HABIT (Harnessing Automatic Behaviours Intervention Trial): A habits-based pilot behaviour change intervention to increase physical activity in people with mild cognitive impairment or subjective cognitive decline.

Physical activity behaviour change intervention based on habits. For older people experiencing decline to their memory and thinking skills, such as those with mild cognitive impairment (MCI) or subjective cognitive decline (SCD), keeping physically active is important to maintain brain health and reduce risk of dementia. Despite this, over 80% of older Australians do not do enough physical activity in their daily lives. To date, interventions to help people increase their physical activity levels have been social cognitive in their approach, and involved setting goals, planning and self-monitoring, which are challenging for people with thinking and memory difficulties. Recent research suggests that automatic, every-day habits play an important role in maintaining physical activity levels over the long-term. The current project aims to assess the feasibility and acceptability of a habits-based behaviour change intervention to help people with MCI or SCD increase their regular physical activity engagement. This pilot project has two arms, the ‘Remote Intervention’, and the ‘In-Person Intervention’. The sample will be 20 older adults (65 years and older) with mild cognitive impairment (MCI) or subjective cognitive decline (SCD), who are undertaking the study. On completion of screening and written informed consent, participants will be randomised to either the remote or in person groups stratified for gender. The randomisation will be completed by a researcher utilizing an online random number generator (randomizer.org). and will both undertake ‘Baseline Assessments’, ‘Education Workshop’, ‘Physiologist Interview’, access to Apple Watches, and on-going telephone support throughout the intervention. A baseline assessment consisting of questionnaires assessing multiple cognitive functions will be administered online through the research application following the screening process for remote participants, and in person at Neuroscience Research Australia (NeuRA) for in-person participants. The questionnaires will become available again after 12 weeks of the intervention period (FU1) and again after another 12 weeks of the no-intervention period (FU2), either via the research application or in person at NeuRA. Participants will receive reminders on their phone through the Apple Watch research application to complete these assessments at those times. If they do not complete an assessment, they will receive a follow up email as a reminder, and failing that, the research assistant will call them to find out the reason and if they need help. Each assessment (Baseline, FU1, FU2) should take 1 hour, and will be monitored by the research team during their completion. Participants will attend a 1.5-hour Education Workshop (either via video-conference or in person at Neuroscience Research Australia). The Education Workshop will cover a multitude of topics including: Importance of Physical Activity, How habits form and how they change, A habits-based approach to physical activity, What is an action plan, What is a coping plan, and How to set up Apple Watches. The workshop will be run by principle investigator Dr Sophie Andrews. It will be interactive, allowing for questions and group discussion. There will be 5 participants involved in each workshop. Following the workshop, all participants will have a 1.5-hour individual interview with a physiologist either in person at their home, or online via video conference. The interview will commence within one week following the workshop. During this interview they will discuss current physical activity, physical activity goals, and current enablers and barriers. The physiologist will then identify potential existing cues to link with a physical activity, a physical activity to incorporate into a longer physical activity or/and a “mini” activity for days when the participant has experienced barriers. They will set up the cue, response, reward relationship and prospective reminders (e.g., have this recorded on paper for the fridge or noticeboard). The physiologist will also confirm that participants have set up their Apple Watch correctly and know how to use it. The aim for participants will be for daily physical activity exercises cued by individual daily habits of 150 minutes of moderate intensity aerobic physical activity or 90 minutes of vigorous intensity exercise per week. The exercise we will be aiming to prescribe is walking. The duration of the exercise regime will be 12 weeks following the interview. All participants will be asked to wear apple watches with a downloaded apple research application for daily prompts and questions regarding mood, stress levels, and if they did the physical activity habit each day. Adherence to the habit-based physical exercise plan will thus be monitored through objective measures (e.g., heart-rate changes, movement) and participant responses recorded through the watch. Weekly reports of Apple Watch statistics will be monitored including movement, HR- resting hr vs active – minutes in mod-vigorous activity each day, steps, calories burnt, active calories in activity and potentially GPS data location. If signs of lack of improvement or waning effectiveness, follow up calls will be made by research assistants to check in. Apple watches will be sent in mail after the Baseline assessment in time for the education workshop and exercise physiologist within a few days of each other. Participants will hold the watch for 12 weeks, then send back at Follow up 1. They will then be sent it 1 week before Follow up 2, where they will again return it. All postage will be paid for by NeuRA. We will aim for participants to wear the watch continuously at all times of the day. For in-person intervention: Apple watches will be handed out at baseline assessments in person, left with participants for 12 weeks, then returned in person for the Follow up 1. They will then be mailed to participants one week before Follow up 2, where they will return it again in person. All participants will receive telephone support from our research team at the following time-courses: Weeks 1-4: Once a week telephone call for reflection on habit success, check in and support Weeks 4-8: Fortnightly telephone check in and support Week 12: Final call for check in and support Support calls will generally last 10 minutes as a quick check in to make sure participants are not having any problems with the intervention, and to offer problem solving solutions to any barriers participants might be facing. Physical activity intervention is planned to be personalised for each participant as it is based on their daily habits. As individuals with cognitive decline use more habit-based approaches to thinking and acting, by using habits to cue physical activity we hope to improve their weekly physical exercise. Thus, through at home visits and calls, we aim to set up individualised cues for physical activities at the beginning of the intervention, and leave participants to continue them each week for 12 weeks. Cues can be related to a time, situation, or even an emotion (e.g., I feel stressed so I eat fast food). We will aim for cues that participants already do regularly (daily or a few times a week) as they rely less on memory Examples of cues: • Getting up in the morning • Having your first cup of coffee • Going to the shops • Getting home from work • Watching the nightly news • Doing teeth before bed • Calling your daughter for a regular check in