Targeting Cognitive Control to Improve Physical Activity Adherence in Midlife for Alzheimer's Risk Reduction

尽管支持体育活动（PA）减少与年龄相关的认知能力下降和相关阿尔茨海默病风险的证据不断增加，但关键问题是，在预防阿尔茨海默病的关键时期，体育活动的采用和坚持程度一直很低。由于PA在中年时开始下降，神经退行性病理增加阿尔茨海默氏症的风险比认知障碍早几十年，因此迫切需要了解中年人如何以及为什么能够更成功地采用和维持PA。自我调节能力已被确定为对我们的意图和计划进行更多身体活动至关重要，然而，文献中缺乏因果证据来检验自我调节能力是否以及如何强烈地影响PA行为改变。因此，我们的目的是测试自我调节结构，认知控制，在不运动的中年人中PA行为改变的因果作用。基于时间自我调节理论（TST），我们假设旨在改善认知控制的认知训练将增加PA行为改变计划的成功，并且用情绪效值刺激训练认知控制将进一步增加中度至重度PA依从性。我们的预测是基于研究表明认知控制在PA坚持和维持中的重要性，证据表明PA的负面情感体验是常见的，并且对未来的PA有害，以及认知控制可通过适应性认知训练进行调节。我们用三个目标来测试我们的整体假设，包括R61阶段（目标1），以开发和完善针对动机、计划和认知控制方面的计算机化培训计划，并从理论上促进PA行为改变，然后是实施R33阶段（目标2），以实验室为基础，随机对照试验（RCT），以确定认知控制情绪价值信息的程度是老年痴呆症中高风险不活动的中年人行为改变的目标机制。目标2中实施的随机对照试验将在农村和城市地区进行测试，以增加样本的多样性和普遍性，这是（目标3）确定改善PA行为改变的干预效果调节因子的基础。我们预测那些认知控制能力差、负性情感体验高、中等强度PA的人将从针对PA行为改变的情感领域的认知控制训练中获益最多。我们的研究结果将通过确定认知控制和影响在中年可持续的PA行为改变中的因果作用而具有重要意义，中年是阿尔茨海默病的关键预防时期。成功将在可扩展的训练计划中达到高潮，以提高PA的依从性，为中年成年人提供个性化和可访问的策略，以改变他们的路线，转向更积极的生活方式，并实现持续的认知和身体健康的良性循环。

Although evidence in favor of physical activity (PA) for reducing age-related cognitive decline and associated Alzheimer’s risk continues to grow, critical issues are persistently low PA adoption and adherence during critical periods for Alzheimer’s prevention. Because PA starts declining at middle-age and neurodegenerative pathologies increasing Alzheimer’s risk start decades before cognitive impairment, there is a pressing need to understand how and why middle-age adults can more successfully adopt and sustain PA. Self-regulatory capacities have been identified as critical for acting on our intentions and plans to be more physically active, however causal evidence testing whether and how strongly self-regulatory capacities affect PA behavior change is absent from the literature. Therefore, our objective is to test the causal role of the self-regulation construct, cognitive control, in PA behavior change among inactive middle-aged adults. Based on the Temporal Self-Regulation Theory (TST), we hypothesize cognitive training designed to improve cognitive control will increase the success of a PA behavior change program, and training cognitive control with emotionally valenced stimuli will further increase moderate-to-vigorous PA adherence. Our predictions are based on research showing the importance of cognitive control in PA adherence and maintenance, evidence that negative affective experiences of PA are common and detrimental to future PA, and the modifiability of cognitive control with adaptive cognitive training. We test our overall hypothesis with three aims, including an R61 phase (Aim 1) to develop and refine a computerized training program targeting aspects of motivation, planning, and cognitive control theorized to promote PA behavior change, followed by an implementation R33 phase (Aim 2) with a lab-based, randomized controlled trial (RCT) to determine the extent that cognitive control for emotionally valenced information is a target mechanism for PA behavior change in inactive middle-age adults at moderate-to-high risk for Alzheimer’s. The RCT implemented in Aim 2 will be tested across rural and urban sites to increase diversity and generalizability of our sample, which forms the basis for (Aim 3) determining moderators of intervention efficacy for improving PA behavior change. We predict those with poor cognitive control and high negative affective experiences to moderate intensity PA will benefit most from cognitive control training targeted to an affective domain for PA behavior change. Our results will be significant by determining the causal role of cognitive control and affect in sustainable PA behavior change in midlife, a critical prevention period for Alzheimer’s. Success will culminate in a scalable training program to boost PA adherence, setting the stage for personalized and accessible strategies for midlife adults to change their course towards a more physically active lifestyle and a virtuous cycle of sustained cognitive and physical health.