Experiences of people with Parkinson's disease and their views on physical activity interventions: a qualitative systematic review
Authors: Hunter Heather , Lovegrove Christopher , Haas Bernhard , Freeman Jennifer , Gunn Hilary 
Published: April 2019

ABSTRACT

Objective:
The objective of the review was to synthesize the best available qualitative evidence on the experiences and preferences of people with Parkinson's disease for physical activity, their perceived motivators and barriers to engagement, as well as their views on support mechanisms and behavior change interventions designed to sustain participation.

Introduction:
National and international guidelines recommend regular physical activity to improve health and wellbeing and to prevent disease. Research on Parkinson's disease indicates that physical activity programs can be beneficial in addressing both physical symptoms and overall wellbeing. However, despite recommendations, sustained engagement in regular physical activity among people with Parkinson's disease is limited. To promote physical activity it is important to understand their perspectives on this topic.

Inclusion criteria:
This review considered studies that included a qualitative evaluation of the experiences and views of people with Parkinson's disease regarding physical activity and interventions designed to sustain participation.

Methods:
The databases MEDLINE, Embase, CINAHL, AMED, Scopus and Web of Science, and unpublished studies in sources of grey literature (Google, OpenGrey, MedNar, Conference Paper Index, PQDT) were searched. Language limiters were restricted to English and dates ranged from the inception of the database to June 30, 2017. Two reviewers assessed studies that met the inclusion criteria independently, using the criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. One reviewer completed data extraction using the standardized qualitative data extraction tool. This was checked for accuracy by a second reviewer. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings.

Results:
Nineteen studies were included in this review following assessment of the methodological quality of each study. Two studies were excluded after the methodological review as the findings were not supported by illustrations of the participant voice. Subsequently, 105 findings were extracted and aggregated into 20 categories and eight synthesized findings. Methodological quality was variable and overall confidence in the findings was determined to be low.

Conclusion:
This review revealed that people with Parkinson's disease viewed physical activity as an enjoyable and positive experience, which aided with control of their symptoms and enhanced their wellbeing and quality of life. Aligned with evidence from older adults and those with long-term conditions, this review identified disease presentation, intrapersonal characteristics, program design, external support and the social and physical environment as contributory factors which influenced the ability of people with Parkinson's disease to sustain engagement in physical activity. The unique contribution and weighting of these factors will affect an individual's participation in physical activity. This review provides important insights into the challenges of undertaking physical activity while living with a progressive and fluctuating disease. These qualitative findings give healthcare providers an insight into the views and experiences of people with Parkinson's disease and are useful, alongside quantitative evidence of effectiveness, for the design of physical activity programs that are meaningful for this population. However, a limitation of this review is that it does not address the views and experiences of people with Parkinson's disease who are inactive.