Exercise Participation in Parkinson's Disease: A Qualitative Study

Abstract

Exercise and physiotherapy improve mobility and health-related quality of life in people with Parkinson’s disease (PD) and exercise is now an important component of disease management. People may live with PD for many years and to maximise the benefits of exercise, individuals need to participate in exercise regularly. People with PD have a range of motor and non-motor impairments that could impact on exercise participation but there is limited evidence about the factors that influence exercise participation in this population. It is important for physiotherapists to understand these factors so that exercise programs can be developed to encourage uptake and sustain participation. A qualitative study explored the experience of 8 participants who were variously successful in a semi-supervised, 6-month falls prevention exercise program. The aim was to understand the participants’ meaning of exercise and how factors influencing exercise participation interact and impact on decisions made about whether to exercise or not. In-depth semi-structured interviews were conducted and analyzed using grounded theory methodology. It was found that, for this group, exercise participation assisted in reframing identity as individuals are faced with losses associated with ageing and PD. Three new influences on exercise participation were identified: the non-motor impairments of apathy and fatigue, a belief in a finite energy quota, and the importance of feedback. Decisions about whether to exercise were the result of a dynamic process of evaluation by the participants in which goals were crucial. A model was developed to explain the interaction of factors involved in making decisions regarding exercise participation. This thesis contains information on how individual factors interact and influence exercise participation in these individuals with PD, suggestions on how to address these in the clinical setting and offers directions for further research.