Capturing ambulatory activity decline in Parkinson's disease

Abstract

Background and purpose: Relatively little is known about the natural evolution of physical activity-related participation restrictions associated with Parkinson's disease (PD). We examined this issue prospectively, using continuous monitoring technology to capture the free-living ambulatory activity of persons with PD engaging in life situations. We specifically sought (1) to explore natural, long-term changes in daily ambulatory activity and (2) to compare the responsiveness of ambulatory activity parameters to clinical measures of gait and disease severity.

Methods: Thirty-three persons with PD participated (Hoehn and Yahr range of 1-3). Participants wore a step activity monitor for up to 7 days at baseline and again at 1-year follow-up. Mean daily values were calculated for parameters indicative of amount, intensity, frequency, and duration of ambulatory activity. Clinical measures included the Unified Parkinson Disease Rating Scale, the 6-Minute Walk, and Maximal Gait Speed. Parametric tests for paired samples were used to investigate changes in ambulatory activity parameters and clinical measures.

Results: Participants had significant declines in the amount and intensity of daily ambulatory activity but not in its frequency and duration (P < 0.007). Declines occurred in the absence of changes in clinical measures of gait or disease severity. The greatest 1-year decline occurred in the number of daily minutes participants spent engaging in at least moderate-intensity ambulatory activity.

Conclusion: Continuous monitoring of ambulatory activity beyond mere step counts may serve as a distinct and important means of quantifying declining ambulatory behavior associated with disease progression or improved ambulatory behavior resulting from rehabilitation and medical and/or surgical interventions in persons with PD.

Figure

Representative 24-hour ambulatory activity records recorded from a single participant at (A) baseline and (B) at 1-year follow-up. Both recordings were collected on the same day of the week. When comparing the graphics, note that the majority of the difference in step count can be accounted for by the reduced number of moderate-intensity minutes (i.e., focal period of high step accumulation) during what presumably was the participant’s daily exercise routine. The participant's baseline average values (7 days of recording) were: Steps = 13,269; Peak Activity Index = 110.40 steps / minute; Maximum Output = 100.40 steps / minute. Moderate intensity minutes = 46.71. Number of Activity Bouts = 68. 76.90% of period spent inactive. The participant's 1-year follow-up average values (7 days of recording) were: Steps = 9159; Peak Activity Index = 103.00 steps / minute; Maximum Output = 93.00 steps / minute. Moderate intensity minutes = 27.43. Number of Activity Bouts =55. 83.00 % of period spent inactive.

Figure

Representative 24-hour ambulatory activity records recorded from a single participant at (A) baseline and (B) at 1-year follow-up. Both recordings were collected on the same day of the week. When comparing the graphics, note that the majority of the difference in step count can be accounted for by the reduced number of moderate-intensity minutes (i.e., focal period of high step accumulation) during what presumably was the participant’s daily exercise routine. The participant's baseline average values (7 days of recording) were: Steps = 13,269; Peak Activity Index = 110.40 steps / minute; Maximum Output = 100.40 steps / minute. Moderate intensity minutes = 46.71. Number of Activity Bouts = 68. 76.90% of period spent inactive. The participant's 1-year follow-up average values (7 days of recording) were: Steps = 9159; Peak Activity Index = 103.00 steps / minute; Maximum Output = 93.00 steps / minute. Moderate intensity minutes = 27.43. Number of Activity Bouts =55. 83.00 % of period spent inactive.