Determinants of Adherence and Satisfaction in Parkinson's Disease Exercise Programs: A Comparison of 16-Months of...

Moderate aerobic activities are promising treatment modalities for mitigating motor and cognitive deficits associated with Parkinson's disease (PD). This study aims to characterize the association of PD-specific characteristics with compliance and satisfaction to the moderate-aerobic activity. Thirty-six participants with PD engaged in either adapted Argentine tango (TANGO) (n=20) or supervised walking (WALK) (n=16) classes for 16 months. Participants attended between59 to 76 classes to be fully compliant. Metrics associated with PD characteristics, including frequency and duration of dyskinesia and OFF state, freezing of gait status (FOG), years since PD diagnosis, Hoehn-Yahr Stage and motor and cognitive function, were collected. Linear regression models were used to examine the association of the PD metrics with treatment compliance (number of completed classes) and self-reported program satisfaction composites. Program engagement analysis revealed a wide attendance distribution (range: 1-76 sessions; mean ± SD: 39.1 ± 26.0 sessions) over the 16-month intervention period. Overall participant satisfaction was favorable (mean ± SD: 4.0 ± 0.8 on a 5-point scale) across motor-cognitive, emotional, and psychosocial domains. Multivariate analysis identified significant negative correlations between dyskinesia metrics and program compliance, with both percentage of waking time with dyskinesia (β = -0.381, R² = 0.145, p = 0.055) and total dyskinesia duration (β = -0.377, R² = 0.142, p =0.058) emerging as key predictors. Program compliance demonstrated a positive association with participant satisfaction (β = 0.378, R² = 0.143, p = 0.063). Hierarchical regression analysis of clinical predictors revealed cognitive function (MoCA scores) as the strongest predictor of participant satisfaction (β = 0.396, R² = 0.157, p = 0.050), followed by non-motor daily living scores (UPDRS Part I; β = -0.343, R² = 0.118, p = 0.093) and dyskinesia duration (β = -0.346, R² = 0.120, p = 0.134). Secondary outcome measures including OFF-time duration, MDS-UPDRS total score, and disease duration showed minimal predictive value (all R² < 0.10, p > 0.15). Notably, FOG demonstrated no significant impact on either program satisfaction (R² = 0.022, p = 0.514) or attendance patterns (FOG-positive: 59.1 ± 21.4 vs. FOG-negative: 60.4 ± 18.9 sessions; t-test, p = 0.79). This study demonstrates that PD-related motor and cognitive characteristics significantly influence engagement in moderate-intensity aerobic interventions. While overall satisfaction was high, dyskinesia frequency and duration were associated with reduced compliance, indicating key barriers to participation. In contrast, cognitive functions emerged as the strongest predictor of satisfaction. However, FOG did not show any effect on program compliance or satisfaction. These findings highlight the need for tailored exercise programs that address motor limitations to enhance adherence and therapeutic outcomes.