## 4 Discussion  
This study investigated the effect of regular exercise habits on the HRQoL in adults with CP and analyzed the relationship between the exercise types of the adults who have exercise habits with CP and their HRQoL. The analysis results showed that adults with CP who had regular exercise habits of at least once a week had significant differences in all items, except BP, compared with those who did not (\(p<0.01\)), suggesting that regular exercise habits have a positive effect on the HRQoL of adults with CP. The results of this study were in keeping with results from previous studies reporting that exercise and physical activities have a positive effect on the HRQoL of adults with CP and other disabled people [8; 25; 26]. The results of a survey on the effect of recreational exercise on the QOL of 129 disabled people participating in adapted sports programs concluded that participation in the programs had a positive effect on individuals' perceptions of health and well-being, reporting that participation in the programs alone causes positive changes in health (79%), QOL (70%), and family life (69.4%) [25]. In addition, other studies have suggested a mechanism by which individuals may feel happiness or rewarded by participating in adapted sports programs, and have reported that they may feel a sense of accomplishment or a sense that their body is in motion through regular physical activity, having a positive effect on mental well-being that increases self-efficacy, self-confidence, and self-esteem [27]. Therefore, such studies have made it clear that, for adults with CP who are able to express their emotions through sports, regular participation in sports has a positive effect on their HRQoL. This study has shown that the presence of exercise habits does not have a significant effect on BP among all subscales of HRQoL. Most adults with CP live their entire lives with chronic pain, so it is one of the most common personal complaints [16; 28; 29]. One study reported that adults with CP who experience chronic pain are often forced to change their way of life, which can eventually be considered a defeat and then cause psychological distress to them [17]. This study has shown that the presence of exercise habits has the least effect on BP in adults with CP, supporting results from previous studies reporting no significant relationship between chronic pain and QOL [8]. In the end, it is considered that a regular exercise habit is not a factor that can solve chronic pain, such as BP, in the HRQoL. The results of correlation analysis for determining the type of relationship between the types of exercise habits of adults with CP and their HRQoL have shown positive (+) correlations with RP only among the physical aspects and with VT, RE, MH, and MCS, excluding SF, among the mental aspects, regarding all subscales of the HRQoL, in terms of exercise duration (\(p<0.05\)), while the results of the analysis of variance showed a significant difference for MH (\(p<0.05\)). Results from previous studies reported that the higher the level of GMFCS, the lower the QOL and HRQoL, and that there was a stronger correlation among the physical aspects, rather than mental ones [30; 31]. Analyzing the two studies, it would be a natural result that adults with CP who suffer a severe degree of disability feel dissatisfaction in terms of physical aspects. However, it is important to note that, even if the degree of disability was not very serious, there was no increase in satisfaction in mental aspects. On the contrary, the results of this study showed that exercise duration had a closer relationship with mental aspects, rather than physical ones, in adults with CP. In other words, with regard to the HRQoL of adults with CP, it has become clear that maintaining regular exercise habits, rather than GMFCS indicating the level of motor functions, is an important factor for improving mental aspects, and that as the duration of exercise increases, the more positively it affects MH.