title: Multiple factors, including non-motor impairments, influence decision making with regard to exercise participation in Parkinson's disease: a qualitative enquiry.
abstract: OBJECTIVE
  To explore how the meaning of exercise and other factors interact and influence the exercise behaviour of individuals with Parkinson's disease (PD) enrolled in a 6-month minimally supervised exercise program to prevent falls, regardless of whether they completed the prescribed exercise or not.
  
  
  METHODS
  This qualitative study utilised in-depth semi-structured interviews analysed using grounded theory methodology.
  
  
  RESULTS
  Four main themes were constructed from the data: adapting to change and loss, the influence of others, making sense of the exercise experience and hope for a more active future. Participation in the PD-specific physiotherapy program involving group exercise provided an opportunity for participants to reframe their identity of their "active" self. Three new influences on exercise participation were identified and explored: non-motor impairments of apathy and fatigue, the belief in a finite energy quota, and the importance of feedback. A model was developed incorporating the themes and influences to explain decision-making for exercise participation in this group.
  
  
  CONCLUSIONS
  Complex and interacting issues, including non-motor impairments, need to be considered in order to enhance the development and ongoing implementation of effective exercise programmes for people with PD.
  
  
  CONCLUSIONS
  Exercise participation can assist individuals to reframe their identity as they are faced with losses associated with Parkinson's disease and ageing. Non-motor impairments of apathy and fatigue may influence exercise participation in people with Parkinson's disease. Particular attention needs to be paid to the provision of feedback in exercise programs for people with Parkinson's disease as it important for their decision-making about continuing exercise.
authors.affiliation: a Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney , Sydney , Australia .|b School of Physiotherapy, Faculty of Health, The University of Canberra , Canberra , Australia , and.
authors.forename: Christine
authors.initials: C
authors.lastname: O'Brien
authors.affiliation: c Ageing, Work and Health Research Group, Faculty of Health Sciences, The University of Sydney , Sydney , Australia.
authors.forename: Lindy
authors.initials: L
authors.lastname: Clemson
authors.affiliation: a Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney , Sydney , Australia .
authors.forename: Colleen G
authors.initials: CG
authors.lastname: Canning
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D057565:Apathy; D003657:Decision Making; D015444:Exercise; D005081:Exercise Therapy; D005221:Fatigue; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000523:psychology* / Q000534:rehabilitation*; D010358:Patient Participation / Q000523:psychology*; D026741:Physical Therapy Modalities; D036301:Qualitative Research
keywords: Apathy; Parkinson’s disease; decision making; exercise; fatigue; physiotherapy