The gap between knowing exercise benefits cognitive health and actually sustaining meaningful activity programs represents one of the most persistent challenges in preventing dementia progression. Most nursing home interventions fail not from poor exercise design, but from inadequate attention to the psychological drivers of long-term adherence.
This randomized controlled trial enrolls 156 nursing home residents with mild cognitive impairment in a 12-week multicomponent exercise program explicitly built on integrated behavioral theory. The HAPA-TPB framework combines the Health Action Process Approach with Theory of Planned Behavior to address both intention formation and action maintenance. The intervention weaves together aerobic exercise, resistance training, and mind-body practices with structured peer interaction and motivational strategies targeting sustained engagement beyond the formal program period.
The theoretical foundation distinguishes this approach from typical activity programs that rely primarily on external scheduling rather than internal motivation development. Previous multicomponent exercise studies have shown cognitive benefits in mild cognitive impairment populations, but sustainability remains problematic once formal supervision ends. The integration of behavioral change theory specifically targets this adherence challenge by addressing intention formation, self-efficacy, and social support mechanisms that predict long-term exercise maintenance. However, the nursing home setting may limit generalizability to community-dwelling older adults who face different barriers to exercise participation. The study's focus on adherence mechanisms rather than just cognitive outcomes represents a potentially valuable shift toward more sustainable dementia prevention strategies.