Project Summary/Abstract:
Exercise is a subset of physical activity that is structured and planned, with a goal to increase fitness. Regular
exercise is associated with slower declines in Parkinson’s-related mobility outcomes and quality of life. However,
fewer than half of people with Parkinson’s disease (PwP) achieve recommended levels of exercise. Exercise
barriers include lowknowledge and expectations of the benefits, mobility concerns, and lack of time or convenient
exercise options. Research is needed to determine how to facilitate exercise initiation, progression, and
maintenance in PwP and those with other disabilities or chronic conditions.
Physical therapy (PT) is a healthcare service that can help PwP and other conditions to address personal
and environmental barriers to exercise. We have successfully piloted a Consultative PT program to help PwP to
increase and maintain their exercise and physical function. We distinguish Consultative PT from traditional PT
by using fewer, less frequent visits. Additionally, Consultative PT focuses on exercise promotion in the presence
of minimal or stable functional deficits, rather than brief but intense episodes of PT for functional gains. However,
referral to Consultative PT challenges traditional perceptions of PT as a treatment for mobility problems. The
proposed effectiveness-implementation hybrid type II study will systematically evaluate Consultative PT in two
dissimilar contexts to inform effective sustainment, equitable spread to other Parkinson’s programs, and future
scaling to other populations that can benefit from exercise monitoring and maintenance.
First, we will use mixed effects regression models to evaluate differences in 12-month physical activity
trajectories between individuals enrolled during periods of (1) standard care, (2) written exercise guidance from
neurologists, and (3) ConsultativePT (Aim1). We will enroll 96 PwP per group. We hypothesize that Consultative
PT will help PwP improve and maintain exercise participation, controlling for disease-specific factors and social
determinants of health. Second, we will contrast consultative PT implementation determinants, strategies,
outcomes, and sustainment between organizations in two dissimilar communities (Aim 2). We will study
determinants at the individual, interpersonal, organizational, and community levels. We hypothesize that
facilitated implementation will lead to similar fidelity, adoption, acceptability, and appropriateness between
organizations, but that the lower-resourced community will experience challenges to reach and sustainment.
This proposal is responsive to the National Institutes of Health notice of special interest on developing and
testing multilevel physical activity interventions (NOT-OD-21-087). Additionally, the proposed project addresses
the Eunice Kennedy Shriver National Institute on Child Health and Human Development’s research theme to
advance safe and effective therapeutic interventions for people with disabilities. Targeting two dissimilar
communities will facilitate the equity of the current and future work to help us optimize abilities for all.
