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

Overview

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.

Interventions

• Behavioral Episodic Future Thinking
  Participants 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 indep
• Other Brochure-Based Health Education
  Participants 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

Primary outcome measures

• Intention to engage in physical activity [Time frame: At baseline (T0), week 4 (T1), week 8 (T2), week 12 (T3), and four weeks after the end of the intervention (week 16, T4)]

Secondary outcome measures (9)

• Physical activity level [Time frame: At baseline (T0), week 4 (T1), week 8 (T2), week 12 (T3), and four weeks after the end of the intervention (week 16, T4).]
• Physical Activity Compliance Rate [Time frame: At baseline (T0), week 4 (T1), week 8 (T2), week 12 (T3), and four weeks after the end of the intervention (week 16, T4).]
• Delay Discounting Rate [Time frame: At baseline (T0), week 4 (T1), week 8 (T2), week 12 (T3), and four weeks after the end of the intervention (week 16, T4)]
• Consideration of future consequences [Time frame: At baseline (T0), week 4 (T1), week 8 (T2), week 12 (T3), and four weeks after the end of the intervention (week 16, T4)]
• Multidimensional Outcome Expectations for Exercise Scale [Time frame: At baseline (T0), week 4 (T1), week 8 (T2), week 12 (T3), and four weeks after the end of the intervention (week 16, T4).]
• Subjective Cognitive Decline Questionnaire [Time frame: At baseline (T0), week 4 (T1), week 8 (T2), week 12 (T3), and four weeks after the end of the intervention (week 16, T4).]
• Short Physical Performance Battery [Time frame: At baseline (T0), week 12 (T3), and four weeks after the end of the intervention (week 16, T4).]
• Handgrip Strength [Time frame: At baseline (T0), week 12 (T3), and four weeks after the end of the intervention (week 16, T4).]
• Calf Circumference [Time frame: At baseline (T0), week 12 (T3), and four weeks after the end of the intervention (week 16, T4).]

Eligibility criteria

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.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Prevention

Study locations

China · 1 center

• The Second Affiliated Hospital of Medical College of Zhejiang University — Hangzhou

Identifiers

NCT: NCT07554027 · 2026-0328

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗