Objective: To characterize physical activity levels as well as barriers and motivators for exercise in US military Veterans with Parkinson disease (PD).

Background: Physical activity may affect PD symptoms; however, most individuals with PD do not achieve adequate exercise. Barriers and motivators of exercise in PD are poorly understood but may offer opportunities to increase activity levels in PD patients.

Methods: We recruited Veterans with mild-moderate PD (Hoehn & Yahr<4) to complete the Exercise Perceptions Questionnaire (EPQ), Physical Activity Scale in the Elderly (PASE), Non-Motor Symptoms Questionnaire (NMSQ), and Parkinson Disease Questionnaire-8 (PDQ-8). A subset of subjects wore a waistband accelerometer for 4 weeks. We compared PASE scores with population norms, accelerometer data and questionnaire responses to identify factors related to physical activity.

Results: 60 Veterans were recruited, with a mean age of 71 (standard deviation [SD] 7.6). Mean disease duration was 5.3 (SD 5.3) years. Mean PASE was 131.6 (SD 75.1), which was lower than scores from the Parkinson Progression Markers Initiative (mean 161.8, SD 83.6, p<0.001). Over 80% of subjects (n=49) reported no regular moderate or vigorous physical activity (MVPA). Accelerometers (n=15) similarly revealed that on average, only 4.5% (SD 4.2%) of waking time was spent in MVPA; participants took an average of 3624 steps/day (SD 1678). The commonest barriers to exercise were physical comorbidities (n=8, 13.3%); motivators included symptom management (n=14, 23.3%) and social engagement (n=11, 18.3%). Higher PASE scores were associated with higher scores on the exercise knowledge subscale (r=0.32, p=0.028) and motivators subscale (r=0.15, p=0.033) of the EPQ; there was a trend toward inverse association with scores on the barriers subscale (r=-0.09, p=0.054). Pairwise correlations between PASE and EPQ are shown in Table 1. Controlling for age and disease stage, PASE was positively associated with cognitive function (MoCA, r=0.12, p=0.045) and inversely associated with motor severity (UPDRS-3, r=-0.15, p=0.038), BMI (r=-0.33, p=0.013) and PDQ-8 (r=-0.41, p=0.011).

Conclusions: Veterans with PD, like the general population, are largely inactive. These data demonstrate the feasibility of fitness trackers to monitor physical activity in PD and can be used to devise interventions to increase exercise in PD patients and potentially improve clinical outcomes.

References: 1. Mantri S, Fullard ME, Duda JE, Morley JF. Physical Activity in Early Parkinson Disease. J Park Dis. 2018;8(1):107-111. doi:10.3233/JPD-171218. 2. Washburn RA, McAuley E, Katula J, Mihalko SL, Boileau RA. The physical activity scale for the elderly (PASE): evidence for validity. J Clin Epidemiol. 1999;52(7):643-651.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/motivators-barriers-and-clinical-correlates-of-physical-activity-in-parkinson-disease/