CogCoach-Health Randomised Controlled Trial - a lifestyle program targeting brain health in people with cognitive concerns

The CogCoach-Health online intervention includes the following: e-Learning: Completion of a 12-week online dementia risk reduction education program. The e-Learning component will consist of six online modules (Chapters), approximately 30-40 minutes in length each, that participants open, learn and complete individually. The modules topics are: 1. Introduction to the e-Learning course and general information about healthy brain ageing; 2. Looking After Your Memory; 3. Physical Activity; 4. Healthy Diet; 5. Staying Cognitively; Socially Active; 6. Stress Reduction. Each module will contain background information on the specific topic, interactive activities, reflections and goal setting to assist with behaviour change. The intervention participants will receive the above Chapters on Weeks 1, 2, 4, 6, 8 and 10. Telehealth Consultations: One session on Cognitive Engagement will be conducted by a research assistant who has at least 4 years training in psychology. The session will be conducted individually via videoconferencing and, where that is not possible, by phone and will last up to 1 hour. It will occur in Week 1 or as soon as can be arranged after randomisation. It will involve discussion and planning of a ‘Cognitive diary’ and goal setting related to engaging in cognitively stimulating activities. Advice will also be given for undertaking cognitive training using the BrainHQ program for which they will be given a 12 month subscription. Access to BrainHQ will be given around Week 1 of the intervention. Each participant is encouraged to complete training on two executive function and two memory tasks, for up to 2 hours per week. These online, game-like tasks are mental exercises that are tailored to the level of ability of the participant and gradually increase in difficulty to increase performance. Two consultation sessions on physical activity will be conducted by an exercise physiologist (EP). The sessions will be conducted individually via videoconferencing and, where that is not possible, by phone and will last up to 45 mins each. Sessions will occur approximately in Weeks 5 and 9. The first session will involve the development of a personalised exercise plan for the participant. Recommendations will be based on the Australian guidelines for physical activity. In the second consultation the exercise physiologist will review participants’ exercise plans and support them in achieving their goals. If in line with the exercise goals, the EP will also introduce the PhysiTrack or the StandingTall app to support maintenance of physical activity, and advise on how to use this app. The apps provide a digital exercise program delivered via an app on a tablet device. StandingTall offers adaptive exercises guided by visual demonstrations, audio cues and educational content adjusts exercise difficulty based on participant feedback. Participants are able to use their own tablet device, or one supplied by the study. Two consultation sessions on diet will be conducted by a dietician. The session will be conducted individually via videoconferencing and, where that is not possible, by phone. Sessions will last up to 1 hour each and will occur approximately in Weeks 7 and 11. The first session will involve the development of an individualised diet plan and goal setting. Recommendations will be based on the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. The MIND diet emphasises unprocessed fruit, vegetables, whole grains, nuts, olive oil, fish, legumes and low consumption of red meat. Adaptations will be made to apply the diet in a culturally sensitive manner. The second consultation involves review of participants’ diet and supporting them in achieving their goals. Physical activity and diet recommendations will be adapted around comorbidities, resources and preferences, thus enabling safe and effective implementation. Telehealth booster sessions: Telehealth booster sessions will be conducted at approximately 4 months and again approximately at 9 months after the completion of the eLearning. These sessions will be conducted by videoconference if possible, and alternatively by phone, and take approximately 45 minutes each. The booster sessions will be guided by a standardised template drawing on motivational interviewing principles to discuss goal progression and support behaviour change. They will also include a recap on session materials. Adherence: Adherence to the e-Learning components will be monitored through website statistics (e.g., time spent on each chapter, number of chapters completed, number of chapter activities completed). We will also record if participants choose not to attend the consultations or access the cognitive brain training. To encourage adherence, we will send participants reminder emails if they have not completed a chapter. However, unlocking the next chapter will not be dependent on completion of the previous one. We will also send newsletters to participants every 2 to 4 weeks, to support continued engagement with the trial material. Process evaluation: As a form of process evaluation within the chapters there will be questions relating to participants’ familiarity of the topic, willingness to change behaviour and perceptions of health. Through the chapters and booster sessions, we will also collect information on goals set by participants and general feedback.