Physical Activity for Cognitive Health: A Model for Intervention Design for People Experiencing Cognitive Concerns and Symptoms of Depression or Anxiety

None of the 21 interview participants were aware of physical activity guidelines for dementia risk reduction, and most lacked detailed procedural knowledge about the type, amount or intensity of activity required. Many assumed incidental activity was sufficient. This gap highlights the need for interventions to provide specific, accessible knowledge — including conceptual and procedural information from trusted sources — as a foundation for behaviour change.

In contrast to existing published literature on physical activity behaviour change, emotional regulation emerged as a particularly prominent theme in interviews. Participants described how depression and anxiety symptoms directly undermined their capacity to act on intentions, even when motivation and knowledge were present. Negative emotions, difficulties with emotional self-regulation and low confidence in psychological self-management skills created a vicious cycle of inactivity that is specific to this population and requires deliberate targeting in intervention design.

While participants broadly valued avoiding dementia, their commitment to personally adopting recommended physical activity was closely tied to their individual risk appraisals and beliefs about personal benefit. Many underestimated their own dementia risk, which was associated with reduced urgency to change behaviour. Interventions need to actively support realistic personal risk appraisal and help participants understand how physical activity can benefit them specifically, including for mood and anxiety symptoms.

Participants who were already active attributed their success to specific self-regulation skills: making activity habitual, monitoring their own behaviour, noticing immediate emotional and physical benefits, and adapting when health problems or life disruptions arose. Those who were inactive described low confidence in these same skills as a key barrier. Interventions should explicitly build behavioural regulation skills, particularly strategies to manage the cognitive and emotional difficulties common in this population.

Access to social opportunities — particularly a sense of accountability to a health professional, coach or peer — was consistently identified as a powerful facilitator of physical activity engagement. Professional support was additionally linked to overcoming fears of injury or health deterioration. Many participants also valued technology-based tools for self-monitoring and accountability. Interventions should provide structured opportunities for social connection, professional guidance and accessible accountability tools.

The final model, organised by the COM-B framework's three domains of Capability, Motivation and Opportunity, identifies five key mechanisms of action: being informed to enable change; individual attitudes and urgency for change; skills and confidence to make and enact intentions; access to social opportunities; and access to reliable and flexible resources. Importantly, these mechanisms interact and reinforce each other, meaning interventions that address multiple areas simultaneously are likely to be more effective than single-focus approaches.

Yes — Semi-structured interviews with 21 people aged 45–80 experiencing cognitive concerns and mild to moderate depression or anxiety formed a primary data source. Participants shared detailed perspectives on their experiences of physical activity, dementia risk reduction, self-regulation, barriers and preferences for intervention support. This lived experience data was a foundational input into the model and produced insights — particularly around emotional regulation — that were not identified in the existing published literature.

Yes — Interview domains were developed by the study team based on their established expertise in dementia risk reduction and mental health research. Behaviour change techniques (BCTs) identified from the literature were mapped to mechanisms of action using an expert consensus tool. The final model was refined through group discussion and consensus among the multidisciplinary research team, which included psychiatrists, psychologists, exercise physiologists and other allied health researchers with direct clinical experience in this population.

Yes — A critical review of 24 published studies examining physical activity interventions for people with cognitive concerns, depression or anxiety was conducted. Studies were searched systematically through Ovid MEDLINE and PubMed and assessed using an established BCT taxonomy. Findings from this review were triangulated with interview themes and the COM-B behavioural science framework to develop the integrated model. Thematic analysis followed Braun and Clarke's established approach, with independent coding and consensus processes to ensure rigour.