Pre-Active PD: Looking At Physical Activity Behavior Change in Parkinson's Disease

This study will utilize a randomized controlled trial design to assess the feasibility and acceptability of the Pre-Active PD intervention for people with Parkinson's Disease who are in the early disease stage (Hoehn \& Yahr stage I or II). The study will compare an experimental group (occupational therapy for exercise behavior change) to a control group (education only). Both groups will be matched for contact time. Individuals will be recruited through the Columbia University Medical Center Parkinson's Disease Center of Excellence. The study will also be listed on the Fox Trial Finder, a website maintained through the Michael J Fox Foundation. Individuals who choose to participate will be screened for eligibility using the inclusion/exclusion criteria and complete the PAR-Q+ safety screen or have medical clearance from their general practitioner. After randomization, participants will be assessed for cognition and history of occupational therapy (OT) and physical therapy (PT). Measures of acceptability will include retention and completion rates, Fitbit wear-time, and the Perceived Autonomy Support Healthcare Climate Questionnaire (PAS-HCCQ). Implementation will be assessed by the Rating Tool to Assess Fidelity of Intervention Delivery. Physical activity levels will be measured by a wearable activity monitor (Actigraph™ GT9X), worn 7 consecutive days pre and post intervention and 2nd follow-up, as well as a questionnaire. We will also use the Self-Efficacy for Exercise Scale and measure balance and mobility. Descriptive statistics (mean, standard deviation) will be calculated for all demographic information and resultant outcome measures.

Baseline and follow-up outcome measures include the following domains: exercise self-efficacy scale, exercise motivation (Behavioral Regulation In Exercise Questionnaire, physical activity levels (Brunel Lifestyle Physical Activity Questionnaire; ActiGraphTM wearable activity monitor, and Modified PA-R Question), physical performance measures (TUG Single Task and Dual Task Cognitive Version; 30 second sit-to-stand; Modified 2 Minute Step Test), self-perception measures (Modified Canadian Occupational Performance Measure; Patients' Global Impression of Change scale), and the Life Space Assessment.

Participants assigned to the occupational therapy intervention group, will receive 6 telehealth coaching sessions and 8 brief email or text check-ins over the course of 4 months. They will also receive a Fitbit and Engage PD Workbook. The third coaching session will be audio and video-recorded (if consented) and later viewed by an assessor to determine how well the intervention was delivered. The recording will be stored until completion of the study. Declining to be recorded will not affect study participation.

The OT intervention group will utilize the Pre-Active PD program (Clinicaltrials.gov NCT03696589) to guide the delivery of the intervention. This will include a checklist of the key elements that are important for the therapist in order to facilitate PA behavior change. In addition, the therapist will utilize motivational interviewing strategies that include four processes (engaging, evoking, planning, and tracking) and five core communication skills (asking open ended questions, affirming, reflective listening, summarizing, and informing and advising). The therapist will introduce the Pre-Active PD workbook and utilize it as a tool and reference for the participant in order to engage and focus them throughout the coaching process, and will educate participants on the types of exercise options and the specific exercise benefits for PD. In the planning process, the therapist will facilitate discussion on development of specific and measurable goals, and will give the participant a Fitbit physical activity monitor so that they can self-monitor their heart rate and physical activity during the course of the intervention period. The recommended exercises will be individualized to each participant but will primarily focus on increasing general physical activity (e.g. steps per day) as well as engagement in moderate-vigorous intensity aerobic exercise a minimum of three times per week. Balance and strengthening exercises will also be recommended as appropriate. Participants will also be given a short exercise safety checklist to assure safety when conducting home exercises.

Participants assigned to the disease management education group, will receive online educational videos that can be watched at their own convenience over the course of 4 months. There will be up to 6 hours of content, and the links to these online videos will be provided via email. Following completion of the study, individuals in the control group will receive an Engage PD Workbook and one OT coaching session.