Experiences of people with Parkinson's disease and their views on physical activity interventions: a qualitative systematic review

"There is only one motive … fun." Perspectives of participants and providers of physical exercise for people with Parkinson's disease

PURPOSE

To explore the perspectives of people with Parkinson's disease (PD) and exercise providers regarding facilitating factors, barriers, needs, and demands relating to physical exercise for people with PD.

MATERIALS AND METHODS

Focus group discussions or telephone interviews of 30 people with PD (with or without an active sports history) and 13 providers were conducted and analyzed using structuring content analysis.

RESULTS

Factors facilitating participation in physical exercise included motivation-enhancing elements (enjoyment, group training environment) and providers with sufficient qualifications in PD-specific training demands. Identified barriers were lack of motivation, physical limitations, poor service accessibility, and inadequate matching of intervention groups based on capability or age. Providers found it difficult to design and conduct group trainings for people with PD with varying physical limitations. Having an active sports history before PD-onset was described as generally beneficial, though a competitive mindset could lead to frustration. People with PD reported needing their physicians to provide better education regarding physical exercise.

CONCLUSION

Enjoyment of physical exercise is a key aspect of maintaining physical activity engagement, which should be considered more in research and clinical practice. Developing qualifications for providers could help to broaden and enhance the dissemination of PD-specific exercise approaches. Physicians should be trained to encourage physical exercise.Implications for rehabilitationPhysicians should highlight the benefits and be knowledgeable regarding the availability of physical exercise interventions for people with PD.Additional physical exercise providers should become qualified to work with people with PD.The joyfulness of physical exercise interventions is a key aspect of maintaining physical activity engagement for people with PD.

Comparing Physical Activity and Exercise Experiences, Values, and Beliefs of Latino, Latina, and/or Latine People and Non-Latino, Non-Latina, and/or Non-Latine People With Parkinson Disease: A Qualitative Study

OBJECTIVE

The objective of this study was to examine and compare the beliefs, values, experiences, and barriers to and facilitators of exercise in Latino/a/e (Latino, Latina, and/or Latine) people and non-Latino/a/e (non-Latino, non-Latina, and/or non-Latine) people with Parkinson disease (PD).

METHODS

This study involved a qualitative research design with data collection via focus groups of Latino/a/e and non-Latino/a/e people with PD. A semistructured interview protocol was used, and a theoretical (social ecological model) thematic analysis was used for data analysis.

RESULTS

Twenty-five individuals (15 non-Latino/a/e and 10 Latino/a/e) participated across 5 focus groups. While there were several common themes among both groups, 7 themes related to exercise in the management of PD were unique to Latino/a/e participants: generalized versus specific knowledge of exercise components; family can have both facilitating and impeding roles; finances influence access to exercise and physical therapy; prior emotional experiences related to exercise and PD affect the future use of exercise; group exercise can have both facilitating and impeding roles; availability and access to a variety of modes and stratification of exercise classes for people with PD facilitate exercise; and cultural beliefs and expectations can impede the use of exercise at the population level.

CONCLUSION

Latino/a/e people with PD have overlapping and unique themes related to the use of exercise. Distinctive factors must be addressed in physical activity interventions and during physical therapists' care of people with PD to maximize the use of exercise and ultimately improve health equity in this overburdened and underserved population.

IMPACT

Physical therapists should provide information and education to their Latino/a/e patients with PD and family members on the frequency, intensity, type, and time of exercise and how to safely participate in physical activity in the home and community to best manage PD. Physical therapists and exercise professionals should work at the environmental level to increase access to affordable, culturally tailored, PD-specific exercise services and enhance community knowledge of PD.

"Exercise… to Me, It's Freedom": Motivation, Support, and Self-Management to Keep Physically Active with Parkinson's Disease: A Qualitative Study

The benefits of exercise have been widely explored among people with Parkinson's (PwP). Exercise can improve non-motor (fatigue, pain, sleep, etc.) and motor features (balance, muscle strength, gait speed, etc.), maintain function, as well as prevent disease progression. Although the benefits are well known, PwP continue to show difficulty adhering to physical activity and exercise. This study aims to explore motivation to exercise, support, and self-management needs among people with Parkinson's, their family members, and physiotherapists. Purposeful and maximum-variation sampling methods (age, sex, geographical setting, and disease severity) were employed. PwP and family members were recruited through physiotherapy services and local support groups. Twelve semi-structured interviews with PwP and two group interviews, one with family members (n = 4) and one with physiotherapists (n = 5), were conducted. Interview guides were informed by patient-public input and a recent systematic review. Interviews were recorded, transcribed, and analysed using thematic analysis informed by the Grounded Theory methodology. Four common themes emerged: (1) The value of an intrinsic connection with exercise, for which there are challenges. A greater connection to exercise led to long-term adherence. (2) Adapting exercise to the needs and preferences of a person is essential. Preferred exercises and environments were mixed, with differences emerging between sexes. (3) Physiotherapists' aim to only maintain physical function led to frustration. Limited self-management opportunities, stigma, and dehumanisation were discussed. (4) Non-motor symptoms, stigma, fear, and determination as well as apathy, pain, and low mood were discussed. Exercise provided physical, emotional, and social rewards. Supports are necessary; however, challenges arise when PwP's motivations are mismatched to family members' and physiotherapists' goals. Co-created goals, tailored to their preferences, and exercise plans with supported self-management are recommended.

Social support from the physiotherapist and the therapeutic relationship in physiotherapy: bridging theory to practice

BACKGROUND/PURPOSE

Therapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their similarities and differences, and measuring them pose challenges. This article aims to facilitate scientific and clinical advancement on social support and the therapeutic relationship in physiotherapy by (a) providing conceptual clarity, (b) discussing measurement tools, and (c) offering practical recommendations for the deliberate incorporation of these constructs in clinical practice.

METHODS

This is a perspective paper drawing on examples from existing research.

KEY RESULTS

Assessing the nature and strength of social support and promoting naturally occurring social support networks are practical ways for physiotherapists to foster social support in physiotherapy clinical practice. Physiotherapists can offer direct support, facilitate the development of an individual's social skills, and promote participation in group activities. To strengthen the therapeutic relationship, it is important to maintain good communication, foster connectedness with the patient, demonstrate professional skills, and adopt a reflective practice. Physiotherapists are encouraged to establish clear roles and responsibilities, prioritize individualized patient-centered care, and involve patients in shared decision-making, ensuring congruence in goals and expectations. Willingness to dedicate time and energy within and beyond direct patient-therapist interactions can foster connections. Moreover, using the body - which is the main point of contact with patients - and physical touch can help physiotherapists to connect with patients. Finally, physiotherapists must be prepared to address and mend any conflicts which can impact the relationship's trajectory.

CONCLUSION

Social support and therapeutic relationships are complementary aspects of one's health care, and it is crucial to purposefully account for both in physiotherapy practice to optimize person-centered care and rehabilitation outcomes.

Exploring the experiences, priorities and preferences of people living with Parkinson's on exercise and physical activity promotion in the UK

BACKGROUND

People with Parkinson's (PwP) want access to timely, relevant, and specific exercise and physical activity (PA) information to enable them to manage their symptoms and maintain wellbeing and quality of life. Research that promotes exercise in this population group is limited. Little is also known about the clinical practice around PA promotion in this population, especially around the time of diagnosis.

OBJECTIVE

To explore the experiences, preferences, and priorities of PwP around exercise and PA promotion and assess their knowledge on these topics.

METHODS

A cross-sectional online survey for PwP in the United Kingdom was conducted from July to December 2021.

RESULTS

430 participants started the survey and 405 completed it. Participants had a mean age of 65.1 (±9.2) and had been living with Parkinson's for a varying time (up to 2 years = 38%, up to 6 years = 39% and for 7 or more years = 23%). Most participants reported they had not received an education (68%; n = 276) or exercise intervention (54%; n = 217) as part of their routine management by the National Health Service (NHS) since diagnosis and had sought services privately. Knowledge of the overall benefits of exercise was good, however participants lacked specific knowledge on the impact of Parkinson's Disease (PD) on posture, falls and muscle strength. 90% of participants reported they would participate in an exercise and PA education interventions.

CONCLUSIONS

PwP want exercise and PA education interventions that provide knowledge, skills and access to opportunities that enable participation. For the majority, these interventions have not been provided as part of their routine care pathway. To align with the priorities and preferences of PwP, interventions should be offered around the time of diagnosis, include content that is relevant and specific to how exercise and PA can mitigate symptoms of PD and should be delivered in person or online in a group setting.

Group-based exercise for Parkinson's: a qualitative study of participants and partners' perceptions of an exercise class delivered through a community-university collaboration

BACKGROUND

Community-based exercise programmes (CBEPs) offer a practical and viable approach to providing people with Parkinson's disease (PwP) the opportunity to exercise as an ancillary therapeutic benefit to pharmacological management. This study explores the perceptions of exercising participants (PwP) and non-participating partners involved in an exercise class delivered through a community-university partnership.

METHODS

Two separate focus group discussions were conducted: one with class participants (PwP: n = 7, H&Y scale I to III), and the other with non-participating partners of PwP (n = 4).

RESULTS

Thematic analysis of the data identified that a range of physical, psychological and social factors were perceived to influence engagement: (1) actively taking control, (2) exercise is medicine for the mind and body, and (3) a community working together to promote exercise for parkinson's. Participants and partners felt that the support from the group, including the instructors and student volunteers, empowered and supported PwP to proactively self-manage their health, enjoy exercise in an inclusive group setting, and develop strong social connections with others in the local Parkinson's community. Support to exercise from healthcare professionals was identified as both an enabler and barrier to participation.

CONCLUSIONS

This study underscores the significance of a community-university partnership as a complementary therapeutic approach for PwP. It also provides critical reflections on its sustainability, including implications for how exercise is considered as medicine for PwP. Additionally, it offers practical recommendations to galvanise community participation and provide inclusive and viable exercise opportunities for PwP.

Impact of Sharing Dance Older Adults on Physical and Psychosocial Outcomes

Dance for older adults is increasingly being used to support health and well-being. While dance may be enjoyable for many, understanding its benefits for those with limited physical and cognitive abilities may provide further support for how dance may be used in these contexts. This was a study of Sharing Dance Older Adults, a dance program with remotely streamed sessions. Data were collected from 48 older adults who took part in the On Your Feet version of the program, and from 38 who took part in the In Your Seat version. Measures included interviews, physical fitness tests and surveys on mood, quality of life, and program satisfaction. Physical fitness significantly improved for both groups, unlike for mood, social well-being, or quality of life. This contrasts with qualitative findings, with participants reporting how the program enhanced their mood, social interactions, and quality of life.

Exercise and physical activity promotion for people newly diagnosed with Parkinson's disease: a UK survey exploring current practice and the views of healthcare professionals

OBJECTIVES

Exercise and physical activity (PA) are increasingly recognized as important components in the management of Parkinson's disease (PD). Their promotion at diagnosis is essential for better management of symptoms and overall well-being. Healthcare professionals (HCPs) are pivotal to the promotion of exercise and PA, but there is limited guidance on the content of such interventions. This study describes current practice, and explores views of HCPs around PA and exercise promotion at diagnosis for people with PD (PwP) DESIGN: A cross-sectional study using an anonymous online survey.

PARTICIPANTS

HCPs working with PwP in the UK.

RESULTS

Twenty-nine doctors, 17 nurses and 106 physiotherapists completed the survey. All nurses, 99% of physiotherapists and 72% of doctors reported that they always promote exercise and PA during clinic appointments. HCPs identified how PA impacts PD symptoms, evidence on the role of exercise, and signposting to support groups as core topics in PA promotion for PwP. However, these topics are mainly addressed during physiotherapy appointments. Referrals to physiotherapy occur most frequently when PwP experience falls or mobility issues, rather than at diagnosis. HCPs (52% doctors and 41% of nurses) identified lack of confidence as a barrier to prescribing exercise to PwP.

CONCLUSION

The importance of promoting PA at diagnosis is widely acknowledged by HCPs. There are variations between disciplines in terms of the tools used, and the timing and duration of interventions. Previously identified barriers to exercise promotion were also found in this study, and should be explored further in order to aid the implementation of effective interventions.

The lived experience of adolescent depression: A systematic review and meta-aggregation

BACKGROUND

The under-detection of depression in adolescents suggests that a better understanding of its presentation may be needed. Conceptualizations of adolescent depression are largely the same as adult depression, with minimal consideration of developmental stage. Exploration of first-hand accounts could help to identify any unique features of adolescent depression. Therefore, this systematic review aimed to understand the lived experience of adolescents with depression to inform clinical practice.

METHODS

The review was registered with PROSPERO (CRD42020198141). Databases (PsychINFO, CINAL, MEDLINE and EMBASE) were searched in March 2022 to identify peer-reviewed qualitative studies on first-hand experiences of adolescent depression. The Joanna Briggs Institute's qualitative data extraction tool and checklist for qualitative research were used to obtain study data and assess methodological quality of included papers. Meta-aggregation was the method of synthesis, whereby extracted themes from the papers were grouped according to shared meanings.

RESULTS

Fifteen papers of mixed methodological quality were identified for inclusion from screening a total of 1,983 references. Studies were published between 2002 and 2021, spanned seven countries and included participants aged 11 to 22 years old. Aggregation of 56 themes resulted in 16 categories and 3 synthesized findings encompassing key aspects of adolescent depression: causes, symptoms and coping. Variability in adolescents' perspectives across these domains was evident. Some symptoms described, such as social disconnection and anger, are not listed in existing diagnostic criteria.

CONCLUSIONS

Subjective experiences of depression among adolescents vary and may not entirely match diagnostic criteria. Awareness of this when assessing for depression may improve detection and help to ensure adolescents feel understood.

Virtual Reality for Motor and Cognitive Rehabilitation

Virtual Reality (VR) affords clinicians the ability to deliver safe, controlled, task-specific customised interventions that are enjoyable, motivating and engaging. Elements of training in VR comply with principles of learning implicated in new skill acquisition and re-learning skills post-neurological disorders. However, heterogeneity in the description of VR systems and the description and control of 'active' ingredients of interventions (like dosage, type of feedback, task specificity, etc.) have led to inconsistency in the synthesis and interpretation of evidence related to the effectiveness of VR-based interventions, particularly in post-stroke and Parkinson's Disease (PD) rehabilitation. This chapter attempts to describe VR interventions with respect to their compliance with principles of neurorehabilitation, with the goal of optimising interventions for effective training and facilitation of maximum functional recovery. This chapter also advocates using a uniform framework to describe VR systems to promote homogeneity in literature in order to help in the synthesis of evidence. An overview of the evidence revealed that VR systems are effective in mediating deficits in upper extremity, posture and gait function seen in people post-stroke and PD. Generally, interventions were more effective when they were delivered as an adjunct to conventional therapy and were customised for rehabilitation purposes, in addition to complying with principles of learning and neurorehabilitation. Although recent studies imply that their VR intervention is compliant with principles of learning, only a few explicitly describe how these principles are incorporated as 'active ingredients' of the intervention. Finally, VR interventions targeting community ambulation and cognitive rehabilitation are yet limited and therefore warrant attention.

Views of men with Parkinson's disease regarding physical activity health messaging

BACKGROUND

Many men with Parkinson's Disease (PD) do not meet the recommended levels of physical activity (PA) for health benefits. Tailored, meaningful, and culturally sensitive PA health messages may be a catalyst to shape men's motivations toward participation.

OBJECTIVE

We explored the views of New Zealand (NZ) men with PD about existing PA health messages, and how these could be adapted to be more effective.

METHODS

This qualitative study recruited six community dwelling, regularly physically active, NZ European men with PD (aged 54-69 years, 2-18 years post-diagnosis) from a community exercise class in Canterbury, NZ. Participants engaged in semi-structured interviews which were audio-recorded, transcribed verbatim, and analyzed inductively for themes.

RESULTS

Participants expressed that effective PA health messages should reflect men's motivations for PA which included physical and mental well-being and social connection. Inclusive, positive, and relatable language and imagery were considered crucial PA message communication strategies. Participants viewed health professionals' PA advice as superficial and unhelpful; however, celebrities with PD were considered inspirational messengers. Messages endorsed by trustworthy sources, such as the Parkinson's Society, were perceived to enhance the credibility.

CONCLUSIONS

Effective PA messages should be gain framed and tailored to the target audience. We recommend health professionals provide comprehensive PA advice or consider onward referral. Future research which uses a co-design participatory methodology to collaborate with men with PD from culturally diverse backgrounds and represent all stages of PA behaviour change is recommended to provide comprehensive insights for meaningful, effective, and culturally sensitive PA health messaging.

A Systematic Review on Physical Health Education Interventions for People with Parkinson's Disease: Content, Impact, and Implementation Considerations Across the Parkinson's Trajectory

BACKGROUND

Educational interventions promoting the role of physical activity (PA) aim to address knowledge, poor exercise self-efficacy, and low outcome expectations, which are well-researched barriers to PA participation in healthy and in people with chronic conditions. However, little is known about the effectiveness of educational interventions in addressing these barriers in people with Parkinson's (PwP).

OBJECTIVE

To examine the content of education interventions that promote PA behavior in PwP, and to assess their effectiveness on physical and psychosocial outcomes.

METHODS

An electronic search (12/2021) of MEDLINE, EMBASE, CINAHL, PubMed PsycINFO, the Web of Science and the Cochrane Library was conducted from 1990 to 2021. Education interventions, alone or combined with other strategies, promoting PA in PwP were included. Quality was assessed using the Johanna Briggs Institute and National Institute of Health quality assessment tools. A narrative synthesis was performed.

RESULTS

Six studies were identified. Five interventions were comprised of education and exercise sessions. Improvement in physical and psychosocial outcomes were suggested but delineating the exact impact of education was impeded due to lack of assessment.

CONCLUSION

Few interventions exist that provide knowledge, and skills promoting PA participation, and fewer are addressed towards newly diagnosed PwP. There is lack of assessment over the effectiveness of education as a tool to facilitate PA participation in PwP. Lack of assessment poses the risk of potentially disregarding effective interventions or adopting ineffective approaches without the evidence. Education interventions can boost PA engagement by increasing factors such as exercise self-efficacy, but further interventions are required to assess this model of relationship.

Validity of mHealth devices for counting steps in individuals with Parkinson's disease

BACKGROUND

Step quantification is a good way to characterize the mobility and functional status of individuals with some functional disorder. Therefore, a validation study may lead to the feasibility of devices to stimulate an increase in the number of steps and physical activity level of individuals with Parkinson's Disease (PD).

AIM

To investigate the validity of mHealth devices to estimate the number of steps in individuals with PD and compare the estimate with a standard criterion measure.

METHOD

An observational study in a university laboratory with 34 individuals with idiopathic PD. The number of steps was measured using mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit INC®), and compared against a criterionstandard measure during the Two-Minute Walk Test using habitual speed.

RESULTS

Our sample was 82% men with a Hoehn and Yahr mean of 2.3 ± 1.3 and mean walking speed of 1.2 ± 0.2 m/s. Positive and statistically significant associations were found between Google Fit (r = 0.92; p < 0.01), STEPZ (r = 0.91; p < 0.01), Pacer (r = 0.77; p < 0.01), Health (r = 0.54; p < 0.01), and Fitbit Inc® (r = 0.82; p < 0.01) with the criterion-standard measure.

CONCLUSIONS

GoogleFit, STEPZ, Fitbit Inc.®, Pacer, and Health are valid instruments to measure the number of steps over a given period of time with moderate to high correlation with the criterion-standard in individuals with PD. This result shows that technology such as smartphone applications and activity monitor can be used to assess the number of steps in individuals with PD, and allows the possibility of using this technology for assessment and intervention purposes.

The Impact of COVID-19 on Community-Based Exercise Classes for People With Parkinson Disease

OBJECTIVE

he purpose of the study was to determine the impact of novel coronavirus 2019 (COVID-19) restrictions on community-based exercise classes for people with Parkinson disease (PD) and their instructors.

METHODS

Data were collected via custom-designed electronic surveys for people with PD and class instructors who reported attending or teaching PD-specific exercise class ≥1 time/week for ≥3 months prior to pandemic restrictions (March 2020). The PD group also completed the Godin Leisure-Time Questionnaire, Self-Efficacy for Exercise scale, Schwab-England scale, and Parkinson's Disease Questionnaire 8.

RESULTS

Eighty-seven people with PD (mean = 70 [7.3] years old) and 43 instructors (51 [12.1] years old) from the United States completed surveys (October 2020 to February 2021). Mean Schwab-England (84 [16]) and Parkinson's Disease Questionnaire 8 (21 [15]) scores indicated low-to-moderate disability in the PD group. Ninety-five percent of the PD group had COVID-19 exposure concerns, and 54% reported leaving home ≤1 time/week. Although 77% of the PD group scored "active" on the Godin Leisure-Time Questionnaire, the mean Self-Efficacy for Exercise Scale score (55 [24]) indicated only moderate exercise self-efficacy, and >50% reported decreased exercise quantity/intensity compared with pre-COVID. There was decreased in-person and increased virtual class participation for both groups. The top in-person class barrier for the PD (63%) and instructor (51%) groups was fear of participant COVID-19 exposure. The top virtual class barriers were lack of socialization (20% of PD group) and technology problems (74% of instructor group).

CONCLUSION

During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and decreased exercise quantity and intensity. Virtual classes may not fully meet the needs of people with PD, and primary barriers include technology and lack of socialization.

IMPACT

As COVID-19 restrictions wane, it is imperative to help people with PD increase exercise and activity. The barriers, needs, and facilitators identified in this study might help inform approaches to increase participation in exercise and activity for people with PD.

LAY SUMMARY

During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and a decrease in exercise quantity and intensity. If you have PD, virtual classes might not fully meet your needs. Primary barriers may include technology problems and lack of social interaction.

The meaning of regular participation in vigorous-intensity exercise among men with Parkinson's disease

PURPOSE

To understand the meaning of regular participation in multiple types of vigorous-intensity exercise for those with Parkinson's disease (PD).

MATERIALS AND METHODS

Using a qualitative phenomenological approach, in-depth individual interviews were conducted with eight male participants who engaged in at least two modes of vigorous-intensity exercise, including Rock Steady Boxing, about their experiences with exercise and the multifaceted role it played in their lives. Interview data were analyzed using systematic coding and organized into primary themes.

RESULTS

Three primary themes emerged from the interview data: (1) the unique importance of social connections with others diagnosed with PD, (2) a sense of purpose, and (3) determination and confidence. Specifically, for those with a minimal history of engagement in exercise, regular participation in multiple types of vigorous-intensity exercise accompanied life-affirming social connections that served to boost feelings of hope and foster a clear sense of purpose in the face of disease. Participation in regular vigorous-intensity exercise fueled determination and confidence to engage in even more vigorous activities.

CONCLUSIONS

Implications for rehabilitation practice include the importance of collaboration between health care professionals and community programs for people with PD. Promotion of group-based community activities, vigorous-intensity modes of exercise, and consideration of a patient's exercise history will be essential for the successful delivery of future services.IMPLICATIONS FOR REHABILITATIONSocial connections built through Rock Steady Boxing, a group exercise program, served as a catalyst for increasing hope, sense of purpose and motivation for people with Parkinson's disease;Vigorous-intensity exercise at Rock Steady Boxing fueled determination and confidence to engage in additional vigorous exercise regimens;Collaboration between health care providers and community partners is essential for long-term service provision for individuals with disability;Exercise history should be considered when making recommendations for physical activity.

Current Perspectives on Aerobic Exercise in People with Parkinson's Disease

Parkinson's disease (PD) is a progressive neurological disorder characterized by motor and non-motor symptoms for which only symptomatic treatments exist. Exercise is a widely studied complementary treatment option. Aerobic exercise, defined as continuous movement of the body's large muscles in a rhythmic manner for a sustained period that increases caloric requirements and aims at maintaining or improving physical fitness, appears promising. We performed both a scoping review and a systematic review on the generic and disease-specific health benefits of aerobic exercise for people with PD. We support this by a meta-analysis on the effects on physical fitness (VO2max), motor symptoms (Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor section), and health-related quality of life (39-item Parkinson's disease Questionnaire (PDQ-39)). Aerobic exercise has generic health benefits for people with PD, including a reduced incidence of cardiovascular disease, a lower mortality, and an improved bone health. Additionally, there is level 1 evidence that aerobic exercise improves physical fitness (VO2max) and attenuates motor symptoms (MDS-UPDRS motor section) in the off-medication state, although the long-term effects (beyond 6 months) remain unclear. Dosing the exercise matters: improvements appear to be greater after training at higher intensities compared with moderate intensities. We found insufficient evidence for a beneficial effect of aerobic exercise on health-related quality of life (PDQ-39) and conflicting results regarding non-motor symptoms. Compliance to exercise regimes is challenging for PD patients but may be improved by adding exergaming elements to the training program. Aerobic exercise seems a safe intervention for people with PD, although care must be taken to avoid falls in at-risk individuals. Further studies are needed to establish the long term of aerobic exercise, including a focus on non-motor symptoms and health-related quality of life.

Delivering patient-centered care in Parkinson's disease: Challenges and consensus from an international panel

An international panel of movement disorders specialists explored the views and perceptions of people with Parkinson's disease (PD) about their condition and its treatment, including the potential mismatch between the clinician's view of the patient's condition and their own view of what aspects of the disease most affect their daily lives. The initiative was focused on Asian countries, so participants comprised experts in the management of PD from key centers in Asia, with additional insight provided by European and the North American movement disorders experts. Analysis of peer-reviewed publications on patient perceptions of PD and the factors that they consider important to their wellbeing identified several contributing factors to the mismatch of views, including gaps in knowledge of PD and its treatment, an understanding of the clinical heterogeneity of PD, and the importance of a multidisciplinary approach to patient care. The faculty proposed options to bridge these gaps to ensure that PD patients receive the personalized treatment they need to achieve the best possible outcomes. It was considered essential to improve patient knowledge about PD and its treatment, as well as increasing the awareness of clinicians of PD heterogeneity in presentation and treatment response. A multidisciplinary and shared-care approach to PD was needed alongside the use of patient-centered outcome measures in clinical trials and clinical practice to better capture the patient experience and improve the delivery of individualized therapy.

Barriers and Motivators to Engage in Exercise for Persons with Parkinson's Disease

Exercise is increasingly being recognized as a key element in the overall management of persons living with Parkinson's disease (PD) but various (disease-specific) barriers may impede even motivated patients to participate in regular exercise. We aimed to provide a comprehensive review of the various barriers and motivators for exercise in persons with PD. We scrutinized data on compliance-related factors published in cross-sectional studies, randomized controlled trials and reviews. We classified the barriers and motivators to exercise from a patient perspective according to the International Classification of Functioning, Disability and Health. We present an overview of the large range of potential motivators and barriers for exercise in persons with PD. Healthcare professionals should consider a wide and comprehensive range of factors, in order to identify which specific determinants matter most for each individual. Only when persons with PD are adequately motivated in a way that appeals to them and after all person-specific barriers have been tackled, we can begin to expect their long-term adherence to exercise. Such long-term compliance will be essential if exercise is to live up to its expectations, including the hope that prolonged engagement in regular exercise might help to modify the otherwise relentlessly progressive course of PD.