Digital gait biomarkers in Parkinson's disease: susceptibility/risk, progression, response to exercise, and prognosis

Martina Mancini¹, Mitra Afshari², Quincy Almeida³, Sommer Amundsen-Huffmaster⁴, Katherine Balfany⁵, Richard Camicioli⁶, Cory Christiansen⁵, Marian L Dale⁷, Leland E Dibble⁸, Gammon M Earhart⁹, Terry D Ellis¹⁰, Garett J Griffith¹¹, Madeleine E Hackney^{12

13}, Jammie Hopkins¹⁴, Fay B Horak⁷, Kelvin E Jones¹⁵, Leah Ling⁸, Joan A O'Keefe¹⁶, Kimberly Kwei¹⁷, Genevieve Olivier⁸, Ashwini K Rao¹⁷, Anjali Sivaramakrishnan¹⁸, Daniel M Corcos¹¹

Affiliations

¹ Department of Neurology, Oregon Health & Science University, Portland, OR, USA. mancinim@ohsu.edu.
² Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA.
³ Carespace Health & Wellness, Waterloo, ON, Canada.
⁴ Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
⁵ Department of Physical Medicine & Rehabilitation, University of Colorado, Aurora, CO, USA.
⁶ Department of Medicine (Neurology) and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
⁷ Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
⁸ Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake, UT, USA.
⁹ Program in Physical Therapy, Washington University School of Medicine in St. Louis, St Louis, MO, USA.
¹⁰ Department of Physical Therapy, Boston University, Boston, MA, USA.
¹¹ Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, USA.
¹² Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, USA.
¹³ VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA.
¹⁴ Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
¹⁵ Department of Medicine, Faculty of Kinesiology, Sport, & Recreation and Neuroscience and Mental Health Institute, University of Alberta, Alberta, AB, Canada.
¹⁶ Departments of Anatomy & Cell Biology and Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
¹⁷ Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), and GH Sergievsky Center, Columbia University, New York, NY, USA.
¹⁸ Department of Physical Therapy at the School of Health Professions at UT Health San Antonio, San Antonio, TX, USA.

PMID: 40118834
PMCID: PMC11928532
DOI: 10.1038/s41531-025-00897-1

Review

Digital gait biomarkers in Parkinson's disease: susceptibility/risk, progression, response to exercise, and prognosis

Martina Mancini et al. NPJ Parkinsons Dis. 2025.

. 2025 Mar 21;11(1):51.

doi: 10.1038/s41531-025-00897-1.

Authors

Affiliations

¹ Department of Neurology, Oregon Health & Science University, Portland, OR, USA. mancinim@ohsu.edu.
² Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA.
³ Carespace Health & Wellness, Waterloo, ON, Canada.
⁴ Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
⁵ Department of Physical Medicine & Rehabilitation, University of Colorado, Aurora, CO, USA.
⁶ Department of Medicine (Neurology) and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
⁷ Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
⁸ Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake, UT, USA.
⁹ Program in Physical Therapy, Washington University School of Medicine in St. Louis, St Louis, MO, USA.
¹⁰ Department of Physical Therapy, Boston University, Boston, MA, USA.
¹¹ Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, USA.
¹² Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, USA.
¹³ VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA.
¹⁴ Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
¹⁵ Department of Medicine, Faculty of Kinesiology, Sport, & Recreation and Neuroscience and Mental Health Institute, University of Alberta, Alberta, AB, Canada.
¹⁶ Departments of Anatomy & Cell Biology and Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
¹⁷ Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), and GH Sergievsky Center, Columbia University, New York, NY, USA.
¹⁸ Department of Physical Therapy at the School of Health Professions at UT Health San Antonio, San Antonio, TX, USA.

PMID: 40118834
PMCID: PMC11928532
DOI: 10.1038/s41531-025-00897-1

Abstract

This narrative review examines the utility of gait digital biomarkers in Parkinson's disease (PD) research and clinical trials across four contexts: disease susceptibility/risk, disease progression, response to exercise, and fall prediction. The review of the literature to date suggests that upper body characteristics of gait (e.g., arm swing, trunk motion) may indicate susceptibility/risk of PD, while pace aspects (e.g., gait speed, stride length) are informative for tracking disease progression, exercise response, and fall likelihood. Dynamic stability aspects (e.g., trunk regularity, double-support time) worsen with disease progression but can improve with exercise. Gait variability emerges as a sensitive biomarker across all 4 contexts but with low specificity. The lack of standardized gait testing protocols and the lack of a minimum set of quantified digital gait biomarkers limit data harmonization across studies. Future studies, using a commonly agreed upon protocol, could be used to demonstrate the utility of specific gait biomarkers for clinical practice.

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Conflict of interest statement

Competing interests: Fay Horak is an employee of APDM Wearable Technologies—a Clario company that may have a commercial interest in the results of this research and technology. This potential conflict has been reviewed and managed by OHSU. All other authors declare no Competing Financial or Non-Financial Interests.

Figures

**Fig. 1. Stereotypical gait pattern in PD and independent domains of gait with their associated digital gait metrics.**
RoM Range of Motion, CoV Coefficient of Variation, SD standard deviation.

**Fig. 2**
Context of use for gait biomarkers for Parkinson’s disease summarized in this review.

See this image and copyright information in PMC

References

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Digital gait biomarkers in Parkinson's disease: susceptibility/risk, progression, response to exercise, and prognosis

Affiliations

Digital gait biomarkers in Parkinson's disease: susceptibility/risk, progression, response to exercise, and prognosis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources