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Capturing Ambulatory Activity Decline in Parkinson's Disease

Cavanaugh, James T. PT, PhD, NCS; Ellis, Terry D. PT, PhD, NCS; Earhart, Gammon M. PT, PhD; Ford, Matthew P. PT, PhD; Foreman, K. Bo PT, PhD; Dibble, Leland E. PT, PhD, ATC

Journal of Neurologic Physical Therapy: June 2012 - Volume 36 - Issue 2 - p 51–57
doi: 10.1097/NPT.0b013e318254ba7a
Research Articles

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.

Department of Physical Therapy, University of New England, Portland, Maine (J.T.C.); Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts (T.D.E.); Program in Physical Therapy, Washington University in St. Louis–School of Medicine, St Louis, Missouri (G.M.E.); Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham (M.P.F.); and Department of Physical Therapy, University of Utah, Salt Lake City (K.B.F., L.E.D.).

Correspondence: James T. Cavanaugh, E-mail:

All authors contributed equally to this work.

The authors declare no conflict of interest.

© 2012 Neurology Section, APTA