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Modifiable facilitators and barriers to exercise adherence in older adults with MCI/dementia using the Theoretical Domains Framework: a systematic review protocol
  1. Xueting Zhen1,
  2. Lina Wang2,
  3. Hang Yan1,
  4. Hong Tao3,
  5. Yaxiu Cai1,
  6. Jie Wang1,
  7. Haiqin Chen4,
  8. Chenxi Ge1
  1. 1School of Medicine, Huzhou University, Huzhou, Zhejiang, China
  2. 2School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou, Zhejiang, China
  3. 3AdventHealth Whole-Person Research, Orlando, Florida, USA
  4. 4Nursing Department, Huzhou Third People's Hospital, Huzhou, Zhejiang, China
  1. Correspondence to Dr Lina Wang; aring2000{at}


Introduction Exercise has multiple benefits on maintaining or improving cognitive function for people with mild cognitive impairment (MCI)/dementia. However, many older adults with MCI/dementia are not sufficiently active to achieve these benefits. Allowing for the current studies on exercise adherence in older adults with MCI/dementia still have some deficiencies. This paper aims: (1) to identify the modifiable facilitators and barriers to exercise adherence for older adults with MCI/dementia in terms of the perspectives of patients, caregivers and healthcare professionals; (2) to organise the identified factors of exercise adherence based on the Theoretical Domains Framework (TDF) among included studies.

Methods and analysis A systematic computerised literature search will be performed in the following online databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wan Fang Database, which published between January 1990 and June 2020. We will identify peer-reviewed publications which examined facilitators and barriers to exercise adherence. Searches will have no limitation in language publications using search terms related to exercise interventions, adherence and MCI/dementia. Two independent reviewers will screen titles, abstracts and full-text articles according to the predetermined inclusion and exclusion criteria. We will use the statistical software Nvivo V.12 to manage the information. Basing on the TDF, we will map identified modifiable facilitators and barriers of literature to the domains of TDF.

Ethics and dissemination This review will summarise modifiable facilitators and barriers to exercise adherence for older adults with MCI/dementia for the first time. Ethical approval is not required as no primary data are collected. We are going to disseminate our findings to the scientific and medical community in peer-reviewed journals. The review findings will facilitate adequate and accurate access to care and treatment to help older adults with MCI/dementia have a broader adoption to exercise.

PROSPERO registration number CRD42019117725.

  • mild cognitive impairment
  • dementia
  • exercise
  • adherence
  • factors

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • XZ and LW are joint first authors.

  • XZ and LW contributed equally.

  • Contributors All authors contributed to the development of the study design and search strategy. XZ and LNW designed the study and wrote the protocol. XZ and HY wrote the search strategy. HY, YC and CG screened the literature. JW and HC checked the selected article. HT refined the English expression of this article. All authors provided feedback and approved the final protocol.

  • Funding This work was supported by the National Natural Science Foundation (NO.71704053); China Scholarship Council (NO.201908330251); Zhejiang Province Natural Foundation (NO.LQ17G030002) and General research projects of Zhejiang Province education department (Y201942543).

  • Disclaimer The funding bodies participated neither in the design of the study nor in the writing of the protocol.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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