Factors contributing to the sustainment of exercise in patients with Parkinson's Disease. The Parkinson's Foundation Quality Improvement Initiative (PF-QII) dataset

Objective: To explore individual processes contributing to changes in exercise. Background: The PF-QII dataset demonstrated that exercise may slow physical and quality of life declines in Parkinson’s Disease (PD). However, barriers to exercise exist. Prior cross-sectional studies do not address individual processes that impact changes in exercise participation. Design/Methods: A mixed methods approach used PF-QII data to categorize 1970 participants with 3 annual visits into “exercise increasers” and “exercise decreasers” using the parametric p-value changes of outcomes based on different absolute cutoffs in random 75% samples. Groups (exercise maintainers, starters, stoppers, increasers, decreasers and non-exercisers) were compared on mobility, quality of life, hospitalization, and fall variables the following year. Then, phone interviews were conducted with 40 PF-QII participants from one Center to assess personal factors influencing exercise changes. Qualitative content analysis was completed using iterative open coding combined with deductive codes based on health behavior change models. Results: A change of 1.5 hours per week was associated with better health with increased exercise or health decrements with decreased exercise. Exercisers were younger, more recently diagnosed, and healthier. The following year, quality of life (PDQ-39) significantly increased (worsened) in the exercise increasers compared to the decreasers (p=0.012), particularly in the emotional well-being and communications subscales. For consistent exercisers, additional hours of exercise increased the odds of decreasing exercise the following year by a factor of 3.6 (CI95% 2.0–6.9). Qualitatively, exercise decreases were frequently due to injuries, depression, or changes in motivation. People with PD rely on their family, friends, and health professionals to trigger and support increasing exercise. Conclusions: Exercisers fluctuated over time, with exercisers having a greater risk of future exercise decreases. Surprisingly, exercise increasers had lower quality of life the following year. Further studies are needed to elucidate possible perception bias after increasing exercise and changes in perceived expectations or psychosocial burden. Disclosure: Dr. Yu has nothing to disclose. Dr. Larson has nothing to disclose. Dr. Roberts holds stock and/or stock options in Texas Instruments, Inc. Dr. Simuni has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Acadia, Adamas, Teva, UCB Pharma, Abbvie, Anavex, Allergan, Accorda, Neuroderm, Photopharmics, Revance, Sanofi, Sunovion, Voyager, US World Meds, and the Michael J. Fox Foundation. Dr. Simuni has received research support from Biogen, Roche, Neuroderm, Sanofi, NINDS, the Michael J. Fox Foundation, and the Parkinson Foundation. Dr. Sadural has nothing to disclose. Dr. Fowler has nothing to disclose. Dr. Gao has nothing to disclose. Dr. Wu has nothing to disclose. Dr. Rafferty has nothing to disclose.