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aaa People with dementia represent a growing proportion of the older adult population. Estimates suggest that 46.8 million people worldwide had dementia in 2015, and this figure will rise to 131.5 million by 2050 (Prince et al., 2015); with 90% of people with dementia aged 65 years and older (World Health Organization [WHO], 2012). Dementia gradually impairs memory, executive functioning, and communication (Butler & Radhakrishnan, 2012; Prince et al., 2015). Nonetheless, people with dementia should be encouraged to continue to enjoy good health for as long as possible as part of a public health strategy and for their continued quality of life (Ginis et al., 2017; Nyman & Szymczynska, 2016). Behavior change techniques (BCTs) are widely used in health promotion interventions and, in particular, the promotion of physical activity. However, the use of BCTs in physical activity promotion that rely on cognitive processes may be ineffective among people with dementia because of their cognitive impairment. There is currently no direct evidence to address this issue among people with dementia, and so, it is open to empirical study (van der Wardt et al., 2017). Inconclusive evidence comes from a recent systematic review of BCTs used to promote physical activity among people with dementia (Nyman, Adamczewska, & Howlett, 2018). Although potential promise was found for goal setting (behavior), this BCT was not used in isolation, but was used with other BCTs that also had potential promise: social support (unspecified) and using a credible source. Therefore, the effectiveness of these three BCTs when used in isolation with people with dementia is unknown, and the remaining BCTs reviewed were either used too infrequently to identify potential promise or only used in ineffective interventions. Therefore, research is needed to identify which BCTs are effective in promoting physical activity among people with dementia. In this editorial, I encourage physical activity researchers and clinicians working with older people with dementia to explore the use of approaches that do not rely on cognitive processes. These approaches may be shown to be more effective when working with people with cognitive impairment, given the nature of their condition, and stimulate novel strategies for encouraging uptake and adherence to physical activities. Further research might also illuminate when particular BCTs are more useful in considering the severity of an individual’s dementia symptoms. People with dementia are heterogeneous and may have relatively mild, moderate, or severe symptoms. Therefore, the trajectory of use of BCTs that do not rely on cognitive processes may gradually become more useful as a person with dementia’s cognitive functioning worsens. In the following editorial, I illustrate the predominant use of BCTs that rely on cognitive processes with reference to a widely used taxonomy of BCTs (Michie et al., 2013). I then propose three avenues of research where BCTs could be more effectively tested with people with dementia: partnership with carers, behaviorist approaches, and choice architecture. Predominant Use of BCTs That Rely on Cognitive Processes

journal of aging and physical activity

Which Behavior Change Techniques Are Effective in Promoting Physical Activity Among Older People With Dementia? A Call for Research Into Three Underexplored Avenues