Better Exercise Habits May Be Matter of Class Availability, Study Finds

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by Steve Bryson, PhD |

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Offering more weekly exercise classes at a higher intensity over a wider geographical area may help to instill  better exercise habits in people with Parkinson’s disease, a study suggested.

The study, “Associations between exercise classes and self-reported exercise by people with Parkinson’s disease at Parkinson’s foundation centers of excellence,” was published in the journal Clinical Parkinsonism & Related Disorders.

Growing evidence supports exercise in helping to ease Parkinson’s motor and non-motor symptoms, improving patients’ muscle strength, balance, gait speed, cognition, mood, and quality of life.

“According to findings from the Parkinson’s Outcome Project (POP), maintaining at least 2.5 [hours] of exercise per week is associated with slower declines in quality of life compared to people with [Parkinson’s disease] who do not exercise regularly,” the researchers noted.

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Still, patients often exercise less than the recommended weekly hours. Among reported common barriers to regular exercise are  disease-specific difficulties, lack of time, fear of falling, and few convenient locations.

Few studies have examined ways that might help people with Parkinson’s improve their exercise habits.

Researchers at the Shirley Ryan AbilityLab, a nonprofit physical medicine and rehabilitation research hospital in Chicago, Illinois, investigated associations between exercise class characteristics and self-reported exercise, as well as the weekly availability, intensity, cost, and location of classes.

“We sought to identify exercise class-related factors associated with the amount of exercise in [Parkinson’s disease] communities,” they wrote. “We hypothesized that greater exercise class availability, more locations, and lower costs would be associated with higher levels of exercise.”

The team used Parkinson’s Outcome Project data covering 3,146 patients at 19 participating Centers of Excellence (COEs), medical facilities recognized and supported by the Parkinson’s Foundation for their expert and multidisciplinary patient care. Parkinson’s COE teams include neurologists, movement disorder specialists, physical and occupational therapists, and mental health professionals.

POP, a Parkinson’s Foundation-sponsored international patient registry, collects data on patient characteristics, medical history, and outcomes to better understand the disease and its course to support research and patient care. Opened in 2009, it currently has more than 13,000 people in five countries participating.

Researchers used POP data related to patient-reported hours of moderate exercise, which included fast walking, dancing, Tai chi, yoga, Pilates, and pool aerobics, as well as such vigorous exercises as running, swimming, stair climbing, and weight lifting.

Hours of self-reported light physical activity were also measured, consisting of regular walking, doing household chores, or seated exercises. The availability of weekly exercise classes, and their cost, intensity, and distance from the class location to the COE were included in the analysis.

Common co-existing medical conditions among participants included back pain (52%), depression (36%), osteoarthritis (35%), high blood pressure (31%), and heart or lung disease (19%).

A higher proportion of exercise classes were found in the community than at a COE itself, and community classes offered more intense exercise. But community classes were farther away from Centers of Excellence. No significant difference was seen in the proportion of free classes at either location.

Greater weekly class availability positively associated with higher odds of patients doing any light physical activity. Increased hours of moderate-vigorous exercise and more light physical activity among those who exercised also linked with greater class availability.

There was a 1.3% increase in the odds of doing any light physical activity for every one-hour increase in weekly class availability. Greater availability also linked with a 0.4% increase in the hours of moderate-vigorous exercise and a 0.8% increase in light physical activity hours among patients who engage in these types of exercises.

These results reflected an average increase of 1.3 minutes of moderate-vigorous exercise and 2.8 minutes of light physical activity for every one-hour gain in class availability.

More high-intensity exercise classes positively associated with better odds of doing any light physical activity. Among those who exercised, higher intensity classes related with a nearly 12-minute increase in moderate-vigorous exercise and an almost 40-minute increase in light physical activity.

“Our findings support the idea that targeting increased availability and intensity of COE and community exercise classes may benefit the [Parkinson’s disease] community,” the researchers wrote.

Although a higher number of free classes was associated with lower odds of doing any moderate-vigorous exercise or light physical activity, they associated with a 4.7-minute increase in moderate-vigorous exercise among those who exercised.

The odds of doing any exercise — moderate-to-vigorous or light — was not related to the average distance to classes at the COE. In comparison, among individuals who exercised, a 9.1-minute increase in moderate-vigorous exercise and a nearly 15-minute increase in light physical activity associated with distance to a class.

Finally, statistical analysis showed that ease of availability to a weekly exercise class was the most significant factor for more hours of light physical activity and of moderate-vigorous exercise to a slightly lesser extent.

“Our results suggest that offering a greater weekly availability of classes at a higher intensity and with a broader geographical distribution may help bridge the gap between recommended and reported exercise,” the team concluded. “These findings favor the implementation of exercise programs at and near COEs, particularly at COEs whose patients have lower than average levels of exercise.”