Use of a Home-Based, Commercial Exercise Platform to Remotely Monitor Aerobic Exercise Adherence and Intensity in People With Parkinson Disease

Abstract

Objective: Physical therapists are well-positioned to prescribe exercise outside of a clinical setting to promote positive health behaviors in people with Parkinson disease (PD). Traditionally, a barrier to precise exercise prescription has been reliance on participant self-reported exercise adherence and intensity. Home-based, commercially available exercise platforms offer an opportunity to remotely monitor exercise behavior and facilitate adherence based on objective performance metrics. The primary aim of this project was to characterize the feasibility and processes of remote aerobic exercise data monitoring from a home-based, commercially available platform in individuals participating in the 12-month Cyclical Lower Extremity Exercise for PD II (CYCLE-II) randomized clinical trial. Secondary aims focused on using exercise behavior to classify the cohort into exercise archetypes and describing a shared decision-making process to facilitate exercise adherence.

Methods: Data from each exercise session were extracted, visualized, and filtered to ensure ride integrity. Weekly exercise frequency was used to determine exercise archetypes: Adherent (2-4 exercise sessions per week), Over-adherent (>4 exercise sessions per week), and Under-adherent (<2 exercise sessions per week).

Results: A total of 123 people with PD completed 22,000+ exercise sessions. Analysis of exercise frequency indicated that 79% of participants were adherent; 8% were over-adherent; and 13% were under-adherent. Three case reports illustrate how shared decision-making with the use of exercise performance data points guided exercise prescription.

Conclusions: The number of exercise sessions and completeness of the data indicate that people with PD were able to utilize a commercial, home-based exercise platform to successfully engage in long-term aerobic exercise. Physical therapists can use objective data as a part of a shared decision-making process to facilitate exercise adherence.

Impact: Commercially available exercise platforms offer a unique approach for physical therapists to monitor exercise behavior outside of a clinical setting. The methods used in this project can serve as a roadmap to utilizing data from consumer-based platforms.

Keywords: Aerobic Exercise; Cycling; Exercise Adherence; Parkinson Disease.

Figure 1

Overview of the data management process for the Cyclical Lower Extremity Exercise for Parkinson Disease II (CYCLE-II) exercise sessions. Over 22,000 rides were recorded and extracted from the Peloton portal from 123 participants with Parkinson disease. Approximately 12.6% of rides were deemed to be of insufficient aerobic duration (red) and were excluded from the final data set. An additional 11.1% of rides were completed by the same rider on the same day in consecutive order and were combined through either summing (time, output) or a weighted average (heart rate, cadence). In total, 17,093 exercise sessions were represented in the final data set. Ex = exercise.

Figure 2

Case series cycling data. The shaded region in each figure represents the recommended weekly exercise duration for people with Parkinson disease per the Parkinson’s Foundation and American College of Sports Medicine (90–150 m/wk). For each week, the aggregate length of workouts (min) is represented by the height of the vertical line (left y-axis), and the mean cadence over the course of those minutes is represented by the corresponding circle (left y-axis). (A) Adherent archetype: the participant was exercising 3x/week and progressing well with exercise duration and cadence until experiencing a significant injury at week 41 that resulted in a 4-week period of biking cessation. Following the imposed rest, the participant slowly progressed back from injury to resume the exercise routine and ultimately completed 133 exercise sessions or 2.9 rides per week (calculated out of 46 weeks due to her medical interruption). (B) Over-adherent archetype: the participant was over-adherent to the exercise program due to cycling 5–7 d/wk with a cadence of 80+ rpms and completed a total of 288 exercise sessions or 5.8 rides per week. (C) Under-adherent: the participant was under-adherent to the exercise program with irregular cycling behaviors and eventually cessation of the program after completing a total of 41 exercise sessions or 0.9 rides per week (calculated out of 46 weeks due to a medical procedure). m = minutes; RPM = revolutions per minute.