Dementia, a highly debilitating disease, ranks among the top 10 diseases affecting older adults worldwide.1 Its impact extends beyond individuals to their families and the economy, with an estimated annual global cost of approximately 1 trillion dollars.2 Mild cognitive impairment (MCI), a transitional stage from normal cognition to dementia, has a transition rate exceeding 50 % within 5 years, contrasting with a mere 3 % in the age-matched population.3 Notably, the MCI reversion rate of MCI to normal cognition in community setting is about 31 %.4 Therefore, it is essential to to implement strategies to prevent further cognitive decline and reduce the prevalence of dementia.

Physical activity (PA) or exercise is an effective and feasible strategy for preventing MCI, with many studies highlights its benefits of PA in improve cognitive function in individuals with MCI.2 A meta-analysis,5 encompassing 71 trials and 5,606 participants, revealed that all types of PA are effective in enhancing or maintaining overall cognition. Another meta-analysis6 of 15 prospective studies involving 33,816 participants with a follow-up period to 12 years showed that PA of any intensity can prevent cognitive decline. The World Health Organization (WHO)7 recommends that adults and older adults should engage in at least 150-300 min of moderate-intensity PA; or at least 75-150 min of vigorous-intensity PA; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week, for substantial health benefits. WHO also emphasizes that even small increases in PA may provide some benefits.7

Despite the benefits of PA, current PA levels among older adults with MCI are suboptimal. A prospective cohort study using the National Health Interview Survey (NHIS) with 129,400 older adults showed that only 8.6 % met the PA recommendations.8 Two cross-sectional studies9,10 showed that older adults with cognitive impairment did lower PA than normal older adults. To promote PA in MCI, it is essential to explore the preference and value of PA among them. Some studies have shown the preference and value of doing PA among people with MCI. Lazris et al.11 found that although most MCI participants were aware of the benefits of exercise, factors such as pain, increased responsibility, and fear of injury leaded to low PA. Chong et al.12 showed that key factors for the long-term maintenance of PA were self-efficacy and perceived benefits, habit formation, and enjoyment. However, the preference and value of PA have not been fully explored.

Social cognitive theory (SCT) offers a systematic and comprehensive theory that has been widely used in promoting PA.13,14 SCT posits that human activity is determined by the interaction of three factors: personal, environmental, and behavioural perspectives, which mutually affect each other.15 Compared to the behavioural perspective, SCT emphasizes the subjective capabilities of individuals. Given its evidence-based PA promotion constructs, SCT is particularly relevant for promoting PA among individuals with MCI. Lautenschlager et al.16 demonstrated that a modified behavioural intervention package based on SCT, including individually tailored programs and progress feedback, improved health among individuals with cognitive impairment.

This qualitative study aimed to investigate the preference and perceived value of PA among community-dwelling older adults with MCI based on the SCT.