PERCEIVED BARRIERS AND FACILITATORS TO EXERCISE ADHERENCE IN PEOPLE WITH PARKINSON'S DISEASE

Abstract

Aim: The aim of this study was to examine the barriers and facilitators affecting participation in exercise programs among individuals with early-stage Parkinson’s disease. Method: This qualitative study included a focus group of 13 Parkinson’s disease patients. Interviews were conducted by preparing semi-structured questions between 01.03.2021 and 01.05.2021. Sessions were recorded on online platforms (zoom, skype). Interviews were transcribed verbatim after the meeting and analysed using content analysis to identify key themes related to exercise adherence. This analysis quantified qualitative data by aggregating frequently occurring words and themes, revealing several significant factors influencing adherence to exercise programs. Results: Overall, participants identified 15 barriers and 8 facilitators to exercise adherence. Four main themes were identified describing the factors that both hindered and facilitated exercise adherence. These themes consisted of body structure and function, participation, personal factors, and environmental factors. The top barriers were showing Parkinson’s motor symptoms, previous low level of physical activity or low participation, transportation, and discomfort at seeing peers' symptoms progress while exercising in a group. On the other hand, awareness about the positive effects of exercise on Parkinson’s disease motor and non-motor symptoms, education about the benefits of exercise, exercising with an expert, and professional support for exercise motivated exercise adherence in Parkinson’s disease patients. Conclusions and Recommendations: Exercise adherence is impacted by motor symptoms. However, educating patients about the benefits of exercise and providing regular guidance from physiotherapists were found to motivate exercise adherence by increasing patient belief that their motor symptoms will decrease.

Keywords

• Barriers
• Facilitators
• Exercise
• Parkinson’s Disease

Parkinson Hastalığı Olan Kişilerde Egzersize Bağlılığın Önündeki Algılanan Engeller ve Kolaylaştırıcılar

Abstract

Amaç: Bu çalışmanın amacı, erken evre Parkinson hastalığı olan bireylerin egzersiz programlarına katılımını etkileyen engelleri ve kolaylaştırıcı faktörleri incelemekti. Yöntem: Bu nitel çalışma 13 Parkinson hastalarından oluşan bir odak grubu içermektedir. Görüşmeler 01.03.2021-01.05.2021 tarihleri arasında yarı yapılandırılmış sorular hazırlanarak gerçekleştirilmiştir. Oturumlar çevrimiçi platformlarda (zoom, skype) kaydedilmiştir. Görüşmeler toplantıdan sonra kelimesi kelimesine yazıya dökülmüş ve egzersize bağlılıkla ilgili temel temaları belirlemek için içerik analizi kullanılarak analiz edilmiştir. Bu analiz, sıkça geçen kelimeleri ve temaları bir araya getirerek nitel verileri nicelleştirmiş ve egzersiz programlarına uyumu etkileyen birkaç önemli faktörü ortaya çıkarmıştır. Bulgular: Genel olarak, katılımcılar egzersize bağlılığın önünde 15 engel ve 8 kolaylaştırıcı tanımlamıştır. Egzersize uyumu hem engelleyen hem de kolaylaştıran faktörleri tanımlayan dört ana tema belirlenmiştir. Bu temalar vücut yapısı ve işlevi, katılım, kişisel faktörler ve çevresel faktörlerden oluşmuştur. En önemli engeller Parkinson'un motor semptomlarını göstermek, önceki düşük fiziksel aktivite seviyesi veya düşük katılım, ulaşım ve bir grup içinde egzersiz yaparken akranlarının semptomlarının ilerlediğini görmekten duyulan rahatsızlıktı. Öte yandan, egzersizin Parkinson hastalığı motor ve motor dışı semptomları üzerindeki olumlu etkileri hakkında farkındalık, egzersizin faydaları hakkında eğitim, bir uzmanla egzersiz yapma ve egzersiz için profesyonel destek Parkinson hastalarında egzersize bağlılığı motive etmiştir. Sonuçlar ve Öneriler: Egzersize bağlılık motor semptomlardan etkilenmektedir. Bununla birlikte, hastaları egzersizin faydaları konusunda eğitmenin ve fizyoterapistlerden düzenli rehberlik sağlamanın, hastaların motor semptomlarının azalacağına dair inançlarını artırarak egzersize uyumu motive ettiği bulunmuştur.

Keywords

• Engeller
• Kolaylaştırıcılar
• Egzersiz
• Parkinson Hastalığı

References

1. Adams, W. C. (2015). Conducting Semi-Structured Interviews. In Handbook of Practical Program Evaluation (pp. 492–505). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119171386.ch19
2. Afshari, M., Yang, A., & Bega, D. (2017). Motivators and Barriers to Exercise in Parkinson’s Disease. Journal of Parkinson’s Disease, 7(4), 703–711. https://doi.org/10.3233/JPD-171173
3. Bassett, S., Stewart, J., & Giddings, L. (2012). Nordic walking versus ordinary walking for people with Parkinson’s disease: A single case design. New Zealand Journal of Physiotherapy, 40(3), Article 3.
4. Bhidayasiri, R., Kalia, L. V., & Bloem, B. R. (2023). Tackling Parkinson’s Disease as a Global Challenge. Journal of Parkinson’s Disease, 13(8), 1277–1280. https://doi.org/10.3233/JPD-239005
5. Bonanni, R., Cariati, I., Tarantino, U., D’Arcangelo, G., & Tancredi, V. (2022). Physical Exercise and Health: A Focus on Its Protective Role in Neurodegenerative Diseases. Journal of Functional Morphology and Kinesiology, 7(2), Article 2. https://doi.org/10.3390/jfmk7020038
6. Braun, V., & and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
7. Crizzle, A. M., & Newhouse, I. J. (2012). Themes Associated With Exercise Adherence in Persons With Parkinson’s Disease: A Qualitative Study. Occupational Therapy In Health Care, 26(2–3),174–186. https://doi.org/10.3109/07380577.2012.692174
8. Davis, J. T., Ehrhart, A., Trzcinski, B. H., Kille, S., & Mount, J. (2003). Variability of Experiences for Individuals Living with Parkinson Disease. Journal of Neurologic Physical Therapy, 27(2), 38.

9. Ding, C., Wu, Y., Chen, X., Chen, Y., Wu, Z., Lin, Z., Kang, D., Fang, W., & Chen, F. (2022). Global, regional, and national burden and attributable risk factors of neurological disorders: The Global Burden of Disease study 1990–2019. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.952161
10. Ellis, T., Boudreau, J. K., DeAngelis, T. R., Brown, L. E., Cavanaugh, J. T., Earhart, G. M., Ford, M. P., Foreman, K. B., & Dibble, L. E. (2013). Barriers to Exercise in People With Parkinson Disease. Physical Therapy, 93(5), 628–636. https://doi.org/10.2522/ptj.20120279
11. Ellis, T. D., Colón-Semenza, C., DeAngelis, T. R., Thomas, C. A., Hilaire, M.-H. S., Earhart, G. M., & Dibble, L. E. (2021). Evidence for Early and Regular Physical Therapy and Exercise in Parkinson’s Disease. Seminars in Neurology, 41, 189–205. https://doi.org/10.1055/s-0041-1725133
12. Emig, M., George, T., Zhang, J. K., & Soudagar-Turkey, M. (2021). The Role of Exercise in Parkinson’s Disease. Journal of Geriatric Psychiatry and Neurology, 34(4), 321–330. https://doi.org/10.1177/08919887211018273
13. Ferreira, L. P. de S., Silva, R. A. da, Costa, M. M. M. da, Roda, V. M. de P., Vizcaino, S., Janisset, N. R. L. L., Vieira, R. R., Sanches, J. M., Soares Junior, J. M., & Simões, M. de J. (2022). Sex differences in Parkinson’s Disease: An emerging health question. Clinics, 77, 100121. https://doi.org/10.1016/j.clinsp.2022.100121
14. Hao, Z., Zhang, X., & Chen, P. (2022). Effects of Ten Different Exercise Interventions on Motor Function in Parkinson’s Disease Patients—A Network Meta-Analysis of Randomized Controlled Trials. Brain Sciences, 12(6), Article 6. https://doi.org/10.3390/brainsci12060698
15. Hunter, H. (2025). An exploration of the experiences and factors influencing physical activity in people with Parkinsons. School of Health Professions Theses. https://pearl.plymouth.ac.uk/hp-theses/24
16. Hunter, H., Lovegrove, C., Haas, B., Freeman, J., & Gunn, H. (2019). Experiences of people with Parkinson’s disease and their views on physical activity interventions: A qualitative systematic review. JBI Database of Systematic Reviews and Implementation Reports, 17(4), 548–613. https://doi.org/10.11124/JBISRIR-2017-003901
17. International Classification of Functioning, Disability and Health. (2025). In Wikipedia. https://en.wikipedia.org/w/index.php?title=International_Classification_of_Functioning,_Disability_and_Health&oldid=1271435978
18. Jones, D., Rochester ,L., Birleson ,A., Hetherington ,V., Nieuwboer ,A., Willems ,A.-M., Van Wegen ,E., & and Kwakkel, G. (2008). Everyday walking with Parkinson’s disease: Understanding personal challenges and strategies. Disability and Rehabilitation, 30(16), 1213–1221. https://doi.org/10.1080/09638280701828955
19. Khalil, H., Nazzal, M., & Al-Sheyab, N. (2016). Parkinson’s disease in Jordan: Barriers and motivators to exercise. Physiotherapy Theory and Practice, 32(7), 509–519. https://doi.org/10.1080/09593985.2016.1219433
20. Kunkel, D., Robison ,Judy, Fitton ,Carolyn, Hulbert ,Sophia, Roberts ,Lisa, Wiles ,Rose, Pickering ,Ruth, Roberts ,Helen, & and Ashburn, A. (2018). It takes two: The influence of dance partners on the perceived enjoyment and benefits during participation in partnered ballroom dance classes for people with Parkinson’s. Disability and Rehabilitation, 40(16), 1933–1942. https://doi.org/10.1080/09638288.2017.1323029
21. Landers, M. R., & and Nilsson, M. H. (2023). A theoretical framework for addressing fear of falling avoidance behavior in Parkinson’s disease. Physiotherapy Theory and Practice, 39(5), 895–911. https://doi.org/10.1080/09593985.2022.2029655
22. Lee, T. K., & Yankee, E. L. (2021). A review on Parkinson’s disease treatment. Neuroimmunology and Neuroinflammation, 8(0), N/A-N/A. https://doi.org/10.20517/2347-8659.2020.58
23. Mcginley, J. L., & Nakayama, Y. (2024). Exercise for People with Parkinson’s Disease: Updates and Future Considerations. Physical Therapy Research, 27(2), 67–75. https://doi.org/10.1298/ptr.R0030
24. Nilsson, M. H., Iwarsson, S., Thordardottir, B., & Haak, M. (2015). Barriers and Facilitators for Participation in People with Parkinson’s Disease. Journal of Parkinson’s Disease, 5(4), 983–992. https://doi.org/10.3233/JPD-150631
25. O’Brien, C., Clemson, Lindy, & and Canning, C. G. (2016). Multiple factors, including non-motor impairments, influence decision making with regard to exercise participation in Parkinson’s disease: A qualitative enquiry. Disability and Rehabilitation, 38(5), 472–481. https://doi.org/10.3109/09638288.2015.1055377
26. Ou, Z., Pan, J., Tang, S., Duan, D., Yu, D., Nong, H., & Wang, Z. (2021). Global Trends in the Incidence, Prevalence, and Years Lived With Disability of Parkinson’s Disease in 204 Countries/Territories From 1990 to 2019. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.776847
27. Patton, M. Q. (2002). Qualitative Research & Evaluation Methods. SAGE.
28. Rowsell, A., Ashburn, A., Fitton, C., Goodwin, V. A., Hulbert, S., Lamb, S. E., McIntosh, E., Nieuwboer, A., Pickering, R., Rochester, L., Chivers-Seymour, K., & Ballinger, C. (2022). Participant expectations and experiences of a tailored physiotherapy intervention for people with Parkinson’s and a history of falls. Disability and Rehabilitation, 44(5), 727–735. https://doi.org/10.1080/09638288.2020.1779824
29. Schootemeijer, S., Van Der Kolk, N. M., Ellis, T., Mirelman, A., Nieuwboer, A., Nieuwhof, F., Schwarzschild, M. A., De Vries, N. M., & Bloem, B. R. (2020). Barriers and Motivators to Engage in Exercise for Persons with Parkinson’s Disease. Journal of Parkinson’s Disease, 10(4), 1293–1299. https://doi.org/10.3233/JPD-202247
30. Smith, M. D., Brazier ,Danielle E, & and Henderson, E. J. (2021). Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson’s Disease. Neuropsychiatric Disease and Treatment, 17, 2965–2985. https://doi.org/10.2147/NDT.S304567
31. Tsukita, K., Sakamaki-Tsukita, H., & Takahashi, R. (2022). Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease. Neurology, 98(8), e859–e871. https://doi.org/10.1212/WNL.0000000000013218
32. Yang, Y., Wang, G., Zhang, S., Wang, H., Zhou, W., Ren, F., Liang, H., Wu, D., Ji, X., Hashimoto, M., & Wei, J. (2022). Efficacy and evaluation of therapeutic exercises on adults with Parkinson’s disease: A systematic review and network meta-analysis. BMC Geriatrics, 22(1), 813. https://doi.org/10.1186/s12877-022-03510-9
33. Yoon, S. Y., Suh, J. H., Yang, S. N., Han, K., & Kim, Y. W. (2021). Association of Physical Activity, Including Amount and Maintenance, With All-Cause Mortality in Parkinson Disease. JAMA Neurology, 78(12), 1446–1453. https://doi.org/10.1001/jamaneurol.2021.3926