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Bianchini E, Galli S, Alborghetti M, De Carolis L, Zampogna A, Hansen C, Vuillerme N, Suppa A, Pontieri FE. Four Days Are Enough to Provide a Reliable Daily Step Count in Mild to Moderate Parkinson's Disease through a Commercial Smartwatch. SENSORS (BASEL, SWITZERLAND) 2023; 23:8971. [PMID: 37960670 PMCID: PMC10649244 DOI: 10.3390/s23218971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
Daily steps could be a valuable indicator of real-world ambulation in Parkinson's disease (PD). Nonetheless, no study to date has investigated the minimum number of days required to reliably estimate the average daily steps through commercial smartwatches in people with PD. Fifty-six patients were monitored through a commercial smartwatch for 5 consecutive days. The total daily steps for each day was recorded and the average daily steps was calculated as well as the working and weekend days average steps. The intraclass correlation coefficient (ICC) (3,k), standard error of measurement (SEM), Bland-Altman statistics, and minimum detectable change (MDC) were used to evaluate the reliability of the step count for every combination of 2-5 days. The threshold for acceptability was set at an ICC ≥ 0.8 with a lower bound of CI 95% ≥ 0.75 and a SAM < 10%. ANOVA and Mann-Whitney tests were used to compare steps across the days and between the working and weekend days, respectively. Four days were needed to achieve an acceptable reliability (ICC range: 0.84-0.90; SAM range: 7.8-9.4%). In addition, daily steps did not significantly differ across the days and between the working and weekend days. These findings could support the use of step count as a walking activity index and could be relevant to developing monitoring, preventive, and rehabilitation strategies for people with PD.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France;
| | - Silvia Galli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Lanfranco De Carolis
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (A.S.)
| | - Clint Hansen
- Department of Neurology, Kiel University, 24105 Kiel, Germany;
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France;
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75005 Paris, France
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (A.S.)
- IRCCS Neuromed Institute, 86077 Pozzilli, Italy
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
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A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept. Healthcare (Basel) 2023; 11:healthcare11040507. [PMID: 36833041 PMCID: PMC9957301 DOI: 10.3390/healthcare11040507] [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: 12/19/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs.
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Zajac JA, Porciuncula F, Cavanaugh JT, McGregor C, Harris BA, Smayda KE, Awad LN, Pantelyat A, Ellis TD. Feasibility and Proof-of-Concept of Delivering an Autonomous Music-Based Digital Walking Intervention to Persons with Parkinson's Disease in a Naturalistic Setting. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1253-1265. [PMID: 37840504 PMCID: PMC10657706 DOI: 10.3233/jpd-230169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Reduced motor automaticity in Parkinson's disease (PD) negatively impacts the quality, intensity, and amount of daily walking. Rhythmic auditory stimulation (RAS), a clinical intervention shown to improve walking outcomes, has been limited by barriers associated with the need for ongoing clinician input. OBJECTIVE To assess the feasibility, proof-of-concept, and preliminary clinical outcomes associated with delivering an autonomous music-based digital walking intervention based on RAS principles to persons with PD in a naturalistic setting. METHODS Twenty-three persons with PD used the digital intervention independently for four weeks to complete five weekly 30-minute sessions of unsupervised, overground walking with music-based cues. The intervention progressed autonomously according to real-time gait sensing. Feasibility of independent use was assessed by examining participant adherence, safety, and experience. Intervention proof-of-concept was assessed by examining spatiotemporal metrics of gait quality, daily minutes of moderate intensity walking, and daily steps. Preliminary clinical outcomes were assessed following intervention completion. RESULTS Participants completed 86.4% of sessions and 131.1% of the prescribed session duration. No adverse events were reported. Gait speed, stride length, and cadence increased within sessions, and gait variability decreased (p < 0.05). Compared to baseline, increased daily moderate intensity walking (mean Δ= +21.44 minutes) and steps (mean Δ= +3,484 steps) occurred on designated intervention days (p < 0.05). Quality of life, disease severity, walking endurance, and functional mobility were improved after four weeks (p < 0.05). CONCLUSIONS Study findings supported the feasibility and potential clinical utility of delivering an autonomous digital walking intervention to persons with PD in a naturalistic setting.
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Affiliation(s)
- Jenna A. Zajac
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Franchino Porciuncula
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - James T. Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Colin McGregor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Louis N. Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Terry D. Ellis
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
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Bianchini E, Caliò B, Alborghetti M, Rinaldi D, Hansen C, Vuillerme N, Maetzler W, Pontieri FE. Step-Counting Accuracy of a Commercial Smartwatch in Mild-to-Moderate PD Patients and Effect of Spatiotemporal Gait Parameters, Laterality of Symptoms, Pharmacological State, and Clinical Variables. SENSORS (BASEL, SWITZERLAND) 2022; 23:214. [PMID: 36616812 PMCID: PMC9823757 DOI: 10.3390/s23010214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Commercial smartwatches could be useful for step counting and monitoring ambulatory activity. However, in Parkinson's disease (PD) patients, an altered gait, pharmacological condition, and symptoms lateralization may affect their accuracy and potential usefulness in research and clinical routine. Steps were counted during a 6 min walk in 47 patients with PD and 47 healthy subjects (HS) wearing a Garmin Vivosmart 4 (GV4) on each wrist. Manual step counting was used as a reference. An inertial sensor (BTS G-Walk), placed on the lower back, was used to compute spatial-temporal gait parameters. Intraclass correlation coefficient (ICC) and mean absolute percentage error (MAPE) were used for accuracy evaluation and the Spearman test was used to assess the correlations between variables. The GV4 overestimated steps in PD patients with only a poor-to-moderate agreement. The OFF pharmacological state and wearing the device on the most-affected body side led to an unacceptable accuracy. The GV4 showed an excellent agreement and MAPE in HS at a self-selected speed, but an unacceptable performance at a slow speed. In PD patients, MAPE was not associated with gait parameters and clinical variables. The accuracy of commercial smartwatches for monitoring step counting might be reduced in PD patients and further influenced by the pharmacological condition and placement of the device.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Bianca Caliò
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Santa Lucia Foundation, IRCCS, 00179 Rome, Italy
| | - Clint Hansen
- Department of Neurology, Kiel University, 24105 Kiel, Germany
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75005 Paris, France
| | - Walter Maetzler
- Department of Neurology, Kiel University, 24105 Kiel, Germany
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Santa Lucia Foundation, IRCCS, 00179 Rome, Italy
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Guo CC, Chiesa PA, de Moor C, Fazeli MS, Schofield T, Hofer K, Belachew S, Scotland A. Digital Devices for Assessing Motor Functions in Mobility-Impaired and Healthy Populations: Systematic Literature Review. J Med Internet Res 2022; 24:e37683. [DOI: 10.2196/37683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/18/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background
With the advent of smart sensing technology, mobile and wearable devices can provide continuous and objective monitoring and assessment of motor function outcomes.
Objective
We aimed to describe the existing scientific literature on wearable and mobile technologies that are being used or tested for assessing motor functions in mobility-impaired and healthy adults and to evaluate the degree to which these devices provide clinically valid measures of motor function in these populations.
Methods
A systematic literature review was conducted by searching Embase, MEDLINE, CENTRAL (January 1, 2015, to June 24, 2020), the United States and European Union clinical trial registries, and the United States Food and Drug Administration website using predefined study selection criteria. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers.
Results
A total of 91 publications representing 87 unique studies were included. The most represented clinical conditions were Parkinson disease (n=51 studies), followed by stroke (n=5), Huntington disease (n=5), and multiple sclerosis (n=2). A total of 42 motion-detecting devices were identified, and the majority (n=27, 64%) were created for the purpose of health care–related data collection, although approximately 25% were personal electronic devices (eg, smartphones and watches) and 11% were entertainment consoles (eg, Microsoft Kinect or Xbox and Nintendo Wii). The primary motion outcomes were related to gait (n=30), gross motor movements (n=25), and fine motor movements (n=23). As a group, sensor-derived motion data showed a mean sensitivity of 0.83 (SD 7.27), a mean specificity of 0.84 (SD 15.40), a mean accuracy of 0.90 (SD 5.87) in discriminating between diseased individuals and healthy controls, and a mean Pearson r validity coefficient of 0.52 (SD 0.22) relative to clinical measures. We did not find significant differences in the degree of validity between in-laboratory and at-home sensor-based assessments nor between device class (ie, health care–related device, personal electronic devices, and entertainment consoles).
Conclusions
Sensor-derived motion data can be leveraged to classify and quantify disease status for a variety of neurological conditions. However, most of the recent research on digital clinical measures is derived from proof-of-concept studies with considerable variation in methodological approaches, and much of the reviewed literature has focused on clinical validation, with less than one-quarter of the studies performing analytical validation. Overall, future research is crucially needed to further consolidate that sensor-derived motion data may lead to the development of robust and transformative digital measurements intended to predict, diagnose, and quantify neurological disease state and its longitudinal change.
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Correno MB, Hansen C, Carlin T, Vuillerme N. Objective Measurement of Walking Activity Using Wearable Technologies in People with Parkinson Disease: A Systematic Review. SENSORS 2022; 22:s22124551. [PMID: 35746329 PMCID: PMC9229799 DOI: 10.3390/s22124551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 12/10/2022]
Abstract
Parkinson’s disease (PD) is a complex neurodegenerative disease with a multitude of disease variations including motor and non-motor symptoms. Quality of life and symptom management may be improved with physical activity. Due to technological advancement, development of small new wearable devices recently emerged and allowed objective measurement of walking activity in daily life. This review was specifically designed to synthesize literature on objective walking activity measurements using wearable devices of patients with PD. Inclusion criteria included patients with a diagnosis of PD and exclusion criteria included studies using animal models or mixed syndromes. Participants were not required to undergo any type of intervention and the studies must have reported at least one output that quantifies daily walking activity. Three databases were systematically searched with no limitation on publication date. Twenty-six studies were eligible and included in the systematic review. The most frequently used device was the ActiGraph GT3X which was used in 10 studies. Duration of monitoring presented a range from 8 h to one year. Nevertheless, 11 studies measured walking activity during a 7-day period. On-body sensor wearing location differed throughout the included studies showing eight positions, with the waist, ankle, and wrist being the most frequently used locations. The main procedures consisted of measurement of walking hours during a 2-day period or more, equipped with a triaxial accelerometer at the dominant hip or ankle. It is also important for further research to take care of different factors such as the population, their pathology, the period, and the environment.
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Affiliation(s)
- Mathias Baptiste Correno
- Laboratory AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.C.); (T.C.); (N.V.)
- LabCom Telecom4Health, Orange Labs, Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, 24105 Kiel, Germany
- Correspondence:
| | - Thomas Carlin
- Laboratory AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.C.); (T.C.); (N.V.)
- LabCom Telecom4Health, Orange Labs, Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
| | - Nicolas Vuillerme
- Laboratory AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (M.B.C.); (T.C.); (N.V.)
- LabCom Telecom4Health, Orange Labs, Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75231 Paris, France
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de Almeida FO, Santana V, Corcos DM, Ugrinowitsch C, Silva-Batista C. Effects of Endurance Training on Motor Signs of Parkinson's Disease: A Systematic Review and Meta-Analysis. Sports Med 2022; 52:1789-1815. [PMID: 35113386 DOI: 10.1007/s40279-022-01650-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence has demonstrated that endurance training (ET) reduces the motor signs of Parkinson's disease (PD). However, there has not been a comprehensive meta-analysis of studies to date. OBJECTIVE The aim of this study was to compare the effect of ET versus nonactive and active control conditions on motor signs as assessed by either the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) or Movement Disorder Society-UPDRS-III (MDS-UPDRS-III). METHODS A random-effect meta-analysis model using standardized mean differences (Hedges' g) determined treatment effects. Moderators (e.g., combined endurance and physical therapy training [CEPTT]) and meta-regressors (e.g., number of sessions) were used for sub-analyses. Methodological quality was assessed by the Physiotherapy Evidence Database. RESULTS Twenty-seven randomized controlled trials (RCTs) met inclusion criteria (1152 participants). ET is effective in decreasing UPDRS-III scores when compared with nonactive and active control conditions (g = - 0.68 and g = - 0.33, respectively). This decrease was greater (within- and between-groups average of - 8.0 and - 6.8 point reduction on UPDRS-III scores, respectively) than the moderate range of clinically important changes to UPDRS-III scores (- 4.5 to - 6.7 points) suggested for PD. Although considerable heterogeneity was observed between RCTs (I2 = 74%), some moderators that increased the effect of ET on motor signs decreased the heterogeneity of the analyses, such as CEPTT (I2 = 21%), intensity based on treadmill speed (I2 = 0%), self-perceived exertion rate (I2 = 33%), and studies composed of individuals with PD and freezing of gait (I2 = 0%). Meta-regression did not produce significant relationships between ET dosage and UPDRS-III scores. CONCLUSIONS ET is effective in decreasing UPDRS-III scores. Questions remain about the dose-response relationship between ET and reduction in motor signs.
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Affiliation(s)
| | - Vagner Santana
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Carlos Ugrinowitsch
- Laboratory of Adaptations To Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Carla Silva-Batista
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil. .,School of Arts, Sciences and Humanities of University of São Paulo, St. Arlindo Béttio, 1000, 03828-000, Vila Guaraciaba, São Paulo, Brazil. .,Laboratory of Adaptations To Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
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Cubo E, Garcia-Bustillo A, Arnaiz-Gonzalez A, Ramirez-Sanz JM, Garrido-Labrador JL, Valiñas F, Allende M, Gonzalez-Bernal JJ, Gonzalez-Santos J, Diez-Pastor JF, Jahouh M, Arribas J, Trejo J. Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial. PLoS One 2021; 16:e0260889. [PMID: 34932580 PMCID: PMC8691608 DOI: 10.1371/journal.pone.0260889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Approximately 40–70% of people with Parkinson’s disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care. Objective To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD. Methods Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales. Results This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care. Conclusion In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care. Trial registration ClinicalTrials.gov Identifier: NCT04694443.
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Affiliation(s)
- Esther Cubo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
- * E-mail:
| | - Alvaro Garcia-Bustillo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | | | | | | | | | | | | | | | - Maha Jahouh
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | - Jose Trejo
- Hospital Universitario Burgos, Burgos, Spain
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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).
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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
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10
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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.
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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
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Ramsey KA, Zhou W, Rojer AGM, Reijnierse EM, Maier AB. Associations of objectively measured physical activity and sedentary behaviour with fall-related outcomes in older adults: a systematic review. Ann Phys Rehabil Med 2021; 65:101571. [PMID: 34530151 DOI: 10.1016/j.rehab.2021.101571] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/23/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Higher physical activity (PA) and lower sedentary behaviour (SB) are associated with better muscle strength, balance, and functional ability, which are imperative for avoiding falls. This systematic review aimed to describe the association between objectively measured PA and SB with falls, fear of falling, and fractures. METHODS Six databases were searched from inception to July 21, 2020 for articles reporting the association of objectively measured PA/SB with falls, fear of falling, and/or fractures in community-dwelling older adults ≥60 years old. Results were synthesized in effect-direction heat maps and albatross plots expressed as Pearson's correlation coefficients (R). RESULTS A total of 43 articles were included, representing 27,629 (range 26 to 5,545) community-dwelling older adults (mean [SD] age 76.6 [8.4] years, 47% female). Longitudinal associations were reported in 13 articles and cross-sectional associations in 30. Falls were reported in 11 articles, fear of falling in 18 and fractures in 2. Higher PA and lower SB were associated with less fear of falling (median [interquartile range] Rs = steps: -0.214 [0.249; -0.148], total PA: -0.240 [0.267; -0.144], and moderate-to-vigorous PA: -0.180 [0.382; -0.121]), but these associations did not extend to falls or fractures, which showed inconsistent effect directions. CONCLUSION Fear of falling is associated with less engagement in PA and more SB, thus indicating that it is a psychological barrier to an active lifestyle. Varying effect directions for associations between PA and SB with falls and fractures may provide evidence for non-linear associations and require further research considering details of the fall or fracture incident. PROSPERO REGISTRATION NUMBER CRD42018103910.
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Affiliation(s)
- Keenan A Ramsey
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Waner Zhou
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Anna G M Rojer
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, National University Health System, Singapore.
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12
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Ellis TD, Colón-Semenza C, DeAngelis TR, Thomas CA, Hilaire MHS, Earhart GM, Dibble LE. Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease. Semin Neurol 2021; 41:189-205. [PMID: 33742432 DOI: 10.1055/s-0041-1725133] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Advances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of early disability coupled with the benefits of exercise suggests that physical therapy should be initiated earlier in the disease. In this review, we present the evidence revealing early disability in PD and the effectiveness of physical therapy and exercise, followed by a discussion of a secondary prevention model of rehabilitation to reduce early disability and optimize long-term outcomes.
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Affiliation(s)
- Terry D Ellis
- Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Cristina Colón-Semenza
- Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Tamara R DeAngelis
- Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Cathi A Thomas
- Parkinson's Disease and Movement Disorders Center, Boston University Medical Campus, Boston, Massachusetts.,American Parkinson Disease Association Information and Referral Center at Boston University Medical Center, Boston, Massachusetts
| | - Marie-Hélène Saint Hilaire
- Parkinson's Disease and Movement Disorders Center, Boston University Medical Campus, Boston, Massachusetts.,Department of Neurology at Boston University School of Medicine, Boston, Massachusetts.,American Parkinson Disease Association Center for Advanced Research at Boston University Medical Center, Boston, Massachusetts
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City, Utah.,Health-Kinesiology-Recreation, The University of Utah, Salt Lake City, Utah
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13
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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.
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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
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14
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Dibble LE, Ellis TD. The sobering and puzzling reality of rehabilitation referrals for Parkinson disease. Parkinsonism Relat Disord 2021; 83:113-114. [PMID: 33551313 DOI: 10.1016/j.parkreldis.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Theresa D Ellis
- Department of Physical Therapy and Athletic Training, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA, 02215, USA.
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15
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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.
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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
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16
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Morris R, Mancin M. Lab-on-a-chip: wearables as a one stop shop for free-living assessments. Digit Health 2021. [DOI: 10.1016/b978-0-12-818914-6.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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The Effect of Conduction Exercise and Self-Acupressure in Treatment of Parkinson's Disease: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:7950131. [PMID: 32849903 PMCID: PMC7439182 DOI: 10.1155/2020/7950131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/05/2020] [Accepted: 07/17/2020] [Indexed: 01/21/2023]
Abstract
Introduction Parkinson's disease cannot be well treated by conventional medication. Acupuncture and Tai Chi are proven to be effective in relieving symptoms of Parkinson's disease. Traditional Chinese medicine exercises may prove to be an effective complementary therapy. Objective To evaluate the efficacy and safety of conduction exercise and self-acupressure in treating Parkinson's disease. Method This study is an accessor- and data analyzer-blind, add-on, randomized, controlled, pilot clinical study. In the treatment group, they were taught to practice conduction exercise and self-acupressure for 8 weeks. No additional treatment was given in the control group. Assessments were done at week 4 and week 8 of the treatment period. The primary outcomes are the total score and domain scores of the Chinese version of 39-item Parkinson's Disease Questionnaire. The secondary outcomes are the total score and domain scores of a custom-designed questionnaire, which is a short form of Nonmotor Symptom Scale. Results 22 patients in the treatment group and 14 in the control group continued to the treatment phase. Patients in the treatment group displayed improvement trends in primary and secondary outcomes. Improvements were significant in two areas of a custom-designed questionnaire: total score (p=0.014) and domain score of gastrointestinal tract (p=0.004). No severe adverse events were reported. Conclusion Conduction exercise and self-acupressure were well accepted by and feasible for Parkinson's disease patients. The data generated can be used for the planning of future studies. The exercise regime can be promoted as a home-based, self-practice therapy for Parkinson's disease patients, due to its safety, low cost, and convenience in implementation. This study is registered with the Chinese Clinical Trial Registry (ChiCTR-IPR-17011987, on 14 July 2017).
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18
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Næss-Schmidt E, Pedersen A, Christiansen D, Andersen NB, Brincks J, Grimm B, Nielsen J, Mechlenburg I. Daily activity and functional performance in people with chronic disease: A cross-sectional study. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1713280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Erhard Næss-Schmidt
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Health, Aarhus University Aarhus Denmark
| | - Asger Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Health, Aarhus University Aarhus Denmark
| | - David Christiansen
- Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Department of Clinical Medicine, Health, Aarhus University Aarhus Denmark
| | - Nils-bo Andersen
- Primary Health Care and Quality Improvement Central Denmark Regiont Viborg Denmark
| | - John Brincks
- Faculty of Health Science, Department of Research in Rehabilitation and Health Promotion, VIA University College Aarhus Denmark
| | - Bernd Grimm
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS) Luxembourg Luxembourg
| | - Jørgen Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Health, Aarhus University Aarhus Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Department of Clinical Medicine, Aarhus University Aarhus Denmark
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19
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Schenkman M, Moore CG, Kohrt WM, Hall DA, Delitto A, Comella CL, Josbeno DA, Christiansen CL, Berman BD, Kluger BM, Melanson EL, Jain S, Robichaud JA, Poon C, Corcos DM. Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial. JAMA Neurol 2019; 75:219-226. [PMID: 29228079 DOI: 10.1001/jamaneurol.2017.3517] [Citation(s) in RCA: 274] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Parkinson disease is a progressive neurologic disorder. Limited evidence suggests endurance exercise modifies disease severity, particularly high-intensity exercise. Objectives To examine the feasibility and safety of high-intensity treadmill exercise in patients with de novo Parkinson disease who are not taking medication and whether the effect on motor symptoms warrants a phase 3 trial. Design, Setting, and Participants The Study in Parkinson Disease of Exercise (SPARX) was a phase 2, multicenter randomized clinical trial with 3 groups and masked assessors. Individuals from outpatient and community-based clinics were enrolled from May 1, 2012, through November 30, 2015, with the primary end point at 6 months. Individuals with idiopathic Parkinson disease (Hoehn and Yahr stages 1 or 2) aged 40 to 80 years within 5 years of diagnosis who were not exercising at moderate intensity greater than 3 times per week and not expected to need dopaminergic medication within 6 months participated in this study. A total of 384 volunteers were screened by telephone; 128 were randomly assigned to 1 of 3 groups (high-intensity exercise, moderate-intensity exercise, or control). Interventions High-intensity treadmill exercise (4 days per week, 80%-85% maximum heart rate [n = 43]), moderate-intensity treadmill exercise (4 days per week, 60%-65% maximum heart rate [n = 45]), or wait-list control (n = 40) for 6 months. Main Outcomes and Measures Feasibility measures were adherence to prescribed heart rate and exercise frequency of 3 days per week and safety. The clinical outcome was 6-month change in Unified Parkinson's Disease Rating Scale motor score. Results A total of 128 patients were included in the study (mean [SD] age, 64 [9] years; age range, 40-80 years; 73 [57.0%] male; and 108 [84.4%] non-Hispanic white). Exercise rates were 2.8 (95% CI, 2.4-3.2) days per week at 80.2% (95% CI, 78.8%-81.7%) maximum heart rate in the high-intensity group and 3.2 (95% CI, 2.8-3.6; P = .13) days per week at 65.9% (95% CI, 64.2%-67.7%) maximum heart rate in the moderate-intensity group (P < .001). The mean change in Unified Parkinson's Disease Rating Scale motor score in the high-intensity group was 0.3 (95% CI, -1.7 to 2.3) compared with 3.2 (95% CI, 1.4 to 5.1) in the usual care group (P = .03). The high-intensity group, but not the moderate-intensity group, reached the predefined nonfutility threshold compared with the control group. Anticipated adverse musculoskeletal events were not severe. Conclusions and Relevance High-intensity treadmill exercise may be feasible and prescribed safely for patients with Parkinson disease. An efficacy trial is warranted to determine whether high-intensity treadmill exercise produces meaningful clinical benefits in de novo Parkinson disease. Trial Registration clinicaltrials.gov Identifier: NCT01506479.
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Affiliation(s)
- Margaret Schenkman
- Physical Therapy Program, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Charity G Moore
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wendy M Kohrt
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora.,Geriatric Research Education and Clinical Center, Veterans Affairs Eastern Colorado Health Care System, Denver
| | - Deborah A Hall
- Department of Neurology, Rush University Medical Center, Chicago, Illinois
| | - Anthony Delitto
- Office of the Dean, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cynthia L Comella
- Department of Neurology, Rush University Medical Center, Chicago, Illinois
| | - Deborah A Josbeno
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cory L Christiansen
- Physical Therapy Program, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora.,Geriatric Research Education and Clinical Center, Veterans Affairs Eastern Colorado Health Care System, Denver
| | - Brian D Berman
- Department of Neurology, School of Medicine, University of Colorado Anschutz Medical, Campus, Aurora
| | - Benzi M Kluger
- Department of Neurology, School of Medicine, University of Colorado Anschutz Medical, Campus, Aurora
| | - Edward L Melanson
- Geriatric Research Education and Clinical Center, Veterans Affairs Eastern Colorado Health Care System, Denver.,Division of Endocrinology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Samay Jain
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie A Robichaud
- Department of Rehabilitation Services, University of Illinois Hospital Health Sciences System, Chicago
| | - Cynthia Poon
- Department of Neurology, Northwestern University, Chicago, Illinois
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois
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20
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Pradhan S, Kelly VE. Quantifying physical activity in early Parkinson disease using a commercial activity monitor. Parkinsonism Relat Disord 2019; 66:171-175. [PMID: 31420310 DOI: 10.1016/j.parkreldis.2019.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 07/08/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Physical inactivity in Parkinson disease (PD) has an impact on motor and non-motor symptoms of the disease. It is unclear whether this decline in physical activity occurs early in the disease, in addition to any decline due to aging, and whether commercial activity monitors can be used to self-monitor physical activity levels in this population. OBJECTIVE To compare the quantity and intensity of physical activity (PA), as measured by commercial activity monitors, in people with mild PD and healthy older adults (HOA). A secondary objective was to assess adherence and user experience with wearing the activity monitoring device. METHODS An observational descriptive study design examined PA levels over a 14-day period using commercially-available activity monitors (Fitbit Charge HR). RESULTS Individuals with PD (n = 30) and HOA (n = 30) both demonstrated high adherence with wear time (PD = 13.8 [0.5] days, HOA = 13.9 [0.4] days, p = 0.55). People with PD took fewer steps per day than HOA (PD = 6416.9 (2795.5), HOA = 11441.3 (3932.1), p < 0.001). Compared to HOA, individuals with PD spent fewer minutes per day engaged in moderate to vigorous intensity activity (PD = 33.0 (22.5), HOA = 72.0(37.3), p < 0.001) and more minutes per day sedentary (PD = 803.74 (154.9), HOA = 578.26 (103.7), p < 0.001). Both groups reported that ease of use and satisfaction with the activity monitor were high. CONCLUSIONS People with mild PD demonstrated reduced quantity and intensity of PA compared to HOA. Both the PD and the HOA groups had good adherence wearing a commercial activity monitor that provided feedback regarding activity levels.
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Affiliation(s)
- Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, United states.
| | - Valerie E Kelly
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, United states
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21
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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.
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Jette AM. Mobile Technology: Increasing the Reach and Scalability of Physical Therapist Services in the Digital Age. Phys Ther 2019; 99:125-126. [PMID: 31222333 DOI: 10.1093/ptj/pzy138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 02/09/2023]
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23
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Ellis TD, Cavanaugh JT, DeAngelis T, Hendron K, Thomas CA, Saint-Hilaire M, Pencina K, Latham NK. Comparative Effectiveness of mHealth-Supported Exercise Compared With Exercise Alone for People With Parkinson Disease: Randomized Controlled Pilot Study. Phys Ther 2019; 99:203-216. [PMID: 30715489 DOI: 10.1093/ptj/pzy131] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Declining physical activity commonly occurs in people with Parkinson disease (PD) and contributes to reduced functional capacity and quality of life. OBJECTIVE The purpose of this study was to explore the preliminary effectiveness, safety, and acceptability of a mobile health (mHealth)-mediated exercise program designed to promote sustained physical activity in people with PD. DESIGN This was a 12-month single-blind (assessor), pilot, comparative-effectiveness, randomized controlled study. METHODS An mHealth-mediated exercise program (walking with a pedometer plus engagement in planned exercise supported by a mobile health application) was compared over 1 year with an active control condition (walking with a pedometer and exercise only). There were 51 participants in a community setting with mild-to-moderately severe (Hoehn and Yahr stages 1-3) idiopathic PD. Daily steps and moderate-intensity minutes were measured using a step activity monitor for 1 week at baseline and again at 12 months. Secondary outcomes included the 6-Minute Walk Test, Parkinson Disease Questionnaire 39 mobility domain, safety, acceptability, and adherence. RESULTS Both groups increased daily steps, moderate-intensity minutes, and 6-Minute Walk Test, with no statistically significant between-group differences observed. In the less active subgroup, changes in daily steps and moderate-intensity minutes were clinically meaningful. An improvement in the Parkinson Disease Questionnaire 39 mobility score favored mHealth in the overall comparison and was statistically and clinically meaningful in the less active subgroup. LIMITATIONS The limitation of the current study was the small sample size. CONCLUSIONS Both groups improved physical activity compared with expected activity decline over 1 year. The addition of the mHealth app to the exercise intervention appeared to differentially benefit the more sedentary participants. Further study in a larger group of people with low activity at baseline is needed.
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Affiliation(s)
- Terry D Ellis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston, MA 02215 (USA); and Center for Neurorehabilitation, Boston University
| | - James T Cavanaugh
- Department of Physical Therapy, University of New England, Portland, Maine
| | - Tamara DeAngelis
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University
| | - Kathryn Hendron
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University
| | - Cathi A Thomas
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University
| | - Marie Saint-Hilaire
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston University
| | - Karol Pencina
- Research Program in Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy K Latham
- Research Program in Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School
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Association between Objectively Measured Physical Activity and Gait Patterns in People with Parkinson's Disease: Results from a 3-Month Monitoring. PARKINSONS DISEASE 2018; 2018:7806574. [PMID: 30416704 PMCID: PMC6207897 DOI: 10.1155/2018/7806574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/15/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
Background Although physical activity (PA) is known to be beneficial in improving motor symptoms of people with Parkinson's disease (pwPD), little is known about the relationship between gait patterns and features of PA performed during daily life. Objective To verify the existence of possible relationships between spatiotemporal and kinematic parameters of gait and amount/intensity of PA, both instrumentally assessed. Methods Eighteen individuals affected by PD (10F and 8M, age 68.0 ± 10.8 years, 1.5 ≤ Hoehn and Yahr (H&Y) < 3) were required to wear a triaxial accelerometer 24 h/day for 3 consecutive months. They also underwent a 3D computerized gait analysis at the beginning and end of the PA assessment period. The number of daily steps and PA intensity were calculated on the whole day, and the period from 6:00 to 24:00 was grouped into 3 time slots, using 3 different cut-point sets previously validated in the case of both pwPD and healthy older adults. 3D gait analysis provided spatiotemporal and kinematic parameters of gait, including summary indexes of quality (Gait Profile Score (GPS) and Gait Variable Score (GVS)). Results The analysis of hourly trends of PA revealed the existence of two peaks located in the morning (approximately at 10) and in the early evening (between 18 and 19). However, during the morning time slot (06:00–12:00), pwPD performed significantly higher amounts of steps (4313 vs. 3437 in the 12:00–18:00 time slot, p < 0.001, and vs. 2889 in the 18:00–24:00 time slot, p=0.021) and of moderate-to-vigorous PA (43.2% vs. 36.3% in the 12:00–18:00 time slot, p=0.002, and vs. 31.4% in the 18:00–24:00 time slot, p=0.049). The correlation analysis shows that several PA intensity parameters are significantly associated with swing-phase duration (rho = −0.675 for sedentary intensity, rho = 0.717 for moderate-to-vigorous intensity, p < 0.001), cadence (rho = 0.509 for sedentary intensity, rho = −0.575 for moderate-to-vigorous intensity, p < 0.05), and overall gait pattern quality as expressed by GPS (rho = −0.498 to −0.606 for moderate intensity, p < 0.05) and GVS of knee flexion-extension (rho = −0.536 for moderate intensity, p < 0.05). Conclusions Long-term monitoring of PA integrated by the quantitative assessment of spatiotemporal and kinematic parameters of gait may represent a useful tool in supporting a better-targeted prescription of PA and rehabilitative treatments in pwPD.
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Ferrazzoli D, Ortelli P, Riboldazzi G, Maestri R, Frazzitta G. Effectiveness of Rotigotine plus intensive and goal-based rehabilitation versus Rotigotine alone in "de-novo" Parkinsonian subjects: a randomized controlled trial with 18-month follow-up. J Neurol 2018; 265:906-916. [PMID: 29442177 PMCID: PMC5878188 DOI: 10.1007/s00415-018-8792-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 01/20/2023]
Abstract
Background Dopamine Replacement Therapy (DRT) represents the most effective treatment for Parkinson’s disease (PD). Nevertheless, several symptoms are unresponsive to treatment and its long-term use leads to serious side effects. To optimize the pharmacological management of PD, dopamine-agonists are often prescribed to “de-novo” patients. Moreover, several studies have shown the effectiveness and the synergic effect of rehabilitation in treating PD. Objective To evaluate the synergism between DRT and rehabilitation in treating PD, by investigating the short and the long-term effectiveness of a multidisciplinary, intensive and goal-based rehabilitation treatment (MIRT) in a group of patients treated with Rotigotine. Materials and methods In this multicenter, single blinded, parallel-group, 1:1 allocation ratio, randomized, non-inferiority trial, 36 “de-novo” PD patients were evaluated along 18 months: 17 were treated with Rotigotine plus MIRT; 19 were treated with Rotigotine alone (R). The primary outcome measure was the total score of Unified Parkinson’s Disease Rating Scale (UPDRS). The secondary outcomes included the UPDRS sub-sections II and III (UPDRS II-III), the 6-Minute Walk Test (6MWT), the Timed Up and Go Test (TUG) and the amount of Rotigotine. Patients were evaluated at baseline (T0), 6 months (T1), 1 year (T2), and at 18 months (T3). Results No differences in UPDRS scores in the two groups (total score, III part and II part, p = 0.48, p = 0.90 and p = 0.40, respectively) were found in the time course. Conversely, a greater improvement in Rotigotine + MIRT group was observed for 6MWT (p < 0.0001) and TUG (p = 0.03). Along time, the dosage of Rotigotine was higher in patients who did not undergo MIRT, at all observation times following T0. Conclusions Over the course of 18 months, the effectiveness of the combined treatment (Rotigotine + MIRT) on the patients’ global clinical status, evaluated with total UPDRS, was not inferior to that of the pharmacological treatment with Rotigotine alone. Importantly, rehabilitation allowed patients to gain better motor performances with lower DRT dosage.
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Affiliation(s)
- D Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy.
| | - P Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy
| | - G Riboldazzi
- Parkinson's Disease and Movement Disorders Center, ASST dei Sette Laghi, Varese, Italy
- Parkinson's disease Rehabilitation Center, Fondazione Borghi, Brebbia, Varese, Italy
| | - R Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Via per Montescano 3, Montescano, 27040, Pavia, Italy
| | - G Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy
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