Pedaling for Parkinson’s Viewed Favorably by Patients in Study
Weekly program encourages exercise regardless of person's age, disease severity
People with Parkinson’s disease reported enjoying and benefiting physically and emotionally from a community cycling program — Pedaling for Parkinson’s (PFP) — viewing it favorably in a survey regardless of their age or disease symptoms and severity, a study of patients at five PFP sites reported.
The aerobic program’s cost, access to parking and transportation, a gym’s proximity to their homes, and the ease of equipment use are essential factors to encouraged attendance, its researchers noted.
“Overall, the cohort of PwP [people with Parkinson’s] in this study were enthusiastic about participating in the research study, considered the burden of participation to be minimal, and felt that they were contributing to the [Parkinson’s] community,” they wrote.
“Our results are encouraging as PwP, regardless of age, sex, and disease duration or severity, exhibit positive feelings towards the PFP program,” the researchers added, noting “this may be due to the safety and feasibility of cycling throughout the disease process, even as gait and postural deficits worsen.”
The study “Components of a successful community-based exercise program for individuals with Parkinson’s disease: results from a participant survey” was accepted for publication in Complementary Therapies in Medicine.
PFP ‘ideal program’ to study real-world exercise behaviors
Exercise is known to exert a protective effect on brain health and could be a complementary therapy for Parkinson’s and like diseases. Both the Parkinson’s Foundation and the American College of Sports Medicine recommend 90 to 150 minutes of exercise per week (between 1.5 and 2.5 hours), while only 27% of patients are estimated to meet the recommendation, the study noted.
Barriers to exercise, including a fear of falling or a lack of motivation, are likely reasons for low activity levels, and could be addressed through community-based programs, close to patients’ homes, that encourage participation through social engagement.
PFP is an aerobic cycling program in the U.S. offering stationary bike classes for people with Parkinson’s. Classes are held year-round at more than 150 fitness centers three times per week, making PFP “an ideal program to observe real-world exercise behaviors” among patients in those communities. (Class sites are available via this PFP webpage.)
Cleveland Clinic researchers enrolled 49 Parkinson’s patients, mostly male (60%) and white (95%) with a mean age of 69 and a mean disease duration of 5.3 years, in a 12-month study of this exercise program. All were already taking part in PFP classes at five facilities in northern Washington state and central Colorado; class protocol allows for 45 to 60 minutes of cycling, including warm-up and cool-down periods.
Previously published study results, focused on attendance and activity levels, showed that most participants (87%) attended between one and two or more weekly classes for 12 months, exercising at moderately high intensity with “no significant differences between cycling adherence and intensity variables based on disease severity, age, or sex.”
These same researchers now investigated, using an exit survey, the personal beliefs, motivations, and barriers to exercise among 40 of these 49 patients. Their goal was to determine how best to “translate” this established exercise program to improve participation among wider groups of people with neurological disorders.
“With the growing body of literature that supports exercise in mitigating disease symptoms and potentially altering the disease trajectory, it is critical to identify exercise attitudes, motivators, and barriers to exercise in this disease population,” the researchers wrote.
On average, the patients attended 75.6 sessions over its year, exercising at moderate-to-high intensity at each session.
Exercise behaviors, intensity and heart rates were monitored at three points: an initial visit, and at six- and 12-month visits before conducting the exit survey. Its questions addressed their personal beliefs and knowledge of exercise and the cycling program, their health and disability, and their attitudes towards the program and fitness environment. Responses to each question were ranked on a scale of 1 to 5, with 1 being strongly disagree, 3 being neutral, and 5 strongly agreeing.
Positive views regardless of age, disease severity
Results showed participants viewed the cycling program positively. Nine questions in the “Personal Beliefs and Knowledge” survey section that addressed exercise in relation to the disease showed patients “are motivated to exercise due to their [Parkinson’s] diagnosis and possess a general belief that exercise is beneficial to their physical and mental well-being,” and its mean score was 4.37 out of 5.
Mean scores among the seven “health and disability” questions, which addressed motor symptoms like dyskinesia, balance and gait, was 4.25; a score of 4.11 was given the 14 questions concerning the PFP program, like comfort and ease of equipment; and 4.35 for the “fitness environment” that addressed issues including cost, location, and transport accessibility.
“The Fitness Environment subdomain revealed that cost of the program, parking and transportation, proximity to residence, and ease of gym navigation are important to participants,” the researchers noted.
Nearly half of these 40 people (45%) learned of the PFP program through word-of-mouth, indicating that “the community bond was strong within the PFP classes.” Others had heard about it through support groups, healthcare providers or facility advertisements.
Overall, participants did not feel that their symptoms stopped them from cycling; they disagreed with statements such as “my [Parkinson’s] symptoms limit my ability to cycle in the PFP class,” “dyskinesias (uncontrolled movements) as a result of my [Parkinson’s] medication limit my ability to cycle”, and “dystonia (muscle spasms or cramps) as a result of my [Parkinson’s] limit my ability to cycle.”
“Regardless of demographic variables and disease severity,” patients “who attended a PFP program enjoyed the class, felt that their [Parkinson’s] symptoms benefitted from exercise, and were motivated to exercise by their [Parkinson’s] diagnosis,” the researchers concluded.
“With the growing body of [Parkinson’s] literature supporting the role of exercise in potentially altering the disease trajectory, it is critical that communities adopt and implement exercise programs that meet the needs of [people with Parkinson’s disease] and facilitate compliance,” they added.