Multiple factors, including non-motor impairments, influence decision making with regard to exercise participation in Parkinson’s disease: a qualitative enquiry

Abstract

Purpose: To explore how the meaning of exercise and other factors interact and influence the exercise behaviour of individuals with Parkinson’s disease (PD) enrolled in a 6-month minimally supervised exercise program to prevent falls, regardless of whether they completed the prescribed exercise or not. Method: This qualitative study utilised in-depth semi-structured interviews analysed using grounded theory methodology. Results: Four main themes were constructed from the data: adapting to change and loss, the influence of others, making sense of the exercise experience and hope for a more active future. Participation in the PD-specific physiotherapy program involving group exercise provided an opportunity for participants to reframe their identity of their “active” self. Three new influences on exercise participation were identified and explored: non-motor impairments of apathy and fatigue, the belief in a finite energy quota, and the importance of feedback. A model was developed incorporating the themes and influences to explain decision-making for exercise participation in this group. Conclusion: Complex and interacting issues, including non-motor impairments, need to be considered in order to enhance the development and ongoing implementation of effective exercise programmes for people with PD.

Implications for Rehabilitation

• Exercise participation can assist individuals to reframe their identity as they are faced with losses associated with Parkinson’s disease and ageing.

• Non-motor impairments of apathy and fatigue may influence exercise participation in people with Parkinson’s disease.

• Particular attention needs to be paid to the provision of feedback in exercise programs for people with Parkinson’s disease as it important for their decision-making about continuing exercise.

• Apathy
• decision making
• fatigue
• exercise
• Parkinson’s disease
• physiotherapy

Acknowledgements

The authors gratefully acknowledge the participants who gave their time to be interviewed for this study.

Declaration of interest

The authors report no conflict of interest.