To assess activity habits among Veterans with mild-to-moderate Parkinson disease

Maintaining moderate and vigorous physical activity (MVPA) is a crucial component of the management of Parkinson disease (PD), and exercise counseling is part of the 2015 AAN PD quality guidelines. However, most individuals with PD do not achieve recommended MVPA targets [Mantri et al. J Park Dis 2018], and self-reported activity is subject to recall and social desirability bias. Wearable technology provides an opportunity for objective measurement of physical activity habits and more detailed understanding of actual activity frequency and intensity.

This was a feasibility study of wearable technology in a cohort of US Veterans with mild-to-moderate Parkinson disease. Subjects completed the Physical Activity Scale in the Elderly (PASE), a validated self-reported questionnaire assessing a variety of leisure and household activities. A subset of subjects agreed to wear a waist Actigraph, which assessed triplanar displacement during waking hours over 28 days. PD-specific cutpoints for step counts and MVPA were used.

Sixty-six subjects completed the PASE; 28 (n=42%) wore the Actigraph. The median age (interquartile range, IQR) was 70 (69-76) and median disease duration (IQR) was 4 years (1-8). Most subjects (n=45, 60%) were Hoehn&Yahr (HY) stage 2. There was no difference in age-adjusted median PASE between those who wore vs did not wear the Actigraph (137.7 vs 112.3, p=0.08). Median daily step count (IQR) was only 3615 steps (1773-4871), and median daily minutes of MVPA (IQR) were only 10.5 minutes (2.0-25.0). PASE was only moderately well-correlated with step count (ρ=0.53, p<0.01) but not with minutes of MVPA (ρ=0.23, p=0.52).

This pilot study demonstrates the feasibility and value of objective activity monitoring among Veterans with PD. We determined that Veterans with PD are highly sedentary, highlighting the need for targeted interventions to increase activity and improve outcomes in this population.