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.
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.
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.
Parallel
Episodic Future Thinking
BehavioralParticipants will receive a 12-week structured Episodic Future Thinking (EFT) intervention. At baseline, participants select multiple Daily Events (activities they can currently perform independently) and Aspirational Events (activities they wish to regain or improve) from a pre-developed event library. Each event has a corresponding structured video. Video sessions include relaxation, vivid future scenarios, sensory cues, and explicit links between physical activity and future functional independence. The intervention progresses across three phases (Weeks 1-4, 5-8, 9-12), shifting from Daily Events to Aspirational Events with gradually reduced frequency(from 4 days/week, 2 sessions/day to 4 days/week, 1 session/day). Participants receive individualized audio files with reminder messages and attend biweekly in-person group sessions where standardized FET videos are viewed under staff supervision. Adherence is monitored through WeChat feedback and weekly check-ins.
Brochure-Based Health Education
Other interventionParticipants will receive a one-time standardized health education session immediately after baseline assessment. The session is delivered face-to-face by trained research staff and provides foundational knowledge about MCR syndrome, including its definition, clinical significance, associated health risks, and the role of physical activity in maintaining cognitive and physical function. Participants are provided with a printed educational brochure titled Exercise Guidance for Older Adults with Motoric Cognitive Risk Syndrome. The brochure includes evidence-based recommendations on exercise types (aerobic, balance, flexibility, strength), recommended frequency and duration based on expert consensus, and safety precautions for older adults with MCR engaging in physical activity.
Intention to engage in physical activity
Behavioral intention toward physical activity was assessed using the Behavioral Intention subscale of the Theory of Planned Behavior Exercise Questionnaire developed by Hu et al. Participants rated three items (e.g., their acceptance, intention, and plan to engage in ≥3 sessions of ≥20 minutes of exercise per week over the next four weeks) on a 6-point Likert scale, with higher scores indicating stronger behavioral intention.
Physical activity level
Physical activity level was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), which includes seven items evaluating the frequency and duration of vigorous activity, moderate activity, and walking for at least 10 minutes during the past week. Weekly activity levels (MET-minutes/week) were calculated by multiplying the MET value of each activity category by the reported frequency and duration.
Physical Activity Compliance Rate
Physical activity compliance was determined based on WHO guidelines. Participants were classified as meeting physical activity recommendations if they achieved at least 150-300 minutes of moderate-intensity aerobic activity per week or 75-150 minutes of vigorous-intensity activity per week, as calculated from the IPAQ-SF. The compliance rate was defined as the proportion of participants who met these criteria.
Delay Discounting Rate
Delay discounting was assessed using a computerized intertemporal choice task adapted from Figner et al. Participants completed 60 trials in which they chose between a smaller-sooner (SS) reward and a larger-later (LL) reward across varying delays and reward differences. The discounting parameter k was estimated using a hyperbolic discounting model (V = A / (1 + αk)), with higher k values indicating steeper delay discounting.
Consideration of future consequences
Consideration of future consequences was measured using the short version of the Consideration of Future Consequences Scale (CFC-S), which includes two subscales: CFC-Future (5 items) and CFC-Immediate (7 items). All items are rated on a 7-point Likert scale, and subscale scores are calculated as the mean of their respective items, with higher scores indicating a stronger tendency to consider future outcomes.
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