Your recent study published in Journal of Physiotherapy investigated the use of exercise in people with Parkinson’s disease. Isn’t it already established that exercise is helpful in this population?

While it is established that exercise is helpful for people with Parkinson’s disease, the issue remains that many people with Parkinson’s disease are either not exercising or not performing sufficient exercise.

We need to understand more about the exercise preferences of people with Parkinson’s disease in order to increase adoption of and adherence to evidence-based exercise.

Then what question did your study set out to answer?

Our study aimed to determine what features of exercise programs would make people with Parkinson’s disease more likely to adopt and adhere to an evidence-based exercise program.

What sort of study did you use to figure that out?

We used a discrete choice experiment, which is a method used by health economists to describe a healthcare intervention by its characteristics. In a discrete choice experiment, levels of each attribute (eg, exercise type) are varied in a series of questions presented to participants who choose the option that they prefer for each question.

Discrete choice experiments determine which attributes are driving consumer preferences and the trade-offs between attributes that people are willing to accept.

How many people enrolled in the study and what did you find?

Five hundred and forty people with Parkinson’s disease completed the study.

We found that participants preferred to engage in regular exercise or add additional exercise if the exercise program provided them physical and/or psychological benefits, were supervised by instructors with expertise in Parkinson’s disease, and the exercise was multimodal in nature (ie, involved a variety of exercise types such as aerobic, strength and balance exercises).

Unsurprisingly, participants were also more willing to engage in regular exercise or add additional exercise when the exercise program cost less and involved less travel.

We also found that men preferred adding strength exercises while women were averse to adding aerobic exercises.

What should clinicians and researchers do in response to these results?

Clinicians should aim to address these factors when prescribing exercise for people with Parkinson’s disease.

For example, it is important to provide them the opportunity to undertake evidence-based exercise at low cost, preferably of a multimodal nature and at a location easily accessible to the individual.

Equipping clinicians and exercise providers with sufficient expertise about Parkinson’s disease is also important in order to gain the trust of this population.

Parkinson’s disease prefer different types of exercise and tailor their messages accordingly to ensure each individual obtains the greatest health benefits from their prescribed exercise program.

It is important that all people with Parkinson’s disease, especially women, understand the benefits of aerobic exercise (van der Kolk et al 2019, Schenkman et al 2018) so they can make an informed choice.

Given we also found that non-exercising people with Parkinson’s disease were willing to take up exercise, researchers should investigate facilitators and barriers to exercise among non- exercisers, from both user and service provider perspectives.

As most participants in the study reported that they already exercised to some degree, it was perhaps not surprising that the participants mostly preferred not to add exercise to their current routines. But they generally weren’t meeting appropriate exercise guidelines, so what can we do about that?

Clinicians should discuss with individuals their barriers and facilitators to exercise and help them find ways to meet exercise guidelines.

There is a need for healthcare systems to change funding models to enable physiotherapists and other exercise providers to provide ongoing long-term support and follow-up to this population, including telehealth.

Researchers can further examine which elements of behaviour change will help people with Parkinson’s disease meet and adhere to exercise guidelines over the long term.

>>Dr Serene Paul is a research and teaching academic at The University of Sydney. Her research interest is in improving physical function and increasing sustainability and access to effective exercise interventions for people with Parkinson’s disease.