The need for mapping personal goals to exercise dosage in community-based exercise programs for people with Parkinson's disease.

Purpose: Community-based exercise can support long-term management of Parkinson's disease, although it is not known if personal goals are met in these programs. The objectives of this study were to: (1) examine the goals of community based exercise programs from the participant and instructor perspectives; (2) establish the extent to which these programs meet self-described exercise outcomes; and (3) explore participant and instructor perspectives on barriers to meeting exercise expectations. Materials and Methods: This study explores the experiences of people with Parkinson's disease participating in a structured exercise program at six community sites. A mixed-methods approach was used, including participant and instructor interviews, assessment of exercise intensity, and mapping of exercise dosage to participant goals. Twenty-four exercise participants provided interview, quality of life, and exercise intensity data. Results: Twenty-one participants exercised for primary management of their Parkinson's disease. None met the exercise dosage necessary to meet this primary objective, although 60% met exercise dosage required to prevent disuse deconditioning. Participants and instructors did not describe similar goals for the community-based exercise program. Conclusions: Community-based exercise programs could be optimized by better aligning participant goals and exercise intensity.

Barriers to physical activity between adults with stroke and their care partners.

BACKGROUND AND PURPOSE: Healthy living includes meeting daily physical activity guidelines. This study compares daily physical activity rates and barriers to physical activity for people with stroke and their partners (spouse or significant other). METHODS: Physical abilities, energy expenditure, daily steps, and barriers to physical activity are evaluated in people who have completed stroke rehabilitation and their partners. RESULTS: Twenty pairs of adults (mean age 69.7 years) participated. Participants with stroke were classified as sedentary, averaging 2,990 (± 2,488) steps per day. Their partners are classified as low active, averaging 6,378 (± 2,149) steps per day. For stroke survivors, physical abilities were positively correlated to daily activity rates. The number of steps walked per day was moderately correlated to 6-minute walk tests (r = 0.550, P < .05), comfortable gait speeds (r = 0.588, P < .05), and fast gait speeds (r = 0.677, P < .01). For care partners, physical abilities were not correlated to daily physical activity. People with stroke report lack of skill as a primary barrier; their partners report lack of time. CONCLUSIONS: The relationship between physical ability and physical activity is reinforced with this study. The impact of stroke on the family, particularly on time demands of the primary caregiver, suggests the needs of the care partner may not be adequately addressed in the rehabilitation process.

Measures of physical ability are unrelated to objectively measured physical activity behavior in older adults residing in continuing care retirement communities.

OBJECTIVE: To explore the relationship between measures of physical performance, physical activity, and self-reported physical activity. DESIGN: Cross-sectional analysis. SETTING: Continuing care retirement communities (CCRCs) in the greater Milwaukee area. PARTICIPANTS: Older adults from independent or assisted living apartments (N=59). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical performance was measured with comfortable and fast gait speeds and the six-minute walk test. Physical activity was measured by an ankle-mounted accelerometer to observe daily steps; stepping rate was averaged over a 7-day wear time. Self-reported physical activity was measured by the Physical Activity Scale for the Elderly (PASE). RESULTS: Participants reported walking more steps per day than older adults who are not living in CCRCs. There was no relationship between physical abilities and total steps walked (r=.087-.213, P>.05). No relationship was observed between measures of physical performance or total steps and PASE scores (r=-.034-.177, P = not significant). The relative contributions of physical activity categories to total PASE score were different than published reports for older adults not living in CCRCs. CONCLUSIONS: Common measures of physical performance often used by clinicians in making decisions on rehabilitation outcomes do not appear to be related to the actual functioning of older adults residing in senior communities. The nature of the environment customized to the needs of the older adult may facilitate increased physical activity participation independent of physical abilities.

Testing functional performance in people with Parkinson disease.

BACKGROUND AND PURPOSE: Although the Unified Parkinson's Disease Rating Scale (UPDRS) is the most common performance measure for people with Parkinson disease (PD), the Berg Balance Scale (BBS), Forward Functional Reach Test (FFR), Backward Functional Reach Test (BFR), Timed "Up & Go" Test (TUG), and gait speed may be used to quantify some aspects of functional performance not measured by the UPDRS. The purpose of this study was to describe the relationship among a set of tests of balance, walking performance, and mobility in people with PD. SUBJECTS: Twenty-five community-dwelling adults (11 female, 14 male) with a diagnosis of PD were recruited from PD support groups in southeastern Wisconsin and consented to participate in the study. The mean age of the participants was 76 years (SD=7). The average Hoehn and Yahr Stage Scale score was 2. METHODS: Functional abilities of each subject were assessed with the UPDRS, BBS, FFR, BFR, TUG, and gait speed. Spearman and Pearson correlations were performed. RESULTS: The UPDRS total score was correlated with the BBS (r=-.64, P<.001), FFR (r=-.52, P<.05), and TUG (r=.50, P<.05) measurements. The BBS is the only test of functional performance where scores correlate with all other functional tests and the UPDRS. DISCUSSION AND CONCLUSIONS: The UPDRS total score may not reflect a comprehensive measure of mobility in people with PD. Because the BBS scores correlate both with UPDRS scores and with scores of all other tests of functional performance, the BBS appears to be a good overall measure of function in this population.