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A qualitative analysis of a progressive resistance exercise programme for people with Parkinson’s disease



Ballarat Health Services, Ballarat, Victoria, 2Faculty of Health Sciences, La Trobe University, Victoria, Musculoskeletal Research Centre, School of Physiotherapy, Faculty of Health Sciences, La Trobe University, Victoria, and 4Ballarat Community Health Centre, Ballarat, Victoria,Australia

Accepted August 2007

Abstract Purpose. This qualitative study explored the perceptions of adults with Parkinson’s disease (PD) about the positive and negative aspects and outcomes of a community-based progressive resistance strengthening programme (PRST), motivators to begin and continue with the PRST program, and factors that might facilitate or create barriers to participation in andcompletion of a PRST programme. Methods. Three women and 10 men with PD participated in a 10-week community-based strengthening programme. Participants were interviewed at the end of the programme. A phenomenological theoretical framework and a grounded theory methodology were used to underpin the analysis of these data. Results. Four themes emerged about the participants’ experiences of theprogramme. These were: (i) Motivators for participation in the PRST programme were broader than physical outcomes, (ii) the outcomes were broader than just physical outcomes, (iii) the indicators of success for participants varied, and (iv) the participants’ experience of a diseasespecific exercise programme was positive. Conclusions. The outcomes of this study provide insights, not identified throughthe quantitative results, into the experiences of people with PD, which have implications for clinicians running future strength training programmes for people with PD.

Keywords: Strengthening, motor activity, exercise therapy, exercise, Parkinson’s disease, qualitative research, interview

Introduction Muscle weakness is thought to contribute to functional disability in people withParkinson’s disease (PD) [1,2]. Weakness can be due to the primary or the secondary effects of this neurodegenerative condition. Primary weakness can occur due to electrophyiological changes in muscle activation patterns in agonist and antagonistic muscle groups, leading to an inability to coordinate muscle units in a way that optimizes muscle force [3]. Secondary weakness can occur due to inactivity as thedisease progresses, leading to disuse muscle atrophy [4]. Progressive resistance strength training (PRST) uses a high resistance load with a small number of exercise repetitions to increase muscle strength [5].

The muscle is exercised until fatigue, and the resistance is progressively increased over time as the person develops the ability to generate greater force [5]. In healthy older people,PRST has been shown to be effective in increasing the cross-sectional area of muscle, muscle power and endurance [6]. There is also evidence that gains in muscle strength may be associated with improvements in functional activities such as sit-to-stand, walking and stair climbing [6]. Despite increasing clinical interest, few studies have investigated the effects of PRST on people with PD [7,8]. Inaddition, most previous studies have investigated the effect in PRST combined with other interventions such as balance training [8], flexibility and aerobic training [9], and endurance, flexibility

Correspondence: Dr M. O’Brien, Ballarat Health Services, 102 Ascot Street, Ballarat, 3350, Victoria, Australia. Tel: þ61 3 5320 3967. Fax: þ61 3 5320 3800. E-mail: michelleob@bhs.org.au ISSN 0963-8288print/ISSN 1464-5165 online ª 2008 Informa UK Ltd. DOI: 10.1080/09638280701614546

Analysis of PRST program for people with PD and balance training [10,11]. Only one published study [7] was located that evaluated the effects of a PRST programme conducted as a single exercise intervention. In that study, an 8-week programme was conducted twice a week for14 people with PD and six healthy...