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Barriers to Exercise in People With Parkinsonís Point to Potential Solutions

The main reasons why people with Parkinson’s disease do not exercise regularly include low expectations of the benefits, lack of time and fear of falling, according to a new study published in the January 3 online edition of Physical Therapy. The research funded in part by the Parkinson's Disease Foundation, may help professionals to find ways to help people maintain beneficial exercise programs.

Research indicates that people with PD can ease some movement symptoms with exercises that build and maintain strength, flexibility and balance. Exercise can also help improve nonmotor difficulties related to PD, such as depression, sleep disturbances and constipation. Yet many people with PD remain sedentary.  

To understand why, researchers led by Lee Dibble, P.T., Ph.D., at the University of Utah, and Terry Ellis, P.T., Ph.D., of Boston University recruited 260 study participants from four academic medical centers where they were receiving outpatient treatment for PD. The average age was 68, and most people had mild to moderate PD. All participants lived at home or in a home setting. Participants rated their exercise level and their reasons for not exercising on a questionnaire administered every six months for two years.  

Based on their responses, the researchers divided study participants into two groups: 164 exercisers and 96 non-exercisers. Participants also used a type of pedometer called a step activity monitor (SAM) for a week, which confirmed the exercise levels they reported.

Results

  • On average, non-exercisers had been diagnosed with PD for about three years longer than exercisers; however, participants in the two groups had the same degree of disease severity.
  • Non-exercisers tended to say that they had low expectations – they felt the same whether or not they were physically active.
  • The main barriers reported by non-exercisers were: low expectations of benefits (40 percent), lack of time and fear of falling (about 25 percent or each).  Exercisers cited these barriers only about 10 percent of the time.
  • Other reasons for not exercising included tightness in the chest, self-perception of being in poor health, discomfort with exercise, feeling depressed and bad weather.

What Does It Mean?

Given the many proven benefits of exercise, identifying barriers is an important step toward improving the lives of people with PD. In this study, the most striking difference between people with PD who did not exercise and those who did was a perception that exercise would not make a difference in their health. 

More research is needed to understand which strategies are most effective for overcoming barriers to exercise. As a start, the study authors advocate that professionals educate people with PD about the specific health benefits of exercise for them. People who believe exercise will help have been shown to exercise at nearly double the rate of those who do not.  Researchers propose, in addition, strategies such as setting fitness goals, improving social support and going to a physical therapist. 

In regards to the other barriers cited, lack of time and fear of falling, the authors suggest that people with PD may benefit from help in scheduling their daily activities to include exercise, and that being more active may help people with PD gain confidence in their movements.

A limitation of this study is that participants were mostly white with high socioeconomic status, and the percentage of exercisers was higher than in another recent study of PD and exercise. It may be that other populations of people with PD experience different barriers to exercise. Additionally, because study is cross-sectional, studying people at one moment in time it is difficult to establish cause and effect. It is not clear whether these participants do not exercise because of their perceptions, or if they tried to exercise and when they failed to feel better, reached these perceptions. Also, cognitive evaluation may also explain why some exercise more than others. 

Future studies should focus on mechanisms that would help caregivers and professionals engage in exercise programs people with PD who prefer a more sedentary routine. 

Learn More

Learn more by viewing two of PDF's PD ExpertBriefings on the topic of exercise, including one by an author of this study, Dr. Ellis.

Watch: Gait, Balance and Falls in Parkinson's Disease

Watch: Physical Therapy and Parkinson's: What You Need to Know

Reference: Terry Ellis, Jennifer K. Boudreau, Tamara R. DeAngelis, Lisa E. Brown, James T. Cavanaugh, Gammon M. Earhart, Matthew P. Ford, K. Bo Foreman, and Leland E. Dibble (2013). Barriers to Exercise in People With Parkinson Disease. PHYS THER. published ahead of print January 3, 2013, doi:10.2522/ptj.20120279 <http://dx.doi.org/10.2522/ptj.20120279>

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Source Date: Mar 29 2013