Parkinson’s disease: a study to examine, develop and feasibility test behaviour change techniques to improve physical activity and exercise self-efficacy (PD Active)
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Date
2024
Authors
Ahern, Leanne
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Background: Parkinson’s disease (PD) is a common progressive neurological condition characterised by motor and non-motor deficits. Physical activity and exercise can improve health outcomes but many people fail to reach or maintain the recommended physical activity guidelines. This was further exacerbated with the onset of COVID-19, where people were unable to attend exercise classes or support groups, resulting in deteriorating health, well-being, and social isolation. Virtual exercise classes were developed in an attempt to overcome those challenges. However, these online classes are not accessible to everyone, and many people are dependent on (face-to-face) organised commitment in order to maintain physical activity and exercise. This emphasised the importance of behaviour change techniques to support self-efficacy and independent physical activity. This in turn requires an in-depth exploration of the reasons why people engage in physical activity, the motivators and barriers to exercise, and how we can promote self-management rather than creating dependence on services.
Objectives: To review the existing literature regarding behaviour change techniques and exercise among people with Parkinson’s disease (PwPD), and to qualitatively explore beliefs about exercise and exercise accessibility among PwPD, their family members/carers, and physiotherapists, and to then develop and test the feasibility of a tailored exercise intervention incorporating behaviour change techniques to improve self-management, exercise accessibility and adherence in PwPD.
Methods: Initially, a systematic review (SR) was conducted to determine behaviour change techniques used to promote exercise adherence and exercise self-efficacy among PwPD, and the findings were mapped to the Theoretical Domains Framework. Following this, a qualitative study was completed involving one-to-one interviews with PwPD and group interviews with family members, and with physiotherapists, to discuss the findings of the review and to explore motivation, support, and self-managements of exercise in PwPD. These studies together informed how exercise and behaviour change can be tailored, explicitly including behaviour self-management strategies. The resulting intervention was tested for feasibility, and measurements of quality of life, self-efficacy, physical activity, and exercise adherence were collected.
Results: The SR showed that the five most important domains when implementing a behaviour change intervention were behaviour regulation, belief about capabilities, social influences, reinforcement and goals. The qualitative interviews highlighted differences in exercise preferences between men and women. Individuals expressed a strong desire to manage their own exercise prescription more; to be involved in the development and progression of exercise programmes, and they believed a shared responsibility (between the physiotherapist and the person) would encourage self-management. Therefore, the resulting intervention included the addition of four behaviour change techniques: activity diary (behaviour regulation), peer support (social influences, reinforcement, belief about capabilities), exercise specific education (goals, belief about capabilities), goals setting (goals, reinforcement) and barrier identification (belief about capabilities, behaviour regulation) to an existing 12-week PD exercise and education program. The feasibility study showed that exercise and behaviour change techniques were feasible and acceptable to participants, and the group dynamic was universally enjoyed.
Conclusion: Overall, this intervention could transform the health outcome for PwPD, by improving their self-efficacy, exercise adherence and empowering them with skills to self-manage their condition, potentially reducing healthcare burden. Clinicians should profile the individual’s motivation type and their baseline understanding of exercise to select the appropriate behaviour change technique. Future pilot studies will include tailoring of the intervention based on the participants’ qualitative feedback; adaptations to the exercise diary (encompassing goal setting), providing videos of the exercises, involving family members more for home exercise programmes, reducing the number of education sessions, and including information about available support services (for family members).
Description
Keywords
Parkinson’s disease , Information Motivation Behaviour Skills Model , Self-efficacy , Exercise therapy
Citation
Ahern, L. 2024. Parkinson’s disease: a study to examine, develop and feasibility test behaviour change techniques to improve physical activity and exercise self-efficacy (PD Active). PhD Thesis, University College Cork.