1
|
Kasanga EA, Soto I, Centner A, McManus R, Shifflet MK, Navarrete W, Han Y, Lisk J, Ehrhardt T, Wheeler K, Mhatre-Winters I, Richardson JR, Bishop C, Nejtek VA, Salvatore MF. Moderate intensity aerobic exercise alleviates motor deficits in 6-OHDA lesioned rats and reduces serum levels of biomarkers of Parkinson's disease severity without recovery of striatal dopamine or tyrosine hydroxylase. Exp Neurol 2024; 379:114875. [PMID: 38944332 DOI: 10.1016/j.expneurol.2024.114875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/11/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
Alleviation of motor impairment by aerobic exercise (AE) in Parkinson's disease (PD) patients points to activation of neurobiological mechanisms that may be targetable by therapeutic approaches. However, evidence for AE-related recovery of striatal dopamine (DA) signaling or tyrosine hydroxylase (TH) loss has been inconsistent in rodent studies. This ambiguity may be related to the timing of AE intervention in relation to the status of nigrostriatal neuron loss. Here, we replicated human PD at diagnosis by establishing motor impairment with >80% striatal DA and TH loss prior to initiating AE, and assessed its potential to alleviate motor decline and restore DA and TH loss. We also evaluated if serum levels of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP), biomarkers of human PD severity, changed in response to AE. 6-hydroxydopamine (6-OHDA) was infused unilaterally into rat medial forebrain bundle to induce progressive nigrostriatal neuron loss over 28 days. Moderate intensity AE (3× per week, 40 min/session), began 8-10 days post-lesion following establishment of impaired forelimb use. Striatal tissue DA, TH protein and mRNA, and serum levels of NfL/GFAP were determined 3-wks after AE began. Despite severe striatal DA depletion at AE initiation, forelimb use deficits and hypokinesia onset were alleviated by AE, without recovery of striatal DA or TH protein loss, but reduced NfL and GFAP serum levels. This proof-of-concept study shows AE alleviates motor impairment when initiated with >80% striatal DA loss without obligate recovery of striatal DA or TH protein. Moreover, the AE-related reduction of NfL and GFAP serum levels may serve as objective blood-based biomarkers of AE efficacy.
Collapse
Affiliation(s)
- Ella A Kasanga
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Isabel Soto
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Ashley Centner
- Department of Psychology, Binghamton University, Binghamton, NY, United States of America
| | - Robert McManus
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Marla K Shifflet
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Walter Navarrete
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Yoonhee Han
- Department of Environmental Health Sciences, Robert Stempel School of Public Health & Social Work, Florida International University, Miami, FL, United States of America; Isakson Center for Neurological Disease Research, College of Veterinary Medicine, University of Georgia, Athens, GA, United States of America
| | - Jerome Lisk
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Travis Ehrhardt
- Clearcut Ortho Rehab & Diagnostics, Fort Worth, TX, United States of America
| | - Ken Wheeler
- Clearcut Ortho Rehab & Diagnostics, Fort Worth, TX, United States of America
| | - Isha Mhatre-Winters
- Department of Environmental Health Sciences, Robert Stempel School of Public Health & Social Work, Florida International University, Miami, FL, United States of America; Isakson Center for Neurological Disease Research, College of Veterinary Medicine, University of Georgia, Athens, GA, United States of America
| | - Jason R Richardson
- Department of Environmental Health Sciences, Robert Stempel School of Public Health & Social Work, Florida International University, Miami, FL, United States of America; Isakson Center for Neurological Disease Research, College of Veterinary Medicine, University of Georgia, Athens, GA, United States of America
| | - Christopher Bishop
- Department of Psychology, Binghamton University, Binghamton, NY, United States of America
| | - Vicki A Nejtek
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Michael F Salvatore
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States of America.
| |
Collapse
|
2
|
Bode M, Kalbe E, Liepelt-Scarfone I. Cognition and Activity of Daily Living Function in people with Parkinson's disease. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02796-w. [PMID: 38976044 DOI: 10.1007/s00702-024-02796-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024]
Abstract
The ability to perform activities of daily living (ADL) function is a multifaceted construct that reflects functionality in different daily life situations. The loss of ADL function due to cognitive impairment is the core feature for the diagnosis of Parkinson's disease dementia (PDD). In contrast to Alzheimer's disease, ADL impairment in PD can be compromised by various factors, including motor and non-motor aspects. This narrative review summarizes the current state of knowledge on the association of cognition and ADL function in people with PD and introduces the concept of "cognitive ADL" impairment for those problems in everyday life that are associated with cognitive deterioration as their primary cause. Assessment of cognitive ADL impairment is challenging because self-ratings, informant-ratings, and performance-based assessments seldomly differentiate between "cognitive" and "motor" aspects of ADL. ADL function in PD is related to multiple cognitive domains, with attention, executive function, and memory being particularly relevant. Cognitive ADL impairment is characterized by behavioral anomalies such as trial-and-error behavior or task step omissions, and is associated with lower engagement in everyday behaviors, as suggested by physical activity levels and prolonged sedentary behavior. First evidence shows that physical and multi-domain interventions may improve ADL function, in general, but the evidence is confounded by motor aspects. Large multicenter randomized controlled trials with cognitive ADL function as primary outcome are needed to investigate which pharmacological and non-pharmacological interventions can effectively prevent or delay deterioration of cognitive ADL function, and ultimately the progression and conversion to PDD.
Collapse
Affiliation(s)
- Merle Bode
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Eberhard Karls University Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Eberhard Karls University Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
- IB-Hochschule, Stuttgart, Germany.
| |
Collapse
|
3
|
Ahern L, Timmons S, Lamb SE, McCullagh R. Behavioural change for Parkinson's Disease: A randomised controlled feasibility study to promote physical activity and exercise adherence among people with Parkinson's: study protocol. HRB Open Res 2024; 7:7. [PMID: 38784965 PMCID: PMC11109530 DOI: 10.12688/hrbopenres.13843.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
Background Parkinson's is a common progressive neurological condition characterized by motor and non-motor deficits. Physical activity and exercise can improve health, but many people with Parkinson's (PwP) have trouble reaching the recommended dosage. Our recent literature review found improvements in exercise adherence with behavioural change interventions, but it remains unclear which are most effective. Further qualitative research and patient and public involvement has informed a novel behavioural change intervention to be tested alongside an existing exercise program. Objective To examine the feasibility of behavioural change techniques delivered alongside an exercise programme to improve physical activity, function, and self-efficacy in PwP (and study procedures) to inform a future pilot RCT trial. Methods A parallel-arm single blinded randomised feasibility study. Twenty participants with Parkinson's (Hoehn and Yahr stage 1-3) will be recruited from a physiotherapy primary-care waiting list. Following written consent, and baseline assessment, the participants will be randomly allocated to the intervention (n=10) or the control group (n=10). Both groups will receive usual care, which includes a weekly program of a multidisciplinary education, a supervised exercise class and a prescribed home exercise program. The intervention group will receive additional behavioural change techniques, targeting behaviour regulation, belief about capabilities and social influences. Class and home exercise adherence, behavioural component uptake and adherence, and negative events will be recorded. Outcomes will include enrolment and maintenance rates, physical function, falls, physical activity, and exercise self-efficacy measured pre- and post- the 12-week program (in-person). Surveys will be used to compare experiences and satisfaction between groups. Exit interviews will be completed with the intervention group only, exploring their experience of the behavioural change techniques. Discussion The results will help inform a future pilot RCT, based on the intervention acceptability, consent rate, maintenance, and protocol integrity. Trial Registration ClincialTrials.gov NCT06192628.
Collapse
Affiliation(s)
- Leanne Ahern
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, College of Medicine and Health, University College Cork, Cork, County Cork, Ireland
| | - Sarah E. Lamb
- Faculty of Health and Life Sciences, University of Exeter, Exeter, England, UK
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
| |
Collapse
|
4
|
van den Bergh R, Evers LJW, de Vries NM, Silva de Lima AL, Bloem BR, Valenti G, Meinders MJ. Usability and utility of a remote monitoring system to support physiotherapy for people with Parkinson's disease. Front Neurol 2023; 14:1251395. [PMID: 37900610 PMCID: PMC10601712 DOI: 10.3389/fneur.2023.1251395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/07/2023] [Indexed: 10/31/2023] Open
Abstract
Background Physiotherapy for persons with Parkinson's disease (PwPD) could benefit from objective and continuous tracking of physical activity and falls in daily life. Objectives We designed a remote monitoring system for this purpose and describe the experiences of PwPD and physiotherapists who used the system in daily clinical practice. Methods Twenty-one PwPD (15 men) wore a sensor necklace to passively record physical activity and falls for 6 weeks. They also used a smartphone app to self-report daily activities, (near-)falls and medication intake. They discussed those data with their PD-specialized physiotherapist (n = 9) during three regular treatment sessions. User experiences and aspects to be improved were gathered through interviews with PwPD and physiotherapists, resulting in system updates. The system was evaluated in a second pilot with 25 new PwPD (17 men) and eight physiotherapists. Results We applied thematic analysis to the interview data resulting in two main themes: usability and utility. First, the usability of the system was rated positively, with the necklace being easy to use. However, some PwPD with limited digital literacy or cognitive impairments found the app unclear. Second, the perceived utility of the system varied among PwPD. While many PwPD were motivated to increase their activity level, others were not additionally motivated because they perceived their activity level as high. Physiotherapists appreciated the objective recording of physical activity at home and used the monitoring of falls to enlarge awareness of the importance of falls for PwPD. Based on the interview data of all participants, we drafted three user profiles for PwPD regarding the benefits of remote monitoring for physiotherapy: for profile 1, a monitoring system could act as a flagging dashboard to signal the need for renewed treatment; for profile 2, a monitoring system could be a motivational tool to maintain physical activity; for profile 3, a monitoring system could passively track physical activity and falls at home. Finally, for a subgroup of PwPD the burdens of monitoring will outweigh the benefits. Conclusions Overall, both PwPD and physiotherapists underline the potential of a remote monitoring system to support physiotherapy by targeting physical activity and (near-)falls. Our findings emphasize the importance of personalization in remote monitoring technology, as illustrated by our user profiles.
Collapse
Affiliation(s)
- Robin van den Bergh
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
| | - Luc J. W. Evers
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
- Radboud University, Institute for Computing and Information Sciences, Department of Data Science, Nijmegen, Netherlands
| | - Nienke M. de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
| | - Ana L. Silva de Lima
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
| | - Giulio Valenti
- Philips Research, Department of Connected Care and Remote Patient Management, Eindhoven, Netherlands
| | - Marjan J. Meinders
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, Netherlands
| |
Collapse
|
5
|
Danoudis M, Iansek R. Physical activity levels in people with Parkinson's disease treated by subthalamic nucleus deep brain stimulation. Disabil Rehabil 2023; 45:2890-2895. [PMID: 36124542 DOI: 10.1080/09638288.2022.2112626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To explore the physical activity of people with Parkinson's disease (PD) with subthalamic nucleus deep brain stimulation (STN-DBS) and investigate factors associated with physical activity. METHODS Twenty-four participants who had STN-DBS for one or more years were recruited. Eligibility criteria included Hoehn and Yahr stage ≤ 4, continuation of STN-DBS, living at home and able to provide informed consent. Physical activity was measured using the self-report physical activity scale for the elderly (PASE). Motor and non-factors that influence physical activity in PD, such as gait disturbance and mood, were recorded using clinical measures. RESULTS Participants had long-standing PD of moderate severity, mean Hoehn and Yahr 2.3, and mild to moderate functional disability, MDS-UPDRS M-EDL mean 16.2. PASE scores were significantly lower compared to norms for adults ≤ 70 years (115.2 versus 143, p= 0.045). There was a significant negative correlation between PASE scores and falls history, fatigue, fear of falling (FOF) and quality of life (p < 0.05). CONCLUSIONS This study provides further evidence that physical activity levels in PD with STN-DBS remain low compared to PASE norms for older adults. Future research investigating interventions to improve factors associated with low physical activity levels should be considered.Implications for RehabilitationDespite the benefits of deep brain stimulation (DBS) on motor function and activities of daily living, physical activity levels remain low in people with Parkinson's disease (PD) with subthalamic nucleus (STN)-DBS compared to norms for older adults.A history of falls, greater fear of falling (FOF) and higher levels of fatigue are associated with lower levels of physical activity in people with PD with STN-DBS.When planning rehabilitation interventions consideration should be given to strategies that promote and support regular physical activity for people with PD with STN-DBS.Rehabilitation clinicians should consider using falls prevention programmes and include strategies to decrease FOF for people with PD with STN-DBS.Consideration should be given to the presence of fatigue when planning the rehabilitation programme for the person with PD with STN-DBS.
Collapse
Affiliation(s)
- Mary Danoudis
- Clinical Research Centre for Movement Disorders and Gait, Parkinson's Foundation Centre of Excellence, Kington Centre, Monash Health, Cheltenham, Australia
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, Parkinson's Foundation Centre of Excellence, Kington Centre, Monash Health, Cheltenham, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, Australia
| |
Collapse
|
6
|
Kasanga EA, Soto I, Centner A, McManus R, Shifflet MK, Navarrete W, Han Y, Lisk J, Wheeler K, Mhatre-Winters I, Richardson JR, Bishop C, Nejtek VA, Salvatore MF. Moderate intensity aerobic exercise in 6-OHDA-lesioned rats alleviates established motor deficits and reduces neurofilament light and glial fibrillary acidic protein serum levels without increased striatal dopamine or tyrosine hydroxylase protein. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.11.548638. [PMID: 37502851 PMCID: PMC10369940 DOI: 10.1101/2023.07.11.548638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Alleviation of motor impairment by aerobic exercise (AE) in Parkinson's disease (PD) points to a CNS response that could be targeted by therapeutic approaches, but recovery of striatal dopamine (DA) or tyrosine hydroxylase (TH) has been inconsistent in rodent studies. Objective To increase translation of AE, 3 components were implemented into AE design to determine if recovery of established motor impairment, concomitant with >80% striatal DA and TH loss, was possible. We also evaluated if serum levels of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP), blood-based biomarkers of disease severity in human PD, were affected. Methods We used a 6-OHDA hemiparkinson rat model featuring progressive nigrostriatal neuron loss over 28 days, with impaired forelimb use 7 days post-lesion, and hypokinesia onset 21 days post-lesion. After establishing forelimb use deficits, moderate intensity AE began 1-3 days later, 3x per week, for 40 min/session. Motor assessments were conducted weekly for 3 wks, followed by determination of striatal DA, TH protein and mRNA, and NfL and GFAP serum levels. Results Seven days after 6-OHDA lesion, recovery of depolarization-stimulated extracellular DA and DA tissue content was <10%, representing severity of DA loss in human PD, concomitant with 50% reduction in forelimb use. Despite severe DA loss, recovery of forelimb use deficits and alleviation of hypokinesia progression began after 2 weeks of AE and was maintained. Increased NfLand GFAP levels from lesion were reduced by AE. Despite these AE-driven changes, striatal DA tissue and TH protein levels were unaffected. Conclusions This proof-of-concept study shows AE, using exercise parameters within the capabilities most PD patients, promotes recovery of established motor deficits in a rodent PD model, concomitant with reduced levels of blood-based biomarkers associated with PD severity, without commensurate increase in striatal DA or TH protein.
Collapse
|
7
|
Girnis JL, Cavanaugh JT, Baker TC, Duncan RP, Fulford D, LaValley MP, Lawrence M, Nordahl T, Porciuncula F, Rawson KS, Saint-Hilaire M, Thomas CA, Zajac JA, Earhart GM, Ellis TD. Natural Walking Intensity in Persons With Parkinson Disease. J Neurol Phys Ther 2023; 47:146-154. [PMID: 37016469 PMCID: PMC10330027 DOI: 10.1097/npt.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND AND PURPOSE Few persons with Parkinson disease (PD) appear to engage in moderate-intensity walking associated with disease-modifying health benefits. How much time is spent walking at lower, yet still potentially beneficial, intensities is poorly understood. The purpose of this exploratory, observational study was to describe natural walking intensity in ambulatory persons with PD. METHODS Accelerometer-derived real-world walking data were collected for more than 7 days at baseline from 82 participants enrolled in a PD clinical trial. Walking intensity was defined according to the number of steps in each active minute (1-19, 20-39, 40-59, 60-79, 80-99, or ≥100 steps). Daily minutes of walking and duration of the longest sustained walking bout were calculated at each intensity. Number of sustained 10 to 19, 20 to 29, and 30-minute bouts and greater at any intensity also were calculated. Values were analyzed in the context of physical activity guidelines. RESULTS Most daily walking occurred at lower intensities (157.3 ± 58.1 min of 1-19 steps; 81.3 ± 32.6 min of 20-39 steps; 38.2 ± 21.3 min of 40-59 steps; 15.1 ± 11.5 min of 60-79 steps; 7.4 ± 7.0 min of 80-99 steps; 7.3 ± 9.6 min of ≥100 steps). The longest daily sustained walking bout occurred at the lowest intensity level (15.9 ± 5.2 min of 1-19 steps). Few bouts lasting 20 minutes and greater occurred at any intensity. DISCUSSION AND CONCLUSIONS Despite relatively high daily step counts, participants tended to walk at remarkably low intensity, in bouts of generally short duration, with relatively few instances of sustained walking. The findings reinforced the need for health promotion interventions designed specifically to increase walking intensity.Video Abstract available for more insight from authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A426 ).
Collapse
Affiliation(s)
- Jaimie L. Girnis
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - James T. Cavanaugh
- Department of Physical Therapy, University of New England, Portland, Maine
| | - Teresa C. Baker
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Ryan P. Duncan
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Daniel Fulford
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | | | - Michael Lawrence
- Department of Physical Therapy, University of New England, Portland, Maine
| | - Timothy Nordahl
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Franchino Porciuncula
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Kerri S. Rawson
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Boston University, Boston Massachusetts
| | - Cathi A. Thomas
- Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Boston University, Boston Massachusetts
| | - Jenna A. Zajac
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Gammon M. Earhart
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Neuroscience, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Terry D. Ellis
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| |
Collapse
|
8
|
Zajac JA, Cavanaugh JT, Baker T, Duncan RP, Fulford D, Girnis J, LaValley M, Nordahl T, Porciuncula F, Rawson KS, Saint-Hilaire M, Thomas CA, Earhart GM, Ellis TD. Does clinically measured walking capacity contribute to real-world walking performance in Parkinson's disease? Parkinsonism Relat Disord 2022; 105:123-127. [PMID: 36423521 PMCID: PMC9722599 DOI: 10.1016/j.parkreldis.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/05/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study examined how clinically measured walking capacity contributes to real-world walking performance in persons with Parkinson's disease (PD). METHODS Cross-sectional baseline data (n = 82) from a PD clinical trial were analyzed. The 6-Minute Walk Test (6MWT) and 10-Meter Walk Test (10MWT) were used to generate capacity metrics of walking endurance and fast gait speed, respectively. An activity monitor worn for seven days was used to generate performance metrics of mean daily steps and weekly moderate intensity walking minutes. Univariate linear regression analyses were used to examine associations between each capacity and performance measure in the full sample and less and more active subgroups. RESULTS Walking capacity significantly contributed to daily steps in the full sample (endurance: R2=.13, p < .001; fast gait speed: R2=.07, p = .017) and in the less active subgroup (endurance: R2 =.09, p = .045). Similarly, walking capacity significantly contributed to weekly moderate intensity minutes in the full sample (endurance: R2=.13, p < .001; fast gait speed: R2=.09, p = .007) and less active subgroup (endurance: R2 = .25, p < .001; fast gait speed: R2 =.21, p = .007). Walking capacity did not significantly contribute to daily steps or moderate intensity minutes in the more active subgroup. CONCLUSIONS Walking capacity contributed to, but explained a relatively small portion of the variance in, real-world walking performance. The contribution was somewhat greater in less active individuals. The study adds support to the idea that clinically measured walking capacity may have limited benefit for understanding real-world walking performance in PD. Factors beyond walking capacity may better account for actual walking behavior.
Collapse
Affiliation(s)
- Jenna A Zajac
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA.
| | - James T Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Teresa Baker
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Ryan P Duncan
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Neurology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Daniel Fulford
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Jaimie Girnis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | | | - Timothy Nordahl
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Franchino Porciuncula
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Kerri S Rawson
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University, Boston, MA, USA
| | - Cathi A Thomas
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University, Boston, MA, USA
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Neurology, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Neuroscience, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Terry D Ellis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| |
Collapse
|
9
|
Dong S, Wang Y, Wei H, Du S, Li X, Zhu J, Wang Y, Cai Z. Effects of Baduanjin Exercise on Rehabilitation of Patients With Mild to Moderate Parkinson’s Disease. Front Neurosci 2022; 15:827180. [PMID: 35126049 PMCID: PMC8811304 DOI: 10.3389/fnins.2021.827180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives Rehabilitation, aerobic exercise, and many traditional Chinese exercises are known to significantly improve balance in patients with Parkinson’s disease. Baduanjin, a traditional physical and mental exercise, has long been practiced for health care as it regulates organs, the nervous and motor systems. Methods We recruited 31 eligible participants. Patients underwent a 3-week Baduanjin program, including 35-min exercise daily. Scores on the Modified Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Non-motor Symptoms Scale (NMSS), and gait and balance tests were compared before and after the Baduanjin program. Results MDS-UPDRS-total (t = 4.669, P ≤ 0.001), MDS-UPDRS part-I (t = 5.805, P ≤ 0.001), MDS-UPDRS part-II (t = 5.234, P ≤ 0.001), MDS-UPDRS part-III (t = 3.274, P = 0.003), and NMSS (t = 4.815, P ≤ 0.001) scores significantly decreased after the 3-week intervention. Gait parameters like step (t = 2.289, P = 0.030) and cycle (t = 2.181, P = 0.038) durations also significantly improved, while Balance-check® indicators, including the total score (t = −2.147, P = 0.041) and grade (t = 3.432, P = 0.002) significantly differed before and after exercise. Conclusion Baduanjin exercise shows beneficial effects for non-motor symptoms, balance, gait, and daily activities in patients with Parkinson’s disease. Baduanjin can be included in the patients’ family exercise, which is conducive to their rehabilitation, as well as for obtaining important social and economic benefits. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [ChiCTR-IPR-17011875].
Collapse
Affiliation(s)
- Shuangshuang Dong
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Yiqing Wang
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Hongyu Wei
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Shouyun Du
- Department of Neurology, Guanyun People’s Hospital, Lianyungang, China
| | - Xiaojing Li
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Jianbing Zhu
- Department of Radiology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Yi Wang
- Department of Radiology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Zenglin Cai
- Department of Neurology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
- Department of Neurology, Gusu University of Nanjing Medical University, Suzhou, China
- Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- *Correspondence: Zenglin Cai,
| |
Collapse
|
10
|
Domingos J, de Lima ALS, Steenbakkers-van der Pol T, Godinho C, Bloem BR, de Vries NM. Boxing with and without Kicking Techniques for People with Parkinson's Disease: An Explorative Pilot Randomized Controlled Trial. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2585-2593. [PMID: 36245387 PMCID: PMC9837687 DOI: 10.3233/jpd-223447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND People with Parkinson's disease (PD) benefit from boxing exercise. Adding kicking variations to the boxing may provide additional benefit to improve balance. However, the benefits and adherence to such trainings is unknown. OBJECTIVE To explore the feasibility, safety, and benefits on balance of boxing training combined with kicking techniques in comparison to boxing without kicking in PD. METHODS Participants were randomized to group-based boxing training with kicking techniques (BK) or to group-based boxing alone training (BO). Both groups trained for one hour, once a week, for a period of 10 weeks. Participants were assessed at baseline and ten weeks post-intervention for difference in balance, fear of falling, balance confidence, walking ability, and quality of life. RESULTS Twenty-nine people with PD (median age 64 years; median disease duration 5 years) participated. Both interventions were feasible and acceptable for all participants. No adverse events occurred. Most participants (BK 80%; BO 75%) were satisfied with the training. We found no significant between group difference on either the primary (Mini-BEST) or secondary outcomes. The within group comparison showed that balance improved in both groups after the intervention (BK 22.60 (2.7) to 25.33 (2.64) p = 0.02; BO 23.09 (3.44) to 25.80 (2.39); p = 0.01 on the Mini BEST test). CONCLUSION Both types of boxing seem to be feasible and safe. Adding kicking techniques to boxing does not improve balance significantly more than boxing alone. Incorporation of kicking may be a valuable addition to the exercise therapy repertoire.
Collapse
Affiliation(s)
- Josefa Domingos
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Monte de Caparica, Portugal
| | - Ana Ligia Silva de Lima
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Tessa Steenbakkers-van der Pol
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Monte de Caparica, Portugal
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Nienke M. de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| |
Collapse
|
11
|
Leavy B, Hagströmer M, Conradsson DM, Franzén E. Physical Activity and Perceived Health in People With Parkinson Disease During the First Wave of Covid-19 Pandemic: A Cross-sectional Study From Sweden. J Neurol Phys Ther 2021; 45:266-272. [PMID: 34369451 DOI: 10.1097/npt.0000000000000372] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND People with Parkinson disease (PD) are known to be at risk of physical inactivity and may therefore be especially vulnerable to negative health outcomes during the COVID-19 pandemic due to social distancing recommendations. PURPOSE To investigate sensor-derived physical activity and perceived health of people with PD during the first wave of the COVID-19 pandemic, as well as the factors associated with these outcomes. METHODS Physical activity was measured over 7 days using the Actigraph GT3x accelerometer. Data were collected regarding perceived health status and physical activity habits, as well as rehabilitation attendance during the pandemic. Multiple linear and logistic regression analyses were used to identify factors associated with physical activity and perceived changes in health. RESULTS Of 89 participants, a majority (67%) reported a pandemic-related reduction in exercise habits. Women more commonly reported a reduction in scheduled exercise and cancelled rehabilitation than men. Study participants took on average 5876 ± 3180 steps per day. In the multivariate analysis, female gender, being 70 years of age and older, and greater reported mobility problems were associated with being less physically active. A pandemic-induced deterioration in health was reported by 42% and women were 5 times more likely than men to do so (odds ratio: 5.12, 95% confidence interval, 1.87-15.03; P = 0.002). DISCUSSION AND CONCLUSIONS Despite a pandemic-related reduction in reported exercise habits and rehabilitation, the participants in this Swedish sample were relatively physically active. However, women were less active at moderate-vigorous levels and were at greater risk of deterioration in perceived health during this time.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A359).
Collapse
Affiliation(s)
- Breiffni Leavy
- Department of Neurobiology (B.L., M.H., D.A.C., E.F.), Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden; Research and Development Department (B.L., E.F.), Stockholm Sjukhem's Foundation, Stockholm, Sweden; Academic Primary Care Centre (M.H.), Region Stockholm, Stockholm, Sweden; and Medical Unit Occupational Therapy & Physiotherapy (D.M.C., E.F.), Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | |
Collapse
|
12
|
Handlery R, Stewart JC, Pellegrini C, Monroe C, Hainline G, Flach A, Handlery K, Fritz S. Physical Activity in De Novo Parkinson Disease: Daily Step Recommendation and Effects of Treadmill Exercise on Physical Activity. Phys Ther 2021; 101:6317708. [PMID: 34244805 DOI: 10.1093/ptj/pzab174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/19/2021] [Accepted: 05/11/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE People with Parkinson disease (PD) have low physical activity (PA) levels and are at risk for cardiovascular events. The 3 purposes of this study were to determine a step threshold that corresponds to meeting aerobic PA guidelines, determine effects of treadmill exercise on PA, and quantify the relationship between changes in daily steps and fitness. METHODS This was a secondary analysis of the Study in Parkinson's Disease of Exercise trial, which randomized participants to high-intensity treadmill exercise, moderate-intensity treadmill exercise, or usual care for 6 months. Daily steps and moderate- to vigorous-intensity PA (MVPA) were assessed at baseline and once each month using an activity monitor. Fitness was assessed via graded exercise test at baseline and at 6 months. A step threshold that corresponds to meeting PA guidelines was determined by receiver operating characteristic curves. The effect of treadmill exercise on PA was examined in those below the step threshold (ie, the least active participants). Pearson r correlations determined the relationship between daily steps and fitness. RESULTS Individuals with de novo PD (n = 110) were included. Those with ≥4200 steps were 23 times more likely (95% CI = 7.72 to 68) to meet PA guidelines than those with <4200 steps. For those with <4200 steps at baseline (n = 33), only those in the high-intensity exercise group increased daily steps (median of differences = 1250 steps, z = -2.35) and MVPA (median of differences = 12.5 minutes, z = -2.67) at 6 months. For those with <4200 steps, changes in daily steps were not associated with changes in fitness (r = .183). CONCLUSION In people with PD and <4200 daily steps at baseline, high-intensity treadmill exercise increased daily steps and MVPA, but these changes were not associated with changes in fitness. IMPACT People with PD should be encouraged to take ≥4200 daily steps to meet PA guidelines through walking.
Collapse
Affiliation(s)
- Reed Handlery
- School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, Arkansas, USA
| | - Jill Campbell Stewart
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Christine Pellegrini
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Courtney Monroe
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Garrett Hainline
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Alicia Flach
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Kaci Handlery
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| | - Stacy Fritz
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, South Carolina, USA
| |
Collapse
|
13
|
von Rosen P, Hagströmer M, Franzén E, Leavy B. Physical activity profiles in Parkinson's disease. BMC Neurol 2021; 21:71. [PMID: 33581724 PMCID: PMC7881685 DOI: 10.1186/s12883-021-02101-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background Identifying physical activity (PA) profiles of people with Parkinson’s Disease (PD) could provide clinically meaningful knowledge concerning how to tailor PA interventions. Our objectives were therefore to i) identify distinct PA profiles in people with PD based on accelerometer data, ii) explore differences between the profiles regarding personal characteristics and physical function. Methods Accelerometer data from 301 participants (43% women, mean age: 71 years) was analysed using latent profile analyses of 15 derived PA variables. Physical function measurements included balance performance, comfortable gait speed and single and dual-task functional mobility. Results Three distinct profiles were identified; “Sedentary” (N = 68), “Light Movers” (N = 115), “Steady Movers” (N = 118). “Sedentary” included people with PD with high absolute and relative time spent in Sedentary behaviour (SB), little time light intensity physical activity (LIPA) and negligible moderate-to-vigorous physical activity (MVPA). “Light Movers” were people with PD with values close to the mean for all activity variables. “Steady Movers” spent less time in SB during midday, and more time in LIPA and MVPA throughout the day, compared to the other profiles. “Sedentary” people had poorer balance (P = 0.006), poorer functional mobility (P = 0.027) and were more likely to have fallen previously (P = 0.027), compared to “Light Movers. The Timed Up and Go test, an easily performed clinical test of functional mobility, was the only test that could distinguish between all three profiles. Conclusion Distinct PA profiles, with clear differences in how the time awake is spent exist among people with mild-moderate PD.
Collapse
Affiliation(s)
- Philip von Rosen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Academic Primary Care Center, Region Stockholm, Stockholm, Sweden.,Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Karolinska University Hospital, Medical unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professionals, Stockholm, Sweden.,Stockholms Sjukhem Foundation, Reseach and Development Department, Stockholm, Sweden
| | - Breiffni Leavy
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Stockholms Sjukhem Foundation, Reseach and Development Department, Stockholm, Sweden
| |
Collapse
|
14
|
Colón-Semenza C, Fulford D, Ellis T. Effort-Based Decision-Making for Exercise in People with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:725-735. [PMID: 33459665 DOI: 10.3233/jpd-202353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with Parkinson's disease (PwPD) are less active than their age-matched peers. Non-motor symptoms, specifically, deficient motivation, may influence decision-making for exercise due to the impaired mesolimbic dopaminergic pathway. OBJECTIVE The purpose of this study was to determine if effort-based decision-making for physical effort was different in PwPD compared to healthy controls. We sought to determine the relationship between effort-based decision making for exercise and a discrete motor task as well as the impact of components of motivation on decision-making for physical effort in PwPD. METHODS An effort-based decision-making paradigm using a discrete motor task (button pressing) and a continuous exercise task (cycling) was implemented in 32 PwPD and 23 healthy controls. Components of motivation were measured using the Apathy Scale and the Temporal Experience of Pleasure Scale- Anticipatory Pleasure scale. RESULTS The presence of Parkinson's disease (PD) did not moderate decisions for either physical effort task. There was a moderate correlation between decisions for both tasks, within each group. The anticipation of pleasure and apathy were predictors of decisions for both physical effort tasks in PwPD, but not in healthy controls. CONCLUSION PwPD responded similarly to effort and reward valuations compared to those without PD. Individuals were consistent in their decisions, regardless of the physical effort task. The anticipation of pleasure and apathy were significant predictors of decisions for exercise in PwPD only. Increased anticipation of pleasure, reduction of apathy, and the use of rewards may enhance engagement in high effort exercise among PwPD.
Collapse
Affiliation(s)
| | - Daniel Fulford
- Departments of Occupational Therapy and Psychology & Brain Sciences, Boston University, Boston, MA, USA
| | - Terry Ellis
- Center for Neurorehabilitation, Department of Physical Therapy & Athletic Training, Boston University, Boston, MA, USA
| |
Collapse
|
15
|
Ito H, Yokoi D, Kobayashi R, Okada H, Kajita Y, Okuda S. The relationships between three-axis accelerometer measures of physical activity and motor symptoms in patients with Parkinson's disease: a single-center pilot study. BMC Neurol 2020; 20:340. [PMID: 32912171 PMCID: PMC7488269 DOI: 10.1186/s12883-020-01896-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background Various wearable devices for objectively evaluating motor symptoms of patients with Parkinson’s disease (PD) have been developed. Importantly, previous studies have suggested protective effects of physical activity in PD. However, the relationships between conventional clinical ratings for PD and three-axis accelerometer measures of physical activity (e.g., daily physical activity levels [PAL] or metabolic equivalents of task [METs]) are still unclear, particularly for METs. In the current study, we sought to elucidate these relationships on a daily basis, and to clarify optimal predictors for clinical states on a 30-min basis. Methods Patients who were hospitalized for adjustment of drugs or deep brain stimulation were enrolled. Using waist-worn three-axis accelerometers, PAL and METs parameter data were obtained and compared with UPDRS-3[On] and symptom diary data. We extracted data from the patients’ best and worst days, defined by the best and worst UPDRS-3[On] scores, respectively. Thus, 22 data sets from 11 patients were extracted. We examined the correlations and produced scatter plots to represent the relationships, then investigated which METs parameters and activity patterns were the best predictors for “On” and “dyskinesia”. Results The parameter “mean METs value within the 95–92.5 percentile range on a day (95–92.5 percentile value)” exhibited the strongest correlation with conventional daily clinical ratings (Rho: − 0.799 for UPDRS-3[On], 0.803 for On hours [p < 0.001]). Scatter plots suggested that PAL tended to have higher values in patients with involuntary movement. However, METs parameters focusing on higher METs seemed to alleviate this tendency. We clarified that “time over 2.0 METs” and “time over 1.5 METs” could be predictors for “On” and “dyskinesia” on a 30-min basis, respectively (AUROC: 0.779 and 0.959, 95% CI: 0.733–0.824 and 0.918–1.000). The specificity and sensitivity of the optimal activity pattern for “On” were 0.858 and 0.621. Conclusions This study suggested feasible activity patterns and METs parameters for objective evaluation of motor symptoms on a 30-min or daily basis. Three-axis accelerometer measures focusing on higher METs may be appropriate for evaluating physical activity. Further larger-scale studies are necessary to clarify the validity, reliability, and clinical utility of these objective measures.
Collapse
Affiliation(s)
- Hiroto Ito
- Department of Neurology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Japan.
| | - Daichi Yokoi
- Department of Neurology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Japan.,Department of Neurology, Kakeyu Misayama rehabilitation center, 1308 Kakeyuonsen, Ueda, Nagano, Japan
| | - Rei Kobayashi
- Department of Neurology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Japan
| | - Hisashi Okada
- Department of Neurology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Japan
| | - Yasukazu Kajita
- Department of Neurology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Japan.,Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, Japan
| | - Satoshi Okuda
- Department of Neurology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Japan
| |
Collapse
|
16
|
‘Mind the gap’ — a scoping review of long term, physical, self-management in Parkinson’s. Physiotherapy 2020; 107:88-99. [DOI: 10.1016/j.physio.2019.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 09/09/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
|
17
|
What Determines Spontaneous Physical Activity in Patients with Parkinson's Disease? J Clin Med 2020; 9:jcm9051296. [PMID: 32369962 PMCID: PMC7288325 DOI: 10.3390/jcm9051296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/17/2022] Open
Abstract
Physical activity (PA) is a factor that may have an influence on the symptoms of Parkinson's disease (PD). The aim of this study was to identify the potential determinants of spontaneous PA in a PD patient group. A total of 134 PD patients aged 65.2 ± 9.2 years with a Hoehn-Yahr scale score ≤4 and a Mini Mental State Examination (MMSE) score ≥24 were examined. For the study's purposes, the authors analyzed age, sex, education, history of PD, dopaminergic treatment, the severity of PD symptoms using Unified Parkinson's Disease Rating Scale (UPDRS), and Hoehn-Yahr scale. Additionally, all participants were evaluated through a set of scales for specific neuropsychiatric symptoms including depression, anxiety, apathy, fatigue, and sleep disorders. A linear regression analysis was used with backward elimination. In the total explanatory model, for 12% of the variability in activity (R2 = 0.125; F(16.133) = 2.185; p < 0.01), the significant predictor was starting therapy with the dopamine agonist (DA) (β= 0.420; t= 4.068; p = 0.000), which was associated with a longer duration of moderate PA. In the total explanatory model, for more than 13% of the variance in time spent sitting (R2 = 0.135; F(16.130) = 2.267; p < 0.01), the significant predictors were secondary education and the results of the UPDRS. The patients with secondary and vocational education, those starting treatment with DA and those with a less severe degree of Parkinson's symptoms (UPDRS), spent less time sitting in a day. It is possible to identify determinants of spontaneous PA. It may elucidate consequences in terms of influence on modifiable conditions of PA and the proper approach to patients with unmodifiable PA factors.
Collapse
|
18
|
Krishnamurthi N, Fleury J, Belyea M, Shill HA, Abbas JJ. ReadySteady intervention to promote physical activity in older adults with Parkinson's disease: Study design and methods. Contemp Clin Trials Commun 2020; 17:100513. [PMID: 32211555 PMCID: PMC7083754 DOI: 10.1016/j.conctc.2019.100513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 02/02/2023] Open
Abstract
The main motor impairments of gait and balance experienced by people with Parkinson's disease (PD) contribute to a sedentary lifestyle, resulting in poor physical conditioning, loss of functional independence, and reduced quality of life. Despite the known benefits of physical activity in PD, the majority of older adults with PD are insufficiently active. Few studies incorporate behavioral change approaches to promoting physical activity in PD. The main goal of this research is to foster community mobility in older adults with PD by promoting physical activity and improving gait patterns using a theory-based behavioral change intervention. The ReadySteady intervention combines wellness motivation theory with polestriding physical activity, which has been shown to be beneficial for people with PD. The intervention will be tested using a randomized controlled design, including inactive older adults diagnosed with PD. Participants will be randomly assigned the 12-week ReadySteady intervention, 12-week polestriding, and education intervention, or 12-week education intervention. Thirty-six older adults with PD will participate in each of the interventions. Level of physical activity, clinical scores, quantitative measures of gait and balance control, and motivational variables for each intervention will be measured at three time points: pre-intervention, post-intervention (12 weeks), and follow-up (24 weeks). If the intervention is beneficial, it may serve as a sustainable addition to current practice in health promotion efforts serving the PD population.
Collapse
Affiliation(s)
- Narayanan Krishnamurthi
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Julie Fleury
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Michael Belyea
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Holly A. Shill
- Muhammad Ali Parkinson Center, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
| | - James J. Abbas
- Center for Adaptive Neural Systems, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, 85287, USA
| |
Collapse
|
19
|
Bouça-Machado R, Rosário A, Caldeira D, Castro Caldas A, Guerreiro D, Venturelli M, Tinazzi M, Schena F, J Ferreira J. Physical Activity, Exercise, and Physiotherapy in Parkinson's Disease: Defining the Concepts. Mov Disord Clin Pract 2019; 7:7-15. [PMID: 31970204 DOI: 10.1002/mdc3.12849] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/04/2019] [Accepted: 09/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background Exercise is gaining extreme relevancy as a new therapeutic intervention for Parkinson's disease (PD). However, the frequent misuse of the concepts exercise, physiotherapy, and physical activity limits the possibility of summarizing research findings. This review aims to clarify these concepts and summarize the evidence on exercise in PD. Methods We critically appraised physical activity-related concepts and conducted a systematic review of clinical trials evaluating exercise interventions in PD. Additionally, we discussed the implications for PD clinical practice and research. Results Exercise is a subset of physical activity, and a major component of physiotherapy for PD management, having as the main goal to improve physical fitness. The appraisal of the 83 identified clinical trials found high variability in exercise interventions. Multimodal exercise was the most studied, and 60 minutes, two times/week for 12 weeks, the most reported prescription parameters. Conclusion The best available evidence recommends increasing physical activity levels in PD. Exercise and physiotherapy programs seem the most efficacious strategies to achieve this goal. As a result of the heterogeneity in the type and manner exercise is prescribed, it is not possible to propose strong recommendations for exercise in PD. We believe that, in addition to the clarification of concepts here presented, a collaborative and rigorous work of different areas of knowledge is needed.
Collapse
Affiliation(s)
- Raquel Bouça-Machado
- Instituto de Medicina Molecular Lisbon Portugal.,CNS-Campus Neurológico Sénior Torres Vedras Portugal
| | - Ana Rosário
- Instituto de Medicina Molecular Lisbon Portugal
| | - Daniel Caldeira
- Instituto de Medicina Molecular Lisbon Portugal.,Laboratory of Clinical Pharmacology and Therapeutics Faculdade de Medicina, Universidade de Lisboa Lisbon Portugal
| | | | | | - Massimo Venturelli
- Department of Neurological and Movement Sciences University of Verona Verona Italy
| | - Michele Tinazzi
- Department of Neurological and Movement Sciences University of Verona Verona Italy
| | - Federico Schena
- Department of Neurological and Movement Sciences University of Verona Verona Italy
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular Lisbon Portugal.,CNS-Campus Neurológico Sénior Torres Vedras Portugal.,Laboratory of Clinical Pharmacology and Therapeutics Faculdade de Medicina, Universidade de Lisboa Lisbon Portugal
| |
Collapse
|
20
|
Terashi H, Taguchi T, Ueta Y, Mitoma H, Aizawa H. Association of daily physical activity with cognition and mood disorders in treatment-naive patients with early-stage Parkinson’s disease. J Neural Transm (Vienna) 2019; 126:1617-1624. [DOI: 10.1007/s00702-019-02085-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
|
21
|
Urell C, Zetterberg L, Hellström K, Anens E. Factors explaining physical activity level in Parkinson´s disease: A gender focus. Physiother Theory Pract 2019; 37:507-516. [PMID: 31387476 DOI: 10.1080/09593985.2019.1630875] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: To analyze the multivariate associations between self-rated level of physical activity and demographic characteristics, self-efficacy for physical activity, fall-related self-efficacy, fear of falling, enjoyment from participation in physical activity, social support, fatigue, and health-related quality of life in persons with PD with a focus on gender.Method: Participants were persons with PD (n = 285, mean age 69.1 ± 7 years). Self-reported scales measuring level of physical activity (Physical Activity Disability Survey-Revised), enjoyment of physical activity (study- specific questions), self-efficacy for physical activity (Exercise Self-Efficacy Scale), fall-related self-efficacy (Falls Efficacy Scale), social support (Social Influences on Physical Activity), fatigue (Fatigue Severity Scale) and health-related quality of life (Parkinson's Disease Questionnaire-39) were used. The response rate was 58.2%.Results: Multiple regression analyses showed that 54.5% of the level of physical activity was explained by low-degree limitations in mobility and activities of daily life (ADL), being younger, higher self-efficacy for physical activity, communication limitations, bodily discomfort, social support and shorter time since diagnosis. Enjoyment of physical activity explained the level of physical activity for women, whereas self-efficacy for physical activity explained the level of physical activity for men.Conclusion: Implementing strategies to increase functional mobility, self-efficacy for physical activity, social support, and enjoyment of physical activity might facilitate persons with PD beginning and/or maintain different physical activities.
Collapse
Affiliation(s)
- Charlotte Urell
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Lena Zetterberg
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Karin Hellström
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Elisabeth Anens
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| |
Collapse
|
22
|
Long-Term Effects of Balance Training on Habitual Physical Activity in Older Adults with Parkinson's Disease. PARKINSONS DISEASE 2019; 2019:8769141. [PMID: 31485305 PMCID: PMC6702829 DOI: 10.1155/2019/8769141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/29/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
Abstract
The HiBalance program is a progressive and highly challenging balance training intervention incorporating Parkinson's disease (PD) specific balance components. The program improves balance and gait and increases the amount of ambulation in short-term, in older adults with PD. Yet, potential short- and long-term effects on habitual physical activity and sedentary behavior are currently unidentified. The aim of this study was to conduct preplanned secondary analyses of short- and long-term effects of the HiBalance program on objectively measured amount and bouts of brisk walking, sedentary behavior, and total physical activity in older adults with PD. Further, our aim was to investigate demographic, intervention-related, disease-related, and function-related factors potentially related to a difference in activity after intervention. A total of 100 older adults with mild-moderate PD were recruited. The intervention group participated in the HiBalance program, and the control received care as usual and was offered the HiBalance program after study termination. Physical activity data were collected using accelerometers at baseline, after intervention and after 6 and 12 months. A multilevel model was utilized to investigate the postintervention and long-term (6 and 12 months) effects on total physical activity, amount and bouts of brisk walking (i.e., moderate intensity physical activity), and sedentary behavior. Between-group difference for the main outcome brisk walking was at postintervention: Δ -10, CI -23.78 to 3.69 min/day (p < 0.05); 6 months: Δ -10, CI -23.89 to 3.89 min/day (p < 0.05); and 12 months: Δ -4, CI -16.81 to 8.81 min/day (p=0.43). Being part of the intervention group as well as finishing training during spring/summer showed an independent association to increased brisk walking after the intervention period. In conclusion, the HiBalance program increases the physical activity on moderate intensity after intervention and at 6 months but not at 12 months, independently of improved balance. Season seems to influence the effect on the physical activity.
Collapse
|
23
|
Ellingson LD, Zaman A, Stegemöller EL. Sedentary Behavior and Quality of Life in Individuals With Parkinson's Disease. Neurorehabil Neural Repair 2019; 33:595-601. [PMID: 31208286 DOI: 10.1177/1545968319856893] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background. Sedentary behavior is a growing public health concern and may have particular relevance for the Parkinson disease (PD) population. However, the influence of sedentary time on factors associated with quality of life (QOL) in PD is unknown. The primary purpose of this study was to examine relationships between sedentary behaviors and markers of PD-specific QOL. A secondary purpose was to examine relationships between physical activity behaviors and QOL. Methods. We assessed sedentary and active behaviors using objective and interview measures and examined relationships between these behaviors and a measure of PD-specific QOL in individuals with PD. Results. Results demonstrated that sedentary time was significantly related to several aspects of QOL, including perceived deficits in the domains of mobility, cognitive processing, and communication. Additionally, results showed that time spent watching television was more strongly associated with lower levels of QOL than other more engaging sedentary activities. For physical activity, relationships between objective measures and QOL were weaker and only significantly associated with mobility. Time spent doing housework was associated with lower levels of QOL, whereas time spent in recreational activity was associated with lower levels of discomfort. Discussion. These results suggest that targeting decreases in sedentary behaviors (eg, reducing time spent watching television, breaking up prolonged bouts of sedentary time) may be effective for improving QOL in individuals with PD.
Collapse
|
24
|
Montero Ferro A, P Basso-Vanelli R, Moreira Mello RL, Sanches Garcia-Araujo A, Gonçalves Mendes R, Costa D, Gianlorenço AC. Effects of inspiratory muscle training on respiratory muscle strength, lung function, functional capacity and cardiac autonomic function in Parkinson's disease: Randomized controlled clinical trial protocol. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1777. [PMID: 31090181 DOI: 10.1002/pri.1777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/04/2019] [Accepted: 03/17/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Individuals with Parkinson's disease (PD), in addition to motor impairment, may evolve with respiratory and autonomic nervous system disorders. Currently, there are few studies with emphasis on muscle and pulmonary dysfunction and that verify the benefits of inspiratory muscle training (IMT) in this population. AIM The aim of this study was to evaluate whether IMT is effective for the improvement of respiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in PD. METHODS A randomized and controlled trial will be conducted with 26 participants with idiopathic PD, with aged between 50 and 65 years, in the Stages I to III by the Modified Hoehn and Yahr Scale. Respiratory muscle strength will be performed by manovacuometry and lung function by spirometry. Functional capacity will be evaluated by the 6-min walk test and autonomic cardiac function by heart rate variability. In addition, thoracic mobility measurement will also be performed. After the evaluations, these participants will be randomly assigned to two groups: the IMT group with Powerbreathe® , which will perform the eight series of 2 min each, with 1 min of rest between them, totaling 30 min, at 60% of the maximum inspiratory pressure and the control group, who will perform the same training protocol but with the load maintained at 9 cmH2 O. All participants will be submitted to the same motor training protocol. CONCLUSION It is expected that IMT increases the inspiratory muscle strength, contributing to the improved expiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in individuals with mild to moderate PD.
Collapse
Affiliation(s)
- Alyne Montero Ferro
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Renata P Basso-Vanelli
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Roberta Lorena Moreira Mello
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Adriana Sanches Garcia-Araujo
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Renata Gonçalves Mendes
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Dirceu Costa
- Physiotherapy Graduation and Rehabilitation Sciences Post Graduation Program, Nove de Julho University-UNINOVE, São Paulo, Brazil
| | - Anna Carolyna Gianlorenço
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| |
Collapse
|
25
|
Associations between daily-living physical activity and laboratory-based assessments of motor severity in patients with falls and Parkinson's disease. Parkinsonism Relat Disord 2019; 62:85-90. [DOI: 10.1016/j.parkreldis.2019.01.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/23/2022]
|
26
|
Paz TDSR, Guimarães F, Britto VLSD, Correa CL. Treadmill training and kinesiotherapy versus conventional physiotherapy in Parkinson’s disease: a pragmatic study. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Physiotherapy has been identified in the literature as an important treatment for individuals with Parkinson’s disease (PD) to improve functional capacity. Little is discussed about the physiotherapy practice environment for this population. Objective: To assess pragmatically the effects of two physiotherapy protocols: Conventional Physiotherapy (CP) and Treadmill Training and Kinesiotherapy (TTK) in PD patients. Method: Twenty-four PD patients classified from 1 to 3 on the Hoehn and Yahr scale were randomly distributed into two groups. In CP group (12 patients), exercises aimed to improve range of motion, bradykinesia, postural adjustments and gait. In TTK group (12 patients), exercises aimed to improve physical fitness, mobility and functional independence. The treatments were performed for 50 minutes, twice a week for 14 weeks. The following evaluations were performed before and after the interventions: Unified Parkinson’s Disease Rating Scale (UPDRS); gait speed (GS); up stairs (US) and down stairs (DS) tests; timed get-up-and-go test (TUG) and 6-Minute Walk Distance Test (6-MWDT). Sociodemographic and clinical data were presented as descriptive analysis. Variables with normal and non-normal distributions were analyzed by specific statistical tests. Results: Intragroup analysis showed significant results for the TTK group (TUG, US, DS, GS, UPDRS total and UPDRS II) and for the CP group only UPDRS total. Intergroup analysis was favorable for the TTK group (TUG, US, DS, 6-MWDT). Conclusion: CP group improved the patients’ general clinical status, while treadmill and kinesiotherapy improved the physical-functional and clinical aspects.
Collapse
|
27
|
Son H, Park WS, Kim H. Mobility monitoring using smart technologies for Parkinson’s disease in free-living environment. Collegian 2018. [DOI: 10.1016/j.colegn.2017.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
Silva de Lima AL, Evers LJW, Hahn T, de Vries NM, Daeschler M, Boroojerdi B, Terricabras D, Little MA, Bloem BR, Faber MJ. Impact of motor fluctuations on real-life gait in Parkinson's patients. Gait Posture 2018; 62:388-394. [PMID: 29627498 DOI: 10.1016/j.gaitpost.2018.03.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with PD (PWP) have an increased risk of becoming inactive. Wearable sensors can provide insights into daily physical activity and walking patterns. RESEARCH QUESTIONS (1) Is the severity of motor fluctuations associated with sensor-derived average daily walking quantity? (2) Is the severity of motor fluctuations associated with the amount of change in sensor-derived walking quantity after levodopa intake? METHODS 304 Dutch PWP from the Parkinson@Home study were included. At baseline, all participants received a clinical examination. During the follow-up period (median: 97 days; 25-Interquartile range-IQR: 91 days, 75-IQR: 188 days), participants used the Fox Wearable Companion app and streamed smartwatch accelerometer data to a cloud platform. The first research question was assessed by linear regression on the sensor-derived mean time spent walking/day with the severity of fluctuations (MDS-UPDRS item 4.4) as independent variable, controlled for age and MDS-UPDRS part-III score. The second research question was assessed by linear regression on the sensor-derived mean post-levodopa walking quantity, with the sensor-derived mean pre-levodopa walking quantity and severity of fluctuations as independent variables, controlled for mean time spent walking per day, age and MDS-UPDRS part-III score. RESULTS PWP spent most time walking between 8am and 1pm, summing up to 72 ± 39 (mean ± standard deviation) minutes of walking/day. The severity of motor fluctuations did not influence the mean time spent walking (B = 2.4 ± 1.9, p = 0.20), but higher age (B = -1.3 ± 0.3, p = < 0.001) and greater severity of motor symptoms (B = -0.6 ± 0.2, p < 0.001) was associated with less time spent walking (F(3216) = 14.6, p < .001, R2 = .17). The severity of fluctuations was not associated with the amount of change in time spent walking in relation to levodopa intake in any part of the day. SIGNIFICANCE Analysis of sensor-derived gait quantity suggests that the severity of motor fluctuations is not associated with changes in real-life walking patterns in mildly to moderate affected PWP.
Collapse
Affiliation(s)
- Ana Lígia Silva de Lima
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands; CAPES Foundation, Ministry of Education of Brazil, Brasília/DF, Brazil.
| | - Luc J W Evers
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands; Institute for Computing and Information Sciences, Nijmegen, The Netherlands
| | - Tim Hahn
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | | | | | | | - Max A Little
- Aston University, Birmingham, UK; Media Lab, Massachusetts Institute of Technology, Cambridge, USA
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Marjan J Faber
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
| |
Collapse
|
29
|
|
30
|
The Effect of Associated Parkinsonism on Rehabilitation in Stroke Patients: A Case Series. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:64-69. [PMID: 32595376 PMCID: PMC7315070 DOI: 10.14744/semb.2017.69772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/20/2017] [Indexed: 11/20/2022]
Abstract
Stroke and Parkinson’s disease are 2 major causes of movement impairment and a decreased ability to perform daily activities. The aim of this case series was to demonstrate the difficulty of rehabilitation in stroke patients with accompanying parkinsonism. Four stroke patients with parkinsonism who underwent rehabilitation at the Physical Medicine and Rehabilitation Clinic between March and May of 2016 were evaluated. The Standardized Mini-Mental State Examination (SMMSE), the Functional Independence Measure (FIM), the Barthel Index (BI), the Berg Balance Scale (BBS), and the Stroke Impact Scale version 3.0 (SIS) were used in the assessment. Of the 4 patients, 3 were female, and the mean age was 74.5±9.3 years. The mean hospital stay was 19±5.3 days. The initial test scores recorded were low, and they remained low at the time of discharge. After rehabilitation, the mean FIM score in the group was 42% of the maximum possible score, the mean SMMSE was 55%, the BI was 18%, the BBS was 0.08%, and the SIS was 25%. Three patients required a wheelchair, and 1 patient could ambulate with a walker at discharge. A stroke accompanied by parkinsonism negatively affects mobility and functional status, primarily through the deterioration of balance. In this study, cognitive function was reduced to half of the maximum, and the balance and function loss was more than 50%. Barthel index; berg balance scale; functional independence measure; mini-mental state examination; parkinsonism; stroke; stroke impact scale.
Collapse
|
31
|
Colón-Semenza C, Latham NK, Quintiliani LM, Ellis TD. Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study. JMIR Mhealth Uhealth 2018; 6:e42. [PMID: 29449201 PMCID: PMC5832905 DOI: 10.2196/mhealth.8074] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/30/2017] [Accepted: 12/14/2017] [Indexed: 01/06/2023] Open
Abstract
Background Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. Objective The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. Methods A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. Results Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were “satisfied” or “very satisfied” with the training program, and all participants were “satisfied” or “very satisfied” with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. Conclusions Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach.
Collapse
Affiliation(s)
- Cristina Colón-Semenza
- Center for Neurorehabilitation, Department of Physical Therapy & Athletic Training, College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Nancy K Latham
- Boston Claude D Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Lisa M Quintiliani
- School of Medicine, Department of Medicine, Section of General Internal Medicine, Boston University, Boston, MA, United States
| | - Terry D Ellis
- Center for Neurorehabilitation, Department of Physical Therapy & Athletic Training, College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| |
Collapse
|
32
|
Impacts of an Exercise Program and Motivational Telephone Counseling on Health-Related Quality of Life in People With Parkinson's Disease. Rehabil Nurs 2018; 44:161-170. [PMID: 29345633 DOI: 10.1097/rnj.0000000000000106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to test the effects of group exercise and telephone counseling on physical and psychosocial health in people with Parkinson's disease (PD). DESIGN This was a quasiexperimental study with a nonequivalent control group. METHODS This study took place in Seoul, South Korea. Twenty-two and 20 subjects participated in the intervention and comparison groups, respectively. The intervention group performed group exercises twice a week and received motivational telephone counseling every 2 weeks for 12 weeks. FINDINGS Significant effects of the intervention were found in overall health-related quality of life (HRQOL; p = .012) and in the following HRQOL dimensions: stigma (p = .026), social function (p = .003), cognition (p = .028), and communication (p = .014). No other variables such as activities of daily living, functional fitness, and depression exhibited statistically significant effects. CONCLUSION/CLINICAL RELEVANCE These results indicate that group exercise with telephone counseling positively affects some aspects of HRQOL in PD patients.
Collapse
|
33
|
Nero H, Benka Wallén M, Franzén E, Conradsson D, Ståhle A, Hagströmer M. Objectively Assessed Physical Activity and its Association with Balance, Physical Function and Dyskinesia in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:833-840. [PMID: 27589536 DOI: 10.3233/jpd-160826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The desirable effects of physical activity in individuals with Parkinson's disease are well-known, although according to results from previous studies factors associated with objectively assessed physical activity are not fully investigated. OBJECTIVE To investigate demographic, disease-related and mobility-related factors that associate with objectively measured physical activity, in a sample of older adults with mild to moderate Parkinson's disease. METHODS Demographic, disease-related and mobility-related factors were gathered by interview from a total of 91 older adults with Parkinson's disease, followed by an evaluation of balance control using the Mini-BESTest. After initial testing, participants wore a tri-axial accelerometer during a week of free-living. Correlation analysis and multiple linear regression was used to investigate factors associated with total PA, represented by total activity counts, and time in brisk walking. RESULTS Motor impairment, physical function, body mass index and dyskinesia contributed to the variance of total physical activity, explaining 34 % of the variance, while physical function and balance control were significant factors associated with brisk walking, explaining 22 %. CONCLUSIONS This study identified factors that have not been shown to associate with objectively measured physical activity previously, such as dyskinesia, balance control and self-rated physical function. The findings also demonstrated that associated factors differ, depending on the activity behavior being investigated. However, other factors than those included in this study may also be of importance.
Collapse
Affiliation(s)
- Håkan Nero
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Martin Benka Wallén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - David Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Ståhle
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
34
|
Adams JL, Dinesh K, Xiong M, Tarolli CG, Sharma S, Sheth N, Aranyosi AJ, Zhu W, Goldenthal S, Biglan KM, Dorsey ER, Sharma G. Multiple Wearable Sensors in Parkinson and Huntington Disease Individuals: A Pilot Study in Clinic and at Home. Digit Biomark 2017; 1:52-63. [PMID: 32095745 DOI: 10.1159/000479018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/26/2017] [Indexed: 12/24/2022] Open
Abstract
Background Clinician rating scales and patient-reported outcomes are the principal means of assessing motor symptoms in Parkinson disease and Huntington disease. However, these assessments are subjective and generally limited to episodic in-person visits. Wearable sensors can objectively and continuously measure motor features and could be valuable in clinical research and care. Methods We recruited participants with Parkinson disease, Huntington disease, and prodromal Huntington disease (individuals who carry the genetic marker but do not yet exhibit symptoms of the disease), and controls to wear 5 accelerometer-based sensors on their chest and limbs for standardized in-clinic assessments and for 2 days at home. The study's aims were to assess the feasibility of use of wearable sensors, to determine the activity (lying, sitting, standing, walking) of participants, and to survey participants on their experience. Results Fifty-six individuals (16 with Parkinson disease, 15 with Huntington disease, 5 with prodromal Huntington disease, and 20 controls) were enrolled in the study. Data were successfully obtained from 99.3% (278/280) of sensors dispatched. On average, individuals with Huntington disease spent over 50% of the total time lying down, substantially more than individuals with prodromal Huntington disease (33%, p = 0.003), Parkinson disease (38%, p = 0.01), and controls (34%; p < 0.001). Most (86%) participants were "willing" or "very willing" to wear the sensors again. Conclusions Among individuals with movement disorders, the use of wearable sensors in clinic and at home was feasible and well-received. These sensors can identify statistically significant differences in activity profiles between individuals with movement disorders and those without. In addition, continuous, objective monitoring can reveal disease characteristics not observed in clinic.
Collapse
Affiliation(s)
- Jamie L Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester Medical Center, Rochester, New York, USA
| | - Mulin Xiong
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Saloni Sharma
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | | | | | - William Zhu
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Steven Goldenthal
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin M Biglan
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester Medical Center, Rochester, New York, USA.,Department of Computer Science, University of Rochester, Rochester, New York, USA
| |
Collapse
|
35
|
Abstract
BACKGROUND AND PURPOSE Objective ambulatory activity during daily living has not been characterized for people with Parkinson disease prior to initiation of dopaminergic medication. Our goal was to characterize ambulatory activity based on average daily step count and examine determinants of step count in nonexercising people with de novo Parkinson disease. METHODS We analyzed baseline data from a randomized controlled trial, which excluded people performing regular endurance exercise. Of 128 eligible participants (mean ± SD = 64.3 ± 8.6 years), 113 had complete accelerometer data, which were used to determine daily step count. Multiple linear regression was used to identify factors associated with average daily step count over 10 days. Candidate explanatory variable categories were (1) demographics/anthropometrics, (2) Parkinson disease characteristics, (3) motor symptom severity, (4) nonmotor and behavioral characteristics, (5) comorbidities, and (6) cardiorespiratory fitness. RESULTS Average daily step count was 5362 ± 2890 steps per day. Five factors explained 24% of daily step count variability, with higher step count associated with higher cardiorespiratory fitness (10%), no fear/worry of falling (5%), lower motor severity examination score (4%), more recent time since Parkinson disease diagnosis (3%), and the presence of a cardiovascular condition (2%). DISCUSSION AND CONCLUSIONS Daily step count in nonexercising people recruited for this intervention trial with de novo Parkinson disease approached sedentary lifestyle levels. Further study is warranted for elucidating factors explaining ambulatory activity, particularly cardiorespiratory fitness, and fear/worry of falling. Clinicians should consider the costs and benefits of exercise and activity behavior interventions immediately after diagnosis of Parkinson disease to attenuate the health consequences of low daily step count.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A170).
Collapse
|
36
|
Cerff B, Maetzler W, Sulzer P, Kampmeyer M, Prinzen J, Hobert MA, Blum D, van Lummel R, Del Din S, Gräber S, Berg D, Liepelt-Scarfone I. Home-Based Physical Behavior in Late Stage Parkinson Disease Dementia: Differences between Cognitive Subtypes. NEURODEGENER DIS 2017; 17:135-144. [DOI: 10.1159/000460251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 02/06/2017] [Indexed: 11/19/2022] Open
|
37
|
Bhidayasiri R, Martinez-Martin P. Clinical Assessments in Parkinson's Disease: Scales and Monitoring. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:129-182. [PMID: 28554406 DOI: 10.1016/bs.irn.2017.01.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Measurement of disease state is essential in both clinical practice and research in order to assess the severity and progression of a patient's disease status, effect of treatment, and alterations in other relevant factors. Parkinson's disease (PD) is a complex disorder expressed through many motor and nonmotor manifestations, which cause disabilities that can vary both gradually over time or come on suddenly. In addition, there is a wide interpatient variability making the appraisal of the many facets of this disease difficult. Two kinds of measure are used for the evaluation of PD. The first is subjective, inferential, based on rater-based interview and examination or patient self-assessment, and consist of rating scales and questionnaires. These evaluations provide estimations of conceptual, nonobservable factors (e.g., symptoms), usually scored on an ordinal scale. The second type of measure is objective, factual, based on technology-based devices capturing physical characteristics of the pathological phenomena (e.g., sensors to measure the frequency and amplitude of tremor). These instrumental evaluations furnish appraisals with real numbers on an interval scale for which a unit exists. In both categories of measures, a broad variety of tools exist. This chapter aims to present an up-to-date summary of the most relevant characteristics of the most widely used scales, questionnaires, and technological resources currently applied to the assessment of PD. The review concludes that, in our opinion: (1) no assessment methods can substitute the clinical judgment and (2) subjective and objective measures in PD complement each other, each method having strengths and weaknesses.
Collapse
Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Juntendo University, Tokyo, Japan.
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| |
Collapse
|
38
|
Swank C, Shearin S, Cleveland S, Driver S. Auditing the Physical Activity and Parkinson Disease Literature Using the Behavioral Epidemiologic Framework. PM R 2016; 9:612-621. [PMID: 27777097 DOI: 10.1016/j.pmrj.2016.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 11/26/2022]
Abstract
Motor and nonmotor symptoms associated with Parkinson disease place individuals at greater risk of sedentary behaviors and comorbidities. Physical activity is one modifiable means of improving health and reducing the risk of morbidity. We applied a behavioral framework to classify existing research on physical activity and Parkinson disease to describe the current evolution and inform knowledge gaps in this area. Research placed in phase 1 establishes links between physical activity and health-related outcomes; phase 2 develops approaches to quantify physical activity behavior; phase 3 identifies factors associated with implementation of physical activity behaviors; phase 4 assesses the effectiveness of interventions to promote activity; and phase 5 disseminates evidence-based recommendations. Peer-reviewed literature was identified by searching PubMed, Google Scholar, and EBSCO-host. We initially identified 287 potential articles. After further review, we excluded 109 articles, leaving 178 included articles. Of these, 75.84% were categorized into phase 1 (n = 135), 10.11% in phase 2 (n = 18), 9.55% into phase 3 (n = 17), 3.37% into phase 4 (n = 6), and 1.12% into phase 5 (n = 2). By applying the behavioral framework to the physical activity literature for people with Parkinson disease, we suggest this area of research is nascent with more than 75% of the literature in phase 1. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Chad Swank
- School of Physical Therapy, Texas Woman's University, 5500 Southwestern Medical Ave, Dallas, TX 75235-7299(∗).
| | - Staci Shearin
- Department of Physical Therapy, University of Texas Southwestern School of Health Professions, Dallas, TX(†)
| | | | - Simon Driver
- Baylor Institute for Rehabilitation, Dallas, TX(§)
| |
Collapse
|
39
|
Delextrat A, Bateman J, Esser P, Targen N, Dawes H. The potential benefits of Zumba Gold® in people with mild-to-moderate Parkinson’s: Feasibility and effects of dance styles and number of sessions. Complement Ther Med 2016; 27:68-73. [DOI: 10.1016/j.ctim.2016.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/13/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022] Open
|
40
|
Del Din S, Godfrey A, Mazzà C, Lord S, Rochester L. Free-living monitoring of Parkinson's disease: Lessons from the field. Mov Disord 2016; 31:1293-313. [PMID: 27452964 DOI: 10.1002/mds.26718] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Silvia Del Din
- Institute of Neuroscience; Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University; Newcastle upon Tyne UK
| | - Alan Godfrey
- Institute of Neuroscience; Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University; Newcastle upon Tyne UK
| | - Claudia Mazzà
- Department of Mechanical Engineering; The University of Sheffield; Sheffield UK
- INSIGNEO Institute for In Silico Medicine; The University of Sheffield; Sheffield UK
| | - Sue Lord
- Institute of Neuroscience; Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University; Newcastle upon Tyne UK
| | - Lynn Rochester
- Institute of Neuroscience; Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University; Newcastle upon Tyne UK
| |
Collapse
|
41
|
Klenk J, Srulijes K, Schatton C, Schwickert L, Maetzler W, Becker C, Synofzik M. Ambulatory Activity Components Deteriorate Differently across Neurodegenerative Diseases: A Cross-Sectional Sensor-Based Study. NEURODEGENER DIS 2016; 16:317-23. [PMID: 27197840 DOI: 10.1159/000444802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/16/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Reduced ambulatory activity is a major burden in neurodegenerative disease (NDD), leading to severe restrictions in social participation and further deterioration of motor capacities. However, objective evidence on walking behavior patterns and components underlying this impairment and its decline with disease progression is scarce for many NDDs. We aimed to unravel the detailed metrics underlying the reduced ambulatory activity in selected NDDs, and their relation to disease duration. We hypothesized that progressively reduced ambulatory activity is a feature shared across different NDDs, characterized by changes in both common and distinct components. METHODS Sixty-five subjects with NDD (n = 34 degenerative ataxia; n = 15 progressive supranuclear palsy, and n = 16 Parkinson's disease) and 38 healthy older adults (total n = 103) wore a three-axial accelerometer (activPAL3™) for 7 consecutive days. Detailed metrics of ambulatory activity were calculated. RESULTS The average daily walking duration was significantly decreased in all three NDDs, yet characterized by a differential pattern of changes in number and length of walking bouts and sit-to-stand transfers. Decline in walking duration progressed with increased disease duration in all three NDDs, yet at a differing rate. This decline was associated with progressive reductions in walking bout length and walking behavior pattern diversity in all three NDDs. CONCLUSIONS These findings provide objective evidence that reduced ambulatory activity is a shared feature across different NDDs. Moreover, they reveal that several underlying walking behavior components change with increasing disease duration, yet at a differing rate in different NDDs. This indicates that metric analysis of ambulatory activity might provide ecologically relevant and disease-specific progression and outcome markers in several NDDs.
Collapse
Affiliation(s)
- Jochen Klenk
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | | | | | | | | | | | | |
Collapse
|
42
|
Block VAJ, Pitsch E, Tahir P, Cree BAC, Allen DD, Gelfand JM. Remote Physical Activity Monitoring in Neurological Disease: A Systematic Review. PLoS One 2016; 11:e0154335. [PMID: 27124611 PMCID: PMC4849800 DOI: 10.1371/journal.pone.0154335] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/11/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To perform a systematic review of studies using remote physical activity monitoring in neurological diseases, highlighting advances and determining gaps. METHODS Studies were systematically identified in PubMed/MEDLINE, CINAHL and SCOPUS from January 2004 to December 2014 that monitored physical activity for ≥24 hours in adults with neurological diseases. Studies that measured only involuntary motor activity (tremor, seizures), energy expenditure or sleep were excluded. Feasibility, findings, and protocols were examined. RESULTS 137 studies met inclusion criteria in multiple sclerosis (MS) (61 studies); stroke (41); Parkinson's Disease (PD) (20); dementia (11); traumatic brain injury (2) and ataxia (1). Physical activity levels measured by remote monitoring are consistently low in people with MS, stroke and dementia, and patterns of physical activity are altered in PD. In MS, decreased ambulatory activity assessed via remote monitoring is associated with greater disability and lower quality of life. In stroke, remote measures of upper limb function and ambulation are associated with functional recovery following rehabilitation and goal-directed interventions. In PD, remote monitoring may help to predict falls. In dementia, remote physical activity measures correlate with disease severity and can detect wandering. CONCLUSIONS These studies show that remote physical activity monitoring is feasible in neurological diseases, including in people with moderate to severe neurological disability. Remote monitoring can be a psychometrically sound and responsive way to assess physical activity in neurological disease. Further research is needed to ensure these tools provide meaningful information in the context of specific neurological disorders and patterns of neurological disability.
Collapse
Affiliation(s)
- Valerie A. J. Block
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Erica Pitsch
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, United States of America
| | - Peggy Tahir
- University of California San Francisco Library, San Francisco, California, United States of America
| | - Bruce A. C. Cree
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Diane D. Allen
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Jeffrey M. Gelfand
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
43
|
Swank C, Trudelle-Jackson E, Medley A, Thompson M, Jackson A. A Comparison of Physical Activity and Dual Task Gait Among Persons with Parkinson's Disease and Healthy Older Adults. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2016. [DOI: 10.3109/02703181.2015.1134747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chad Swank
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| | | | - Ann Medley
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Mary Thompson
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Allen Jackson
- Department of Kinesiology, Health Promotion and Recreation, University of North Texas, Denton, Texas, USA
| |
Collapse
|
44
|
Abstract
People with Parkinson's disease (PD) are encouraged to participate in physical activity levels equivalent to those recommended for the general population. Understanding factors that influence this activity is important for facilitating this participation. This study examined factors associated with participation in moderate and high intensity daily ambulatory activity in people with mild to moderate PD. Fifty community-dwelling people with mild-moderate PD were monitored with accelerometers over three days to characterise their daily ambulatory activity levels. Personal factors, disease characteristics, gait and cognitive capacity were measured. Prediction models were created to identify factors influencing ambulation activity. People with PD spent approximately 77 minutes walking per day, mostly at a moderate intensity resulting in a median of 6300 steps/day. Disease severity predicted time spent in moderate ambulation bouts (R2 = 0.116, p = .017). Gait (Timed Up and Go (TUG) Test) and executive function together predicted engagement in high intensity ambulatory activity (R2 > 0.170, p < .022). While disease severity, gait performance and executive function were predictive of engagement in moderate and high intensity walking activity, additional personal and social factors should be considered and are likely to also strongly impact on activity levels.
Collapse
|
45
|
Stamford JA, Schmidt PN, Friedl KE. What Engineering Technology Could Do for Quality of Life in Parkinson's Disease: A Review of Current Needs and Opportunities. IEEE J Biomed Health Inform 2015; 19:1862-72. [PMID: 26259205 DOI: 10.1109/jbhi.2015.2464354] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Parkinson's disease (PD) involves well-known motor symptoms such as tremor, rigidity, bradykinesia, and altered gait, but there are also nonlocomotory motor symptoms (e.g., changes in handwriting and speech) and even nonmotor symptoms (e.g., disrupted sleep, depression) that can be measured, monitored, and possibly better managed through activity-based monitoring technologies. This will enhance quality of life (QoL) in PD through improved self-monitoring and also provide information that could be shared with a healthcare provider to help better manage treatment. Until recently, nonmotor symptoms ("soft signs") had been generally overlooked in clinical management, yet these are of primary importance to patients and their QoL. Day-to-day variability of the condition, the high variability in symptoms between patients, and the isolated snapshots of a patient in periodic clinic visits make better monitoring essential to the proper management of PD. Continuously monitored patterns of activity, social interactions, and daily activities could provide a rich source of information on status changes, guiding self-correction and clinical management. The same tools can be useful in earlier detection of PD and will improve clinical studies. Remote medical communications in the form of telemedicine, sophisticated tracking of medication use, and assistive technologies that directly compensate for disease-related challenges are examples of other near-term technology solutions to PD problems. Ultimately, a sensor technology is not good if it is not used. The Parkinson's community is a sophisticated early adopter of useful technologies and a group for which engineers can provide near-term gratifying benefits.
Collapse
|
46
|
Lee J, Park CG, Choi M. Regular exercise and related factors in patients with Parkinson's disease: Applying zero-inflated negative binomial modeling of exercise count data. Appl Nurs Res 2015; 30:164-9. [PMID: 27091273 DOI: 10.1016/j.apnr.2015.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/03/2015] [Indexed: 11/13/2022]
Abstract
PURPOSE This study was conducted to identify risk factors that influence regular exercise among patients with Parkinson's disease in Korea. Parkinson's disease is prevalent in the elderly, and may lead to a sedentary lifestyle. Exercise can enhance physical and psychological health. However, patients with Parkinson's disease are less likely to exercise than are other populations due to physical disability. METHODS A secondary data analysis and cross-sectional descriptive study were conducted. A convenience sample of 106 patients with Parkinson's disease was recruited at an outpatient neurology clinic of a tertiary hospital in Korea. Demographic characteristics, disease-related characteristics (including disease duration and motor symptoms), self-efficacy for exercise, balance, and exercise level were investigated. Negative binomial regression and zero-inflated negative binomial regression for exercise count data were utilized to determine factors involved in exercise. RESULTS The mean age of participants was 65.85 ± 8.77 years, and the mean duration of Parkinson's disease was 7.23 ± 6.02 years. Most participants indicated that they engaged in regular exercise (80.19%). Approximately half of participants exercised at least 5 days per week for 30 min, as recommended (51.9%). Motor symptoms were a significant predictor of exercise in the count model, and self-efficacy for exercise was a significant predictor of exercise in the zero model. CONCLUSION Severity of motor symptoms was related to frequency of exercise. Self-efficacy contributed to the probability of exercise. Symptom management and improvement of self-efficacy for exercise are important to encourage regular exercise in patients with Parkinson's disease.
Collapse
Affiliation(s)
- JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro #510, Seodaemun-gu, Seoul, South Korea, 03722.
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, 946 South Damen Avenue #612, Chicago, IL, 60612, USA.
| | - Moonki Choi
- College of Nursing, Yonsei University, 50-1 Yonsei-ro #511, Seodaemun-gu, Seoul, South Korea, 03722.
| |
Collapse
|
47
|
Levels and Patterns of Physical Activity and Sedentary Behavior in Elderly People With Mild to Moderate Parkinson Disease. Phys Ther 2015; 95:1135-41. [PMID: 25655884 DOI: 10.2522/ptj.20140374] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/28/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Decreased movement ability, one of the hallmarks of Parkinson disease (PD), may lead to inadequate physical activity (PA) and excessive time spent in sedentary behaviors-2 factors associated with an elevated risk for lifestyle-related diseases, poor management of PD, and premature death. To identify the extent to which people with PD are physically active, a comprehensive characterization of PA in this population is needed. OBJECTIVE The study objective was to describe levels and patterns of PA and sedentary behaviors in elderly people with PD. DESIGN This cross-sectional study involved a free-living setting and 53 men and 42 women (mean age=73.4 years) with mild to moderate idiopathic PD. METHODS Time spent in PA and sedentary behaviors was assessed for 1 week with accelerometers. RESULTS Mean daily step counts were 4,765; participants spent 589 minutes in sedentary behaviors, 141 minutes in low-intensity activities, 30 minutes in moderate-intensity lifestyle activities, and 16 minutes in moderate- to vigorous-intensity ambulatory activities. No differences were found between weekdays and weekend days. Patterns were characterized by a rise in total PA in the morning, peaking between 10 am and 3 pm, and a gradual decline toward the late evening. The proportion achieving 150 minutes of moderate- to vigorous-intensity PA per week was 27%, and 16% achieved 7,000 or more steps per day. LIMITATIONS Nonrandomized selection of participants may limit the generalizability of the results. CONCLUSIONS Physical activity levels were generally low, in terms of both total volume and intensity, with only minor variations over the course of a day or between days. These results emphasize the need to develop strategies to increase PA and reduce time spent in sedentary behaviors in elderly people with mild to moderate PD.
Collapse
|
48
|
François C, Grau-Sánchez J, Duarte E, Rodriguez-Fornells A. Musical training as an alternative and effective method for neuro-education and neuro-rehabilitation. Front Psychol 2015; 6:475. [PMID: 25972820 PMCID: PMC4411999 DOI: 10.3389/fpsyg.2015.00475] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/02/2015] [Indexed: 01/14/2023] Open
Abstract
In the last decade, important advances in the field of cognitive science, psychology, and neuroscience have largely contributed to improve our knowledge on brain functioning. More recently, a line of research has been developed that aims at using musical training and practice as alternative tools for boosting specific perceptual, motor, cognitive, and emotional skills both in healthy population and in neurologic patients. These findings are of great hope for a better treatment of language-based learning disorders or motor impairment in chronic non-communicative diseases. In the first part of this review, we highlight several studies showing that learning to play a musical instrument can induce substantial neuroplastic changes in cortical and subcortical regions of motor, auditory and speech processing networks in healthy population. In a second part, we provide an overview of the evidence showing that musical training can be an alternative, low-cost and effective method for the treatment of language-based learning impaired populations. We then report results of the few studies showing that training with musical instruments can have positive effects on motor, emotional, and cognitive deficits observed in patients with non-communicable diseases such as stroke or Parkinson Disease. Despite inherent differences between musical training in educational and rehabilitation contexts, these results favor the idea that the structural, multimodal, and emotional properties of musical training can play an important role in developing new, creative and cost-effective intervention programs for education and rehabilitation in the next future.
Collapse
Affiliation(s)
- Clément François
- Department of Basic Psychology, University of Barcelona , Barcelona, Spain ; Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute , Barcelona, Spain
| | - Jennifer Grau-Sánchez
- Department of Basic Psychology, University of Barcelona , Barcelona, Spain ; Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute , Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Hospitals del Mar i de l'Esperança , Barcelona, Spain
| | - Antoni Rodriguez-Fornells
- Department of Basic Psychology, University of Barcelona , Barcelona, Spain ; Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute , Barcelona, Spain ; Catalan Institution for Research and Advanced Studies , Barcelona, Spain
| |
Collapse
|
49
|
Conradsson D, Löfgren N, Nero H, Hagströmer M, Ståhle A, Lökk J, Franzén E. The Effects of Highly Challenging Balance Training in Elderly With Parkinson's Disease: A Randomized Controlled Trial. Neurorehabil Neural Repair 2015; 29:827-36. [PMID: 25608520 PMCID: PMC4582836 DOI: 10.1177/1545968314567150] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background. Highly challenging exercises have been suggested to induce neuroplasticity in individuals with Parkinson’s disease (PD); however, its effect on clinical outcomes remains largely unknown. Objective. To evaluate the short-term effects of the HiBalance program, a highly challenging balance-training regimen that incorporates both dual-tasking and PD-specific balance components, compared with usual care in elderly with mild to moderate PD. Methods. Participants with PD (n = 100) were randomized, either to the 10-week HiBalance program (n = 51) or to the control group (n = 49). Participants were evaluated before and after the intervention. The main outcomes were balance performance (Mini-BESTest), gait velocity (during normal and dual-task gait), and concerns about falling (Falls Efficacy Scale–International). Performance of a cognitive task while walking, physical activity level (average steps per day), and activities of daily living were secondary outcomes. Results. A total of 91 participants completed the study. After the intervention, the between group comparison showed significantly improved balance and gait performance in the training group. Moreover, although no significant between group difference was observed regarding gait performance during dual-tasking; the participants in the training group improved their performance of the cognitive task while walking, as compared with the control group. Regarding physical activity levels and activities of daily living, in comparison to the control group, favorable results were found for the training group. No group differences were found for concerns about falling. Conclusions. The HiBalance program significantly benefited balance and gait abilities when compared with usual care and showed promising transfer effects to everyday living. Long-term follow-up assessments will further explore these effects.
Collapse
Affiliation(s)
- David Conradsson
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
| | | | - Håkan Nero
- Karolinska Institutet, Stockholm, Sweden
| | - Maria Hagströmer
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Ståhle
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
| | - Johan Lökk
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
50
|
Winfree KN, Pretzer-Aboff I, Agrawal SK. Robust Automated Step Extraction From Time-Series Contact Force Data Using the PDShoe. IEEE Trans Neural Syst Rehabil Eng 2014; 23:1012-9. [PMID: 25532188 DOI: 10.1109/tnsre.2014.2382641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents a method of stride identification, extraction, and analysis of data sets of time-series contact force data for ambulating subjects both with and without Parkinson's disease (PD). This method has been made robust with the use of seeded K-Means clustering, fast Fourier transformation (FFT) spectral analysis, and minimum window size rejection. These methods combine to produce well selected strides of active walking data. We are able to calculate quality of walking measures of stride duration, stance duration (as percent of gait cycle - %GC), swing duration (%GC), time to maximum heel force (%GC), time to maximum toe force (%GC), time spent in heel contact (%GC), and time spent in toe contact (%GC).
Collapse
|