ORCID
https://orcid.org/0000-0002-2695-238X
Language
English (en)
Date of Award
12-15-2025
Degree Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Chair and Committee
Gammon M. Earhart
Committee Members
Erin R. Foster, Catherine E. Lang, Kerri S. Rawson, Linda R. Van Dillen
Abstract
Parkinson disease (PD) is the second most common neurodegenerative disease, characterized by gait and balance impairments that reduce independence and diminish quality of life. Exercise and other rehabilitation strategies, such as rhythmic auditory cueing, are well-researched methods to address motor impairments. However, despite the strong body of research supporting these approaches, many individuals with PD remain sedentary and do not meet current exercise recommendations. This highlights a critical gap between evidence and real-world behavior.
While prior research identified general motivators and barriers to exercise in people with PD, emerging exercise modalities and the growing diversity of community-based programs emphasize the need to understand how these factors differ by exercise type. Exploring how motivators and barriers vary across exercise forms will better inform the design and promotion of these programs. Dance-based interventions, for example, are one form of exercise for individuals with PD that are associated with increased enjoyment and higher adherence. These programs often address gait, balance, and non-motor symptoms, but few directly target or measure strength, a key component of functional mobility across the disease span. Moreover, despite their benefits, dance-based programs may be perceived as inaccessible by some individuals. There is a need to make evidence-based exercise programs, such as dance, more appealing and approachable. Barre exercise, one promising variation that combines elements of classical ballet with strength training, may be a more accessible exercise form, though to our knowledge, it has not been evaluated in people with PD. One potentially beneficial aspect of barre and other dance-based interventions is the integration of music, which may serve as a rhythmic auditory cue to facilitate movement. While rhythmic auditory cueing is known to improve gait, further research is needed to understand how gait patterns may change within cued walking bouts to optimize cue delivery and practical application.
The primary purposes of this dissertation were to: 1) identify and synthesize motivator and barrier data for various forms of exercise for people with PD, 2) investigate the feasibility of a barre exercise intervention for this population, and 3) examine the effect of both external and internal rhythmic auditory cues on gait during cued walking bouts.
In Chapter 2, individuals with PD completed a remote survey, in which they selected exercise forms they currently participate in, as well as those they would be unwilling to engage in. Participants rated their agreement with pre-determined motivator and barrier statements or typed in their own factors. Walking was the most popular exercise form engaged in; dance was the least. Combining all exercise types, the greatest motivator was perceived benefit to general health, while the top barriers included fear of falling and general dislike. Notably, belief in scientific evidence for an exercise form was one of the lowest ranking motivators, except in the case of boxing, suggesting a mismatch between level of evidence and real-world behavior.
Chapter 3 investigated the feasibility of a barre exercise program for individuals with mild to moderate PD. Primary outcomes included benchmarks of attendance, retention, and acceptability. Secondary outcomes evaluated preliminary trends in balance, gait, functional strength, and quality of life. All feasibility benchmarks were met: participants demonstrated high attendance and retention rates and reported high overall satisfaction. While little change was observed in balance, functional strength, and quality of life from pre- to post-intervention, gait outcomes trended toward improvement. The results suggest barre is both feasible and safe for individuals with PD and may have the potential to positively influence gait. Additionally, the results support the importance of social cohesion and social support in the success of group-based exercise programs.
In Chapter 4, two samples of individuals with PD completed either 30-second (n=100 participants) or 3-minute (n=30 participants) gait trials. Participants walked using an established rhythmic auditory cueing paradigm, employing either externally-generated music cues or internally-generated mental singing cues, both set to 20% above their preferred uncued cadence. Gait data were binned, and we analyzed the effects of cue condition and time on velocity, stride length, and cadence, and their coefficients of variation within a trial, focusing on the beginning and the end. Results demonstrated small but statistically significant gait decrements within both 30-second and 3-minute trials. Additionally, the results suggest that mental cues may lead to increased strides, while music cues lead to increased cadence, illustrating that strategies for maintaining cue pace may differ between cue delivery methods. More specifically, beyond utilizing a particular type of cue (auditory, visual, tactile) to address a specific gait impairment, the cue delivery method may also play a role, reinforcing the value of a deficit-driven approach to cueing. To mitigate potential gait impairments during cued walks, it may be helpful to reintroduce the cue, employ more moderate cues, or implement adaptive cueing strategies tailored to individual needs.
Overall, the results presented in this dissertation enhance our understanding of exercise and rehabilitation interventions for individuals with PD and represent initial steps toward identifying how they may be more effectively and practically implemented. Collectively, these studies emphasize the need for interventions that are not only grounded in evidence but also socially appealing, practical, and easy to adopt. Future research should focus on enhancing the appeal, accessibility, and sustainability of high-quality rehabilitation treatments, while focusing on how they are implemented into the daily lives of people living with PD.
DOI
https://doi.org/10.48765/kffb-v355
Recommended Citation
Haussler, Allison, "Enhancing Exercise Engagement and Gait in Parkinson Disease: Participation Factors, Novel Approaches, and the Role of Rhythmic Auditory Cueing" (2025). WUSM Theses and Dissertations – All Programs. 52.
https://digitalcommons.wustl.edu/all_etd/52
