Barriers to sustaining physical activity among community-dwelling older adults with Motoric Cognitive Risk Syndrome: a qualitative study of the intention-behaviour gap

Physical activity has been recommended to support physical and cognitive function in older adults with Motoric Cognitive Risk Syndrome (MCR). However, sustained engagement is often difficult, and limited evidence is available regarding why intentions to be active are not consistently translated into regular activity in daily life. Barriers to initiating and sustaining physical activity among community-dwelling older adults with MCR were therefore explored. A theory-informed qualitative descriptive study was conducted with 19 older adults purposively recruited from five urban communities in Hangzhou, China. Semi-structured interviews were conducted in Mandarin Chinese. The data were analysed deductively using directed content analysis guided by Luria’s theory of functional systems, while allowing inductively derived categories to be retained to refine the analytical framework. Ten subthemes were grouped into three theoretically aligned themes: awareness and motivation, information processing and contextual dependence, and executive control and behavioural regulation. Although most participants recognised the benefits of physical activity, their willingness to engage was conditional. The translation of this willingness into action was further shaped by a range of personal and environmental factors. Barriers to physical activity included fluctuating energy levels, reliance on memory and familiar contexts, limited physical capacity, perceived risks, difficulties initiating activity, and the cognitive load associated with physical activity. In contrast, simple and familiar activity tasks, positive experiences, social support, and culturally meaningful community routines facilitated physical activity. Physical activity was also understood in relation to self-cultivation, maintenance of independence, and reduced burden on family members. Barriers to sustained physical activity among older adults with MCR were interpreted as arising from interacting motivational, contextual, physical, and executive demands. Difficulty in initiating physical activity emerged as an important finding. Because sustained physical activity presupposes successful initiation, difficulty initiating activity may be viewed as an early manifestation of the intention-behaviour gap. In addition, physical activity is closely linked to specific cultural values. Future support strategies may be more effective if they reduce the cognitive, physical, and environmental burdens associated with physical activity while remaining sensitive to the specific cultural context. This study was approved by the Ethics Committee of Zhejiang University School of Medicine (Approval No. 2026-005). Not applicable.