Robot-based Intervention to Improve Physical Activity in Older Adults

Not Applicable

Recruiting

• Conditions: Physical Inactivity; Aging; Sedentary Behaviors; Bias, Implicit; Cognition

• Registration Number: NCT06843161
• Lead Sponsor: University of Ottawa

Brief Summary

Physical inactivity is considered a global pandemic negatively impacting the health of over 60% of older adults in America. Interventions aimed at improving physical activity in older adults focus on training reflective processes such as providing information on health benefits of physical activity. These interventions generally find that participants improved their intentions to be physically active rather than supporting actual change in behaviours to become physically active.

There is growing support for the idea that human behaviour is the result of a combination of quick automatic processes and slower reflective processes. Interventional studies have used cognitive bias modification tasks that target the quick automatic processes to retrain participant's bias. Such studies find that participant's bias towards diet, alcohol, and phobias can be altered using these cognitive bias modification tasks.

In this study, the investigators developed a new training task using a robotic device that aims to retrain automatic bias towards physical activity and sedentary behaviours. The robotic device allows greater immersive environments for participants to interact with and be more engaged with the cognitive bias modification task. This interventional study is testing whether this new robot-based training and the protocol for assessing physical activity is feasible for retraining older adults' bias towards physical activity and sedentary behaviour. Participants will be examined on their daily physical activity using an accelerometer, their physical ability using functional tests, and their perceptions on physical activity using questionnaires. To determine whether this protocol is feasible, the investigators will examine participant recruitment and retention rates.

Detailed Description

Over the past two decades, society has encouraged people to be more physically active. As a result, most individuals are now aware of the positive effects of regular physical activity and have the intention to exercise. Yet, this intention is not sufficient, as exercise plans are often not executed. Despite gradually scaling up actions that promote physical activity over the years, people are actually becoming less active. From 2010 to 2016, the number of inactive adults has increased by 5% worldwide, currently affecting more than 1 in 4 adults (1.4 billion people). This gap between intention and action is a challenge that health professionals need to address in order to counteract the pandemic of physical inactivity.

Physical activity is one of the top contributors to health, reducing rates of cardiovascular disease, cancer, hypertension, diabetes, obesity, and depression. This wide spectrum of benefits is particularly important for older adults, who often suffer structural and functional deterioration across several physiological systems. Physical activity can reduce and delay the impact of this age-related deterioration in health and functional independence. However, in the Americas, more than 60% of older adults are physically inactive.

Current interventions to enhance physical activity in older adults rely mainly on reflective processes by providing rational information about the health benefits of a physically active lifestyle. From this perspective, changing conscious goals should lead to substantial behavioural change. Yet, meta-analyses indicate that these interventions are more effective in changing intentions than actual behaviour. Thus, new interventions targeting alternative processes are necessary to explore.

Recent work highlights that engagement in physical activity is governed not only by reflective processes, but also by automatic processes acting outside conscious awareness. For example, in active individuals, stimuli associated with physical activity attract attention, trigger positive affective reactions, and activate approach tendencies. These automatic reactions are thought to facilitate the translation of intention into action. From this perspective, physical inactivity is the result of an imbalance between strong negative automatic reactions to stimuli associated with physical activity and a relatively weaker intention to be physically active. This imbalance between reflective and automatic processes can be particularly pronounced in older adults, who are more likely to spontaneously associate physical activity with fear, pain, or discomfort felt during physical exercise. Therefore, older adults could be particularly responsive to and benefit the most from an intervention targeting the automatic reactions to physical activity and sedentary stimuli.

Interventions targeting automatic reactions to health-related stimuli have already proven to be successful in changing behaviour. For example, interventions have been used to retrain the automatic reaction to alcohol. Using a joystick, patients were repeatedly asked to avoid pictures on a screen that were related to alcohol and to approach pictures unrelated to alcohol. Results showed that adding to a regular treatment an intervention targeting cognitive bias reduced the relapse rates one year after treatment discharge by 9% to 13%. These interventions have also proven to be useful in impacting smoking, social anxiety, and eating behaviour.

Study Timeline

• Status Verified: 2025-02
• Study First Submitted: 2025-02-07
• Study First Submitted QC: 2025-02-18
• Study First Posted: 2025-02-24
• Last Update Submitted: 2025-02-27
• Study Start: 2025-03-01
• Last Update Posted: 2025-03-04
• Primary Completion: 2025-09-30
• Study Completion: 2025-09-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

• 60 years of age or older
• Able to walk
• Able to communicate in English
• Able to travel to the University of Ottawa Lees Campus

Exclusion Criteria

• Diagnosed neurological or psychiatric disorder
• Impaired motor function of the upper limbs
• Unable to understand task instructions

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Determinants of Protocol Feasibility: Recruitment Rate and Retention Rate	From enrollment to the end of recruitment at 7 months	The main purpose of this study is to determine whether the intervention protocol is feasible and thus the primary outcomes are recruitment rates, retention rates, and reasons for study dropout.

Secondary Outcome Measures

Name	Time	Method
Actigraph wGT3X-BT accelerometers for measuring daily step count	From enrollment to the end of recruitment at 7 months	Participants will wear the a small research grade accelerometer on their right hip with support hardware supplied by the researchers to measure their daily step count. As a key measure of physical activity, this device will be worn for 1 week before intervention, after intervention, and once more 1 month after the intervention.
Approach Avoidance Task	From enrollment to the end of recruitment at 7 months	The manikin approach avoidance task has been previously used to determine automatic attitudes towards physical activity and sedentary behaviour. It is a laptop-based task where participants move an avatar towards or away from an image of physical activity or sedentary behaviour. The task measures the reaction time that participants respond to each image type to determine whether they have biased tendencies towards a certain image.
6 Minute Walk Test	From enrollment to the end of recruitment at 7 months	The 6 Minute Walk Test is a common measure to assess walking ability. The test is conducted by having the participant walk as far as possible on a 30m flat indoor course for a period of 6 minutes. Standardized encouragement will be provided at each minute. Total distance walked (meters) in 6 minutes will be documented. The major outcome is the distance walked during the 6 minutes.
Hand Dynamometer for Grip Strength	From enrollment to the end of recruitment at 7 months	Grip strength will be assessed with the JAMAR Hand Dynamometer. Participants will perform the test using their reported dominant hand in a seated position with their elbow flexed 90 degrees. Two tests would be performed by each participant and the higher value (Kilogram\*Force) will be recorded as hand grip strength.
World Health Organization Quality of Life Questionnaire (WHOQOL)	From enrollment to the end of recruitment at 7 months	The scale assesses quality of life (QoL) over four domains: Physical Health (seven items), Psychological Health (six items), Social Relationships (three items), and Environmental Health (eight items). Scores for each item can range from one to five with higher scores indicating better QoL.
Affective and Instrumental Attitude Scale (ASIS)	From enrollment to the end of recruitment at 7 months	This scale assesses participants' attitudes towards physical activity. It has four questions scored from one to seven assessing affective and instrumental attitudes. Scores nearer 1 indicate less affective/instrumental attitudes while scores nearer 7 indicate greater affective/instrumental attitudes.
Physical Effort Scale (PES)	From enrollment to the end of recruitment at 7 months	This questionnaire asks about the participant's perceptions about physical effort, which is usually associated with increased heart rate and breathing. It consists of eight items ranging from one to five with higher scores indicating greater agreement.

Trial Locations

Locations (1)

Faculty of Health Sciences; 🇨🇦 Ottawa, Ontario, Canada