Effect of Episodic Future Thinking on Promoting Physical Activity Among Older Adults With Motoric Cognitive Risk Syndrome: A Randomized Controlled Trial

Effect of Episodic Future Thinking on Promoting Physical Activity Among Older Adults With Motoric Cognitive Risk Syndrome: A Randomized Controlled Trial

Motor Cognitive Risk (MCR), a pre-dementia state characterized by the coexistence of subjective cognitive decline (SCD) and slow gait speed, has a high prevalence among community-dwelling older adults in China and is associated with significantly increased risks of progression to dementia and other adverse health outcomes. Physical activity is the most cost-effective non-pharmacological intervention for slowing cognitive decline and the modifiable factor with the greatest contribution to dementia prevention. However, older adults with cognitive impairment commonly face behavioral challenges such as insufficient physical activity and difficulty maintaining adherence. Episodic Future Thinking (EFT), a novel intervention strategy grounded in health psychology and behavioral economics, has been shown to promote healthy behaviors by reducing delay discounting rates and enhancing future orientation. The goal of this randomized controlled study is to test the effect of EFT intervention in promoting physical activity among older adults with MCR.

Inclusion Criteria:

Participants will be eligible for inclusion if they are 60 years of age or older and meet all of the following four criteria:

• 1. Subjective Cognitive Decline (SCD) Assessed using the Chinese version of the Subjective Cognitive Decline Questionnaire-9 (SCD-9). A total score greater than 5 is considered indicative of SCD.
• 2. Slow Gait Participants will walk 4 meters at their usual pace. Gait speed will be calculated using the recorded time, and gait speed <1.0 m/s will be classified as slow gait.
• 3. No Difficulty in Basic Activities of Daily Living (ADL) Participants must report no difficulty in the following six basic ADL domains: bathing, dressing, toileting, transferring, continence, and eating.
• 4. No Dementia No self-reported history of dementia and a Mini-Mental State Examination (MMSE) score of ≥24, indicating the absence of dementia.

Exclusion Criteria:

Participants will be excluded if they meet any of the following conditions:

• 1. Severe visual or hearing impairment that interferes with communication or assessment.
• 2. Primary psychiatric disorders, such as schizophrenia or bipolar disorder.
• 3. Significant language or communication difficulties that prevent completion of assessments or participation in the intervention.
• 4. Severe diseases of major organs or systems, such as advanced heart failure, end-stage renal disease, or active malignancy, that may affect safety or participation.
• 5. Any other condition that, in the judgment of the research team, makes the participant unsuitable for the study.