***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A previous r and omized , controlled trial of tai chi showed improvements in objective ly measured balance and other motor-related outcomes in patients with Parkinson 's disease . This study evaluated whether patient-reported outcomes could be improved through exercise interventions and whether improvements were associated with clinical outcomes and exercise adherence . In a secondary analysis of the tai chi trial , patient-reported and clinical outcomes and exercise adherence measures were compared between tai chi and resistance training and between tai chi and stretching exercise . Patient-reported outcome measures were perceptions of health-related benefits result ing from participation , assessed by the Parkinson 's Disease Question naire ( PDQ-8 ) and Vitality Plus Scale ( VPS ) . Clinical outcome measures included motor symptoms , assessed by a modified Unified Parkinson 's Disease Rating Scale – Motor Examination ( UPDRS-ME ) and a 50-foot speed walk . Information on continuing exercise after the structured interventions were terminated was obtained at a 3-month postintervention follow-up .  Tai chi participants reported significantly better improvement in the PDQ-8 ( −5.77 points , P = 0.014 ) than did resistance training participants and in PDQ-8 ( −9.56 points , P < 0.001 ) and VPS ( 2.80 points , P = 0.003 ) than did stretching participants . For tai chi , patient-reported improvement in the PDQ-8 and VPS was significantly correlated with their clinical outcomes of UPDRS-ME and a 50-foot walk , but these correlations were not statistically different from those shown for resistance training or stretching . However , patient-reported outcomes from tai chi training were associated with greater probability of continued exercise behavior than were either clinical outcomes or patient-reported outcomes from resistance training or stretching . Tai chi improved patient-reported perceptions of health-related benefits , which were found to be associated with a greater probability of exercise adherence . The findings indicate the potential of patient perceptions to drive exercise behavior after structured exercise programs are completed and the value of strengthening such perceptions in any behavioral intervention Objective The short-term benefits of exercise for persons with Parkinson disease ( PD ) are well established , but long-term adherence is limited . The aim of this study was to explore the feasibility , acceptability , and preliminary evidence of the effectiveness of a virtual exercise coach to promote daily walking in community-dwelling persons with Parkinson disease . Design Twenty subjects with Parkinson disease participated in this phase 1 , single-group , nonr and omized clinical trial . The subjects were instructed to interact with the virtual exercise coach for 5 mins , wear a pedometer , and walk daily for 1 mo .  Retention rate , satisfaction , and interaction history were assessed at 1 mo . Six-minute walk and gait speed were assessed at baseline and after the intervention . Results Fifty-five percent of the participants were women , and the mean age was 65.6 yrs . At the study completion , there was 100 % retention rate . The subjects had a mean satisfaction score of 5.6/7 ( with 7 indicating maximal satisfaction ) with the virtual exercise coach . Interaction history revealed that the participants logged in for a mean ( SD ) of 25.4 ( 7 ) days of the recommended 30 days . The mean adherence to daily walking was 85 % . Both gait speed and the 6-min walk test significantly improved ( P < 0.05 ) . No adverse events were reported . Conclusions Sedentary persons with Parkinson disease successfully used a computer and interacted with a virtual exercise coach .  Retention , satisfaction , and adherence to daily walking were high for 1 mo , and significant improvements were seen in mobility This study was carried out to evaluate progression in Parkinson 's disease ( PD ) by analyzing time taken to transit from one Hoehn and Yahr ( H&Y ) stage to the next stage and to investigate the variables that would be associated with H&Y transition times using a large PD data base that contained prospect ively collected information . Data were obtained from the movement disorder data base of the National Neuroscience Institute in Singapore .  Kaplan-Meier ( KM ) survival analysis  was adopted to investigate the time taken to progress through various H&Y stages .  Cox regression analysis was used to examine the association between the baseline variables at the entry point of each H&Y stage and the progression to the next stage . A total of 695 patients ( mean age : 65.2 , male : 57.3 % ) were studied . Using KM analysis , the median time taken to transit from H&Y stage 1 to 2 , 2 to 2.5 , 2.5 to 3 were 20 , 62 , and 25 months , respectively ; whereas the median time taken to progress from stage 3 to 4 and 4 to 5 were 24 and 26 months , respectively . Cox regression analysis revealed that older age-at-diagnosis , longer PD duration , and higher Unified Parkinson 's Disease Rating Scale ( UPDRS ) motor scores at baseline were associated with a significantly faster progression through various H&Y stages . Gender and ethnicity were not associated with disease progression . In conclusion ,  H&Y transition time  is a useful measure of disease progression in PD and may be utilized in clinical studies evaluating therapeutic interventions and prognostic factors in PD OBJECTIVES We recently completed the ParkFit study , a two-year r and omized controlled trial including 586 sedentary Parkinson 's disease ( PD ) patients , that evaluated a multifaceted intervention ( ParkFit program ) to promote physical activity . The results showed that the ParkFit program enables PD patients to become physically more active , suggesting that this intervention should now be further implemented into clinical practice . To facilitate this process , we here evaluate the implementation of the ParkFit program . METHODS The ParkFit program was evaluated in three ways : ( a ) experiences of patients and physiotherapists , as investigated using interviews and question naires ; ( b ) factors associated with changed activity levels ; and ( c ) subgroup analyses to identify differential effects in subgroups of patients based on baseline physical activity level , age , gender , disease severity , disease duration , and mobility . RESULTS The ParkFit program was well received : 73 % of patients indicated they would recommend the program to other patients , and 90 % of physiotherapists indicated they wanted to use the ParkFit program in other patients . Multiple forward regression analysis result ed in a model with two variables : less baseline physical activity , and better mobility were associated with larger changes in levels of physical activity ( R(2)=38 % ) . The program was effective in almost all subgroups . In women , most sedentary patients and patients with higher disease severity , the estimated effect size was largest . CONCLUSION We conclude that the ParkFit program was effective in almost all specific subgroups . Therapists and patients experienced no major hurdles . Suggestions for improvement are : ( 1 ) improve education for therapists with respect to theories about behavioral change ; ( 2 ) formulate concrete and specific examples of exercise goals ; and ( 3 ) pay more specific attention to patients with co morbidities , cognitive dysfunction and a lack of motivation during education OBJECTIVE The expected emotional consequences of future actions are thought to play an important role in health behavior change . This research examined whether anticipated affective consequences of success and failure vary across stages of physical activity change and differentially predict physical activity adoption as compared to maintenance . DESIGN Using a prospect i ve design over a 3-month period , a community sample of 329 healthy , middle-aged adults were assessed at 2 time points . MAIN OUTCOME MEASURES Anticipated positive and negative emotions , stage of behavior change ( precontemplation [ PC ] , contemplation [ C ] , preparation [ P ] , action [ A ] , maintenance [ M ] ) , and level of physical activity . RESULTS At baseline , anticipated positive emotions were greater in C versus PC , whereas anticipated negative emotions were greater in M versus A and in M versus P. Higher anticipated positive but not negative emotions predicted physical activity adoption and maintenance after 3 months . CONCLUSION Although the expected affective consequences of future success and failure differentiated among individuals in the early and later stages of physical activity change , respectively ; only the anticipated affective consequences of success predicted future behavior AIM This study aim ed to evaluate the feasibility and cultural considerations of a minimally supervised , home-based exercise program in Jordan . METHODS Quantitative and qualitative approaches were used . Thirty participants were r and omly allocated to either an 8-week intervention group ( n = 16 ) , or a st and ard care group ( n = 14 ) . The intervention incorporated the home use of an exercise DVD , walking program and initial instructional sessions and weekly phone calls provided by a physiotherapist . Interviews were used to explore feasibility . Unified Parkinson 's disease rating scale ( UPDRS-III ) ; balance and walking speed were assessed . RESULTS The retention rate was 86.7 % and mean adherence rate was 77 % . Personal and sociocultural barriers of adherence to the exercise program were identified . UPDRS-III at follow-up was lower in the intervention group . CONCLUSION A home exercise program was feasible . Sociocultural barriers specific to Arabic culture may affect the uptake of such an intervention in Parkinson 's disease in these countries 
    Output:
    
Conclusion : This review revealed that people with Parkinson 's disease viewed physical activity as an enjoyable and positive experience , which aided with control of their symptoms and enhanced their wellbeing and quality of life .
Aligned with evidence from older adults and those with long-term conditions , this review identified disease presentation , intrapersonal characteristics , program design , external support and the social and physical environment as contributory factors which influenced the ability of people with Parkinson 's disease to sustain  engagement  in physical activity .
The unique contribution and weighting of these factors will affect an individual 's participation in physical activity .
These qualitative findings give healthcare providers an insight into the views and experiences of people with Parkinson 's disease and are useful , alongside quantitative evidence of effectiveness , for the design of physical activity programs that are meaningful for this population .
However , a limitation of this review is that it does not address the views and experiences of people with Parkinson 's disease who are inactive