Sensor-Based and Patient-Based Assessment of Daily-Living Physical Activity in People with Parkinson’s Disease: Do Motor Subtypes Play a Role?

Irina Galperin,Mira Assad,Nir Giladi,Anat Mirelman,Talia Herman,Jeffrey M Hausdorff,Natalie Ganz

doi:10.3390/s20247015

Abstract

The benefits of daily-living physical activity are clear. Nonetheless, the relationship between physical activity levels and motor subtypes of Parkinson’s disease (PD), i.e., tremor dominant (TD) and postural instability gait difficulty (PIGD), have not been well-studied. It is also unclear if patient perspectives and motor symptom severity are related to objective, sensor-based assessment of daily-living activity in those subtypes. To address these questions, total daily-living physical activity was quantified in 73 patients with PD and 29 healthy controls using a 3D-accelerometer worn on the lower back for at least three days. We found that individuals with the PIGD subtype were significantly less active than healthy older adults (p = 0.007), unlike individuals with the TD subtype. Among the PIGD subtype, higher daily physical activity was negatively associated with more severe ON bradykinesia (rS = -0.499, p = 0.002), motor symptoms (higher ON MDS-UPDRS (Unified Parkinson’s Disease Rating Scale motor examination)-III scores), gait difficulties (rS = -0.502, p = 0.002), motor complications (rS = 0.466, p = 0.004), and balance (rS = 0.519, p = 0.001). In contrast, among the TD subtype, disease-related characteristics were not related to daily-living physical activity. Intriguingly, physical activity was not related to self-report of ADL difficulties (scores of the MDS-UPDRS Parts I or II) in both motor subtypes. These findings highlight the importance of objective daily-living physical activity monitoring and suggest that self-report does not necessarily reflect objective physical activity levels. Furthermore, the results point to important differences in factors related to physical activity in PD motor subtypes, setting the stage for personalized treatment programs.

Highlights

The positive benefits of a daily-living physical activity on health in general, and motor function, in particular, and the negative consequences of reduced physical activity have been well-described [1,2].Sensors 2020, 20, 7015; doi:10.3390/s20247015 www.mdpi.com/journal/sensorsEmerging evidence highlights the importance of capturing daily-living physical activity metrics with activity monitoring via body-worn sensors
Balance and objective measures of gait extracted from accelerometer-based wearable sensors (McRoberts, DynaPort Hybrid system, The Netherlands) in laboratory settings were worse in the postural instability gait difficulty (PIGD) patients, compared to tremor dominant (TD) patients [6]
The PIGD and TD subgroups were generally similar with respect to disease-related characteristics

Summary

Introduction

The positive benefits of a daily-living physical activity on health in general, and motor function, in particular, and the negative consequences of reduced physical activity have been well-described [1,2].Sensors 2020, 20, 7015; doi:10.3390/s20247015 www.mdpi.com/journal/sensorsEmerging evidence highlights the importance of capturing daily-living physical activity metrics with activity monitoring via body-worn sensors. Signals from an activity monitor, typically placed on the lower-back or wrist, can be converted into metrics that reflect the intensity and total daily-living activity. Comparing daily-living activity of healthy adults to those measured in individuals of the PIGD and the TD subtype might provide a more accurate reflection of the impact of PD on the everyday life of these two motor subtypes. This may, perhaps, provide insight into the personalization of treatment

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