants came from high-income countries, which may limit the diversity of views and experiences. Second, due to limited information and the large variations in physical activity regimens in the included studies, subgroup analyses could not performed according to the type of physical activity. Finally, Research targeting older adults with MCI remains relatively scarce, which may result in incomplete coverage of the facilitators and barriers specific to this population.

Implications for Research and Practice

Future research should further explore the facilitators and barriers to different types of physical activity among older adults with different level of cognitive impairment, so as to make intervention strategies more accurate. The evidence for older adults with MCI should be further supplemented. Low- and middle-income countries should be given more concern. In addition, according to the results of this study, future studies can further develop relevant intervention strategies based on BCW.

In practice, relevant caregivers should pay attention to identify the facilitators and barriers of physical activity in older adults with MCI/dementia, and select corresponding strategies to promote physical activity participation in this population. Furthermore, for older adults with MCI/dementia living in different residential settings, with varying levels of cognitive impairment, and for different stakeholders, the developed physical activity promotion strategies should vary in their emphases. In community settings, it is important to diversify highly engaging activity formats to organically integrate physical activity with social interaction. In care facilities, efforts should focus on optimizing the physical environment and activity organization models, while strengthening specialized training for staff. For those living with dementia, providing ample environmental cues, memory aids, and consistent positive reinforcement from caregivers and staff becomes crucial. It is essential to acknowledge the perspectives of different stakeholders. Interventions should equip informal caregivers with the knowledge and skills to offer balanced support (avoiding overprotection) while ensuring that staff receive adequate training in activity adaptation and digital support technologies.

Conclusion

The facilitators and barriers to physical activity among older adults with MCI/dementia comprehensively involve the six domains of the COM-B framework, which exhibit varying emphasis across different residential settings types, levels of cognitive impairment, and stakeholders’ perspectives. This evidence provides a foundation for developing future physical activity promotion strategies for this population.

Supplemental Material

Supplemental Material - Facilitators and Barriers to Physical Activity Participation in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review Based on the COM-B Model

Supplemental Material for Facilitators and Barriers to Physical Activity Participation in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review Based on the COM-B Model by Jiachen Han, Wan Sun, Xin Yin, Luo Wang, Fang Zhou, Shuo Wang in American Journal of Alzheimer’s Disease & Other Dementias®

Footnotes

ORCID iDs

Jiachen Han

Wan Sun

Xin Yin

Luo Wang

Fang Zhou

Shuo Wang

Ethical Considerations

This article does not contain any studies with human or animal participants.

Consent to Participate

There are no human participants in this article and informed consent is not required.

Author Contributions

Jiachen Han: Methodology,Formal analysis,Data Curation,Writing- Original Draft. Wan Sun: Methodology. Xin Yin: Visualization. Luo Wang: Data Curation. Fang Zhou: Conceptualization,Supervision. Shuo Wang: Conceptualization,Supervision,Writing- Review and Editing.

Funding

The authors disclosed receipt of the following financial support for the research,authorship,and/or publication of this article: The authors disclosed receipt of the following financial support for the research,authorship,and/or publication of this article: This work was supported by China Health Talent Development Program [grant number RCLX2320051];2025 Jiangsu Postgraduate Practical Innovation Program [grant number SJCX25_1537];the “QingLan Project” of Universities in Jiangsu Province;the Key Disciplines During the 14th Five-Year Plan Period of Jiangsu Province,China.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Registration

PROSPERO (CRD42024503022).

Supplemental Material

Supplemental material for this article is available online.

References

Alzheimer's Association.

2024 Alzheimer’s disease facts and figures. Alzheime’s Dement. 2024;20(5):3708-3821. doi:10.1002/alz.13809

Jongsiriyanyong

Limpawattana

. Mild cognitive impairment in clinical practice: a review article. Am J Alzheimers Dis Other Demen. 2018;33(8):500-507. doi:10.1177/1533317518791401

Caspersen

Powell

Christenson

. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Publ Health Rep. 1985;100(2):126-131.

Lee

Choi

, et al. Investigation of the approaches to optimal exercise interventions based on dementia type: a theoretical review. Healthcare. 2024;12(5):576. doi:10.3390/healthcare12050576

Cox

Clare

Cyarto

, et al. A randomized controlled trial on the effects of a 6-month home-based physical activity program with individual goal-setting and volunteer mentors on physical activity, adherence, and physical fitness in inactive older adults at risk of cognitive decline: the INDIGO study. J Alzheimer’s Dis. 2021;84(1):207-226. doi:10.3233/JAD-210479

Vancampfort

Stubbs

Lara

Vandenbulcke

Swinnen

Koyanagi

. Mild cognitive impairment and physical activity in the general population: findings from six low- and middle-income countries. Exp Gerontol. 2017;100:100-105. doi:10.1016/j.exger.2017.10.028

Michie

van Stralen

West

. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. doi:10.1186/1748-5908-6-42

Yang

Gao

Wan

. Barriers and facilitators to exercise adherence in community-dwelling older adults: a mixed-methods systematic review using the COM-B model and theoretical domains framework. Int J Nurs Stud. 2024;157:104808. doi:10.1016/j.ijnurstu.2024.104808

Meredith

Cox

Ibrahim

, et al. Factors that influence older adults’ participation in physical activity: a systematic review of qualitative studies. Age Ageing. 2023;52(8):afad145. doi:10.1093/ageing/afad145

10.

Chen

Hou

, et al. Barriers and motivators to promotion of physical activity participation for older adults with mild cognitive impairment or dementia: an umbrella review. Int J Nurs Stud. 2023;143:104493. doi:10.1016/j.ijnurstu.2023.104493

11.

Benjamin

Edwards

Ploeg

Legault

. Barriers to physical activity and restorative care for residents in long-term care: a review of the literature. J Aging Phys Activ. 2014;22(1):154-165. doi:10.1123/japa.2012-0139

12.

Kostka

Borowiak

. Physical activity in older adults in relation to place of residence and coexistent chronic diseases. J Phys Activ Health. 2017;14(1):20-28. doi:10.1123/jpah.2016-0097

13.

Harris

Shiroma

Leung

Kwok

. Patterns of physical activity and sedentary behavior for older adults with Alzheimer’s disease, mild cognitive impairment, and cognitively normal in Hong Kong. J Alzheimers Dis. 2018;66(4):1453-1462. doi:10.3233/jad-180805

14.

Karssemeijer

EGA

de Klijn

Bossers

WJR

Olde Rikkert

MGM

van Heuvelen

MJG

. Ranking barriers, motivators, and facilitators to promote physical activity participation of persons with dementia: an explorative study. J Geriatr Phys Ther. 2020;43(2):71-81. doi:10.1519/jpt.0000000000000210

15.

Page

McKenzie

Bossuyt

, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J. 2021;372:n71. doi:10.1136/bmj.n71

16.

Aromataris

Lockwood

Porritt

, et al. JBI manual for evidence synthesis. 2020. https://implementationmanual.jbi.global. Accessed 2024/4/3.

17.

Wulandari

Rochmawati

. Effectiveness of dignity therapy on well-being among patients under palliative care: a systematic review and meta-analysis. Int J Nurs Stud. 2024;149:104624. doi:10.1016/j.ijnurstu.2023.104624

18.

Xing

RuiXue

, et al. An introduction to mixed methods appraisal tool——MMAT. Chinese General Medicine. 2021;24(31):4015-4020. doi:10.12114/j.issn.1007-9572.2021.00.215

19.

Abdi

Alimoradi

Roozbeh

Amjadi

Robatjazi

. Does acupuncture improve sexual dysfunction? A systematic review. J Compl Integr Med. 2023;20(1):1-16. doi:10.1515/jcim-2021-0194

20.

Hsieh

Shannon

. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288. doi:10.1177/1049732305276687

21.

Balshem

Helfand

Schünemann

, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-406. doi:10.1016/j.jclinepi.2010.07.015

22.

Lewin

Bohren

Rashidian

, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 2: how to make an overall CERQual assessment of confidence and create a summary of qualitative findings table. Implement Sci. 2018;13(Suppl 1):10. doi:10.1186/s13012-017-0689-2

23.

El Haddad

Peiris

Taylor

McLean

. Determinants of non-adherence to exercise or physical activity in people with metabolic syndrome: a mixed methods review. Patient Prefer Adherence. 2023;17:311-329. doi:10.2147/ppa.S383482

24.

Schmidt

Rempel

Murray

McHugh

Vallance

. Exploring beliefs around physical activity among older adults in rural Canada. Int J Qual Stud Health Well-Being. 2016;11:32914. doi:10.3402/qhw.v11.32914

25.

Mehrabi

Drisdelle

Dutt

Middleton

. “If I want to be able to keep going, I must be active.” Exploring older adults’ perspectives of remote physical activity supports: a mixed-methods study. Front Public Health. 2024;12:1328492. doi:10.3389/fpubh.2024.1328492

26.

Belza

Walwick

Shiu-Thornton

Schwartz

Taylor

LoGerfo

. Older adult perspectives on physical activity and exercise: voices from multiple cultures. Prev Chronic Dis. 2004;1(4):A09.

27.

Zhang

Qian

Meng

Ying

. Correlates of exercise behavior based on socio-ecological theoretical model among Chinese urban adults: an empirical study. Behav Sci. 2024;14(9):831. doi:10.3390/bs14090831

28.

Rhodes

Quinlan

. Predictors of physical activity change among adults using observational designs. Sports Med. 2015;45(3):423-441. doi:10.1007/s40279-014-0275-6

29.

Hall

Harvey

. Behavioral regulation: factor analysis and application of the behavioral dyscontrol scale in dementia and mild cognitive impairment. Int J Geriatr Psychiatr. 2008;23(3):314-318. doi:10.1002/gps.1881

30.

Amador-Ortiz

Ahmed

Zehr

Dickson

. Hippocampal sclerosis dementia differs from hippocampal sclerosis in frontal lobe degeneration. Acta Neuropathol. 2007;113(3):245-252. doi:10.1007/s00401-006-0183-4

31.

Kato

. [Prefrontal lobes and the attentional control: a neuropsychological study using modified stroop test]. Rinsho Shinkeigaku. 2001;41(12):1134-1136.

32.

Jiali

Xiaoyang

Yan

Ruolan

Jiangyuan

Ying

. Progress of research on the current status and factors influencing the physical activity of a community-based group of preclinical older adults with Alzheimer’s disease. General Nursing. 2024;22(09):1665-1669. doi:10.12104/j.issn.1674-4748.2024.09.017

33.

Shuhong

. A Study of the Correlation Between Health Promotion Behaviors and Self-Efficacy Among Older Adults With Mild Cognitive Impairment in the Community. MFA; 2021.

34.

Swartwood

. Feasibility and perception of the impact from aerobic exercise in older adults with Alzheimer’s disease. Am J Alzheimers Dis Other Demen. 2012;27(6):397-405. doi:10.1177/1533317512453492

35.

Craig

. How do you feel--now? The anterior insula and human awareness. Nat Rev Neurosci. 2009;10(1):59-70. doi:10.1038/nrn2555

36.

Yaron

Bakker

de Bruin

. In constant search of the good: a qualitative study into insiders’ perspectives on living well with dementia. Front Psychiatr. 2024;15:1285843. doi:10.3389/fpsyt.2024.1285843

37.

Hancox

van der Wardt

Pollock

Booth

Vedhara

Harwood

. Factors influencing adherence to home-based strength and balance exercises among older adults with mild cognitive impairment and early dementia: promoting activity, Independence and stability in early dementia (PrAISED). PLoS One. 2019;14(5):e0217387. doi:10.1371/journal.pone.0217387

38.

Yujie

Hong

. Status quo and optimization countermeasures of elderly care service mode. Sichuan Labor Security. 2024;3(06):37-38.

39.

Junjun

Weihua

Ting

. Current status of sedentary behavior of the elderly in medical-nursing combined institutions and its influencing factors. J Nurs. 2022;29(15):1-6. doi:10.16460/j.issn1008-9969.2022.15.001

40.

Rewerska-Juśko

Rejdak

. Social stigma of people with dementia. J Alzheimers Dis. 2020;78(4):1339-1343. doi:10.3233/jad-201004

41.

Gitlin

. Conducting research on home environments: lessons learned and new directions. Gerontol. 2003;43(5):628-637. doi:10.1093/geront/43.5.628

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.97 MB