Adherence to a lifestyle intervention ‐ self‐efficacy as crux of the matter?Analysis of AgeWell.de as multi‐domain lifestyle intervention against cognitive decline

Abstract Background Recent research on preventing cognitive decline has focused on lifestyle interventions, with first studies indicating cognitive benefits and suggesting a positive link between adherence to the interventions and their effectiveness. The purpose of this study was to analyse possible predictors of this very adherence to single components of a multi‐domain lifestyle intervention. Methods A total of n = 317 participants of the intervention group were included, characterized with an age ≥60 (mean age 68.9) and an increased risk of dementia (CAIDE score of ≥9). Generalized linear regression models were used to regress four predictor blocks (sociodemographic factors, cognitive and psychosocial predictors, lifestyle factors and chronic conditions, all assessed at baseline) on the adherence to each of four components of AgeWell.de (nutritional counselling, enhancement of social and physical activity and cognitive training). Adherence was operationalised as mean score of seven time points at which a study nurse assessed the degree of goal achievement per component. The goals were set individually at beginning of the intervention. Results Strengthening effects on adherence were found for higher education, unimpaired mental state and higher self‐efficacy. Increasing age, reporting depressive symptoms, smoking and partwise higher body mass index were instead negatively associated with adherence. No effect was found for chronic conditions. Conclusion The study has identified both strengthening and mitigating predictors of adherence. This is relevant to future intervention designs aimed at enhancing adherence as a pivotal aspect for effectiveness. While age or education remain non‐modifiable, self‐efficacy emerge as a promising predictor. In light of optimizing the efficacy of forthcoming lifestyle interventions, a reasonable approach may involve the incorporation of strategies for enhancing self‐efficacy within the study design.