MOTOR SIGN AND NON-MOTOR SYMPTOM INFLUENCES DAILY AMBULATORY ACTIVITY IN INDIVIDUALS WITH PARKINSON DISEASE

C. Lopez-Lennon¹, J. Hale¹, E. Suttman¹, A. Rosenfeldt², A. Jansen², A. Weston¹, J. Alberts³, L. Dibble¹

¹University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, United States, ²Cleveland Clinic, Center for Neurological Restoration, Cleveland, United States, ³Cleveland Clinic, Department of Biomedical Engineering and Center for Neurological Restoration, Cleveland, United States

Background: The clinical use of commercially available ambulatory activity monitors to characterize and progress the physical activity of people with PD (PwPD) in the community is currently limited by a variety of factors, including but not limited to how measures of ambulatory activity correspond to disease severity and how non-motor symptoms affect ambulatory activity.

Purpose: The purposes of this study were to characterize the influence of on and off medication disease severity and to characterize the influence of motor and non-motor symptoms severity on ambulatory activity behaviors of PwPD. We hypothesized that motor sign severity and non-motor factors such as autonomic dysfunction would influence ambulatory activity.

Methods: MDS-UPDRS was used to assess motor and non-motor function. MDS-UPDRS III items were used to measure motor sign severity and was assessed on-and-off dopamine replacement medication. PwPD were provided with Garmin Vivofit 4 and were instructed to wear the device during waking hours for the study duration. Daily steps were collected over an observational period of seven days before the initiation of exercise interventions. Participants who wore the device for at least 4 days were included in this analysis.

Results: 208 subjects [137(65.9%) male] with a mean (SD) age of 64 (8.5). Subjects had a mean (SD) Hoehn and Yahr stage of 1.3(0.7) and a mean (SD) score of 38.1(14.9) on the MDS-UPDRS III when off medication. Participants wore the Garmin Vivofit 4 device, a median of 7 days, and had a median (IQR) of 5,177 (3,396-7,277) mean daily steps. Motor sign severity measured during the off-medication state was associated with significantly fewer mean daily steps (β: -34.3, SE 15.6,p= 0.03; β: -33.6, SE 15.5,p= 0.03,), but not when measured on PD medication (β: -24.5, SE 17.4 ,p= 0.16; β:−24.1, SE 17.3,p= 0.17).
The association of common non-motor symptoms of PD (cognition, sleep, fatigue, lightheadedness when standing, pain, urinary problems) and mean daily steps, were evaluated. Lightheadedness in standing and pain were associated with significantly fewer mean daily steps. Participants who reported mild to moderate lightheadedness in standing had an average of 1,888, and 2,499 fewer mean daily steps, respectively, compared to participants who reported no lightheadedness in standing (β: -1,888.1, SE: 836.2,p= 0.023; β: -2,498.7, SE:1,260.7,p= 0.048). Additionally, participants who reported slight pain had1,173 fewer steps per day than those who reported no pain (β: -1,173, SE: 538.6,p= 0.031).

Conclusions: In the current sample of PwPD, there was greater motor severity in the off-medication state, symptoms associated with cardiovascular autonomic dysfunction, and pain resulted in significant reductions in daily ambulatory activity. These findings provide insight into the factors that influence physical activity outside the clinic.

Implications: These findings suggest that clinicians should consider off-medication motor severity and the impact of pain and autonomic dysfunction on physical activity and integrate the objective measurement of these as part of their examination and evaluation process.

Funding acknowledgements: National Institute of Neurological Disorders and Stroke of the National Institutes of Health (2R01NS073717-06A1)

Keywords:
Parkinson Disease
Physical Activity

Topics:
Neurology: Parkinson's disease
Health promotion & wellbeing/healthy ageing/physical activity
Older people

Did this work require ethics approval? Yes

Institution: University of Utah

Committee: Cleveland Clinic Foundation and University ofUtah Institutional Review Boards

Ethics number: 18-1517