All study activities were conducted remotely as described below, resulting in a “touchless” design where subjects never reported for in-person visits. Using administrative data, we invited Veterans with PD living in a five-state area to participate via mail with screening and consent via phone. Survey assessments and step counts (using Fitbits) were acquired using Way to Health, a web-based digital health platform. Subjects underwent a 2-week baseline step collection, 6-week gamification period (targeting 20% step increase) and 4-week followup. Motor symptoms were monitored at the end of each study period with Parkinson’s Kinetigraph (PKG).

We consented 88 subjects with 75 (85%) completing all baseline assessments and 74 (99%) then completing the full study protocol. The cohort had a mean (SD) age of 71 (6.1), disease duration of 5.2 (3.8) years and lived 222 (344) miles from the medical center. Participants averaged 4829 (2745) steps at baseline with a mean increase of 28% (p<0.001) during the gamification intervention and 12% (p<0.01) during followup. Bradykinesia (-0.22 (1.9) vs. +1.11(2.2)) and immobility (-0.4(5.0) vs. +2.8 (5.1)) PKG scores were significantly improved (p<0.05) in subjects meeting their step goal on >50% of days while tremor scores did not change.