Long-Term Engagement and Motivation Through Innovative Strategies in Adapted Physical Activity

Summary

Aging is associated with progressive declines in physical, functional, and psychosocial capacities, leading to reduced autonomy, increased risk of falls, chronic diseases, and decreased quality of life. Physical inactivity is a major aggravating factor, despite strong evidence that regular physical activity helps prevent age-related decline.

Adapted Physical Activity (APA) has demonstrated beneficial effects on physical function, mental health, pain, and healthcare utilization. However, long-term adherence to APA programs among older adults remains low, with fewer than 20% meeting World Health Organization recommendations. Therefore, innovative strategies are needed to improve sustained engagement in physical activity.

This multicenter, randomized, single-blind interventional study aims to compare the effectiveness of different APA strategies on long-term engagement in physical activity among adults aged 60 years and older.

A total of 600 participants will be randomized into four groups combining two key factors: (1) autonomy-based vs. non-autonomy-based approaches, and (2) classical APA vs. TEMPA-based APA programs. Each intervention consists of a 12-week program including 24 supervised sessions, with some groups incorporating a progressive transition toward autonomous practice.

The primary outcome is long-term physical activity engagement assessed using the QAPPA questionnaire at baseline, 6 months, and 12 months.

Secondary outcomes include:

Objective and self-reported physical activity levels (questionnaires and wearable devices) Functional capacities (muscle strength, endurance, gait speed, balance, cardiorespiratory fitness) Motivational and perceptual factors (e.g., enjoyment, fatigue, perceived effort, motivation) Quality of life (EQ-5D-5L) Biological markers (inflammatory, metabolic, metabolomic, and epigenetic profiles) to identify predictors of adherence and physiological response Cost-effectiveness and cost-utility analyses (incremental cost-effectiveness ratio)

Statistical analyses will be conducted using mixed linear models for repeated measures to evaluate time, group, and interaction effects. Additional analyses will include descriptive statistics, group comparisons, longitudinal trends, and economic evaluations.

This study aims to identify effective and sustainable APA strategies to improve long-term physical activity engagement and inform public health policies for older adults.

Conditions

• Aging, Healthy
• Aging

Interventions

OTHER

Group A autonomy arm and classical practice

All participants in Group A will receive a total of 24 Adapted Physical Activity (APA) sessions delivered by a qualified APA professional over a 15-week period. Two sessions per week will be provided during the first 9 weeks. From week 10 to week 15, only one supervised in-person session per week will be offered, and participants will be asked to complete the second session independently. This transition in session planning is expected to promote more sustainable long-term engagement in physical activity, Each session will consist of a warm-up (approximately 10-15 minutes), a main exercise phase (including endurance, strength, balance, flexibility, and coordination exercises), and a cool-down period. The structure of the sessions will be consistent and will comply with physical activity prescription guidelines for older adults

OTHER

GROUP B autonomy arm and TEMPA practice

In Group B, sessions will more explicitly incorporate effort minimization strategies (TEMPA), which will be clearly communicated to participants. These strategies include encouraging focus on perceived enjoyment during exercise, allowing participants to choose music, involving participants in leading warm-ups, integrating game-based activities (e.g., dodgeball-type games), strengthening group cohesion and sense of affiliation, and providing individualized feedback on performance during sessions. To ensure proper implementation, the instructor will receive specific training in the TEMPA theoretical model and its associated adaptations. The instructor will also be required to explicitly communicate the strategies used during sessions. A report documenting the strategies implemented will be completed by the instructor after each session

OTHER

Group C non-autonomy arm and classical practice

All participants in Group C will receive a total of 24 Adapted Physical Activity (APA) sessions delivered by a qualified APA professional over a 12-week period. Participants will attend two APA sessions per week.

OTHER

Group D non-autonomy arm and TEMPA practice

In Group D, sessions will more explicitly incorporate effort minimization strategies (TEMPA), which will be clearly communicated to participants. These strategies include encouraging participants to focus on perceived enjoyment during exercise, allowing them to choose music, involving them in leading the warm-up, integrating game-based activities (e.g., dodgeball-type games), strengthening group cohesion and sense of affiliation, and providing individualized feedback on performance during sessions.

Sponsors & Collaborators

• Centre Hospitalier Universitaire de Nice

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

BASIC_SCIENCE

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

60 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2026-09-30

Primary Completion

2031-09-30

Completion

2031-09-30

Countries

• France

Study Locations