The effect of personal, social and behavioral determinants on physical activity in people with Parkinson's disease
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Exercise is critical for effective disease management of Parkinson’s disease (PD); however, people with PD are less active than their age-matched peers. The social cognitive theory of behavior provides a framework to examine this problem and to generate potential targets of intervention. In this project, I investigate the effect of, personal, social/environmental, and behavioral determinants on exercise and physical activity in people with PD. To investigate the personal and behavioral determinants, we focused upon motivation related to physical activity. We used a neuroeconomic paradigm requiring participants to decide to accept or reject physical effort in the face of varying levels of effort and reward (effort-based decision-making). We sought to determine if effort-based decision-making specifically related to exercise was different in people with PD compared to controls (study 1). In addition, we set out to determine if components of motivation, in the form of apathy and the anticipation of pleasure, predicted decision-making for physical effort in people with PD, when controlling for the physical measures of age, physical capacity and disease severity. We used hierarchical logistic regression models to test the effect of effort, reward and trial (time) at the individual level as well as sex and the presence of PD at the group level in 32 people with PD and 23 age-matched controls. Additional exploratory analyses tested the mediating effect of age, disease severity, physical capacity as well as apathy and the anticipation of pleasure at the group level. We found that people with PD who were receiving dopamine replacement therapy, were physically active, and were non-depressed responded similarly to effort and reward valuations compared to those without PD. However, apathy and the anticipation of pleasure, after controlling for the contribution of age, disease severity and physical capacity, were significant predictors of decisions for both the discrete motor and exercise tasks in people with PD only. The apathy and the anticipation of pleasure may be unique predictors of decisions to engage in exercise in people with PD. To investigate social/environmental and behavioral effects, we developed a PD specific peer coach training program and a remote peer-mentored walking program using mobile health (mHealth) technology with the goal of increasing physical activity in 5 peer dyads with PD (study 2). We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual level changes in walking activity in the peer coach and peer mentee and changes in self-efficacy and disability in the peer mentees. We found that remote peer coaching using mHealth was feasible, safe, and acceptable for persons with PD. Increases in average steps/day, exceeding the clinically important difference, occurred in 4/5 mentees. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Taken together these two studies highlight the importance of addressing the relation between personal, behavioral and social/environmental determinants on exercise and physical activity behavior in people with PD. Motivation for exercise in people with PD was enhanced with peer coaching and when general apathy was low and anticipation of pleasure was high. People with PD who were active and were being treated with dopamine replacement therapy were responsive to rewards and were accepting of physical effort. Prescription of exercise that is associated with pleasure as well as rewards may be readily accepted by people with PD. This prescription can be supported with peer coaching to enhance physical activity outside of the formal healthcare environment. Together these factors may lead to improved management of PD by addressing the effect of motivation on physical activity.