Physical Activity and Its Diurnal Fluctuations Vary by Non-Motor Symptoms in Patients with Parkinson's Disease: An Exploratory Study

[Factors associated with fatigue in patients with Parkinson's disease]

Fatigue is one of the most frequent non-motor symptoms associated with people with Parkinson's disease (PwPD). In this study, we investigated the relationship between fatigue and patients' background characteristics, disease severity, motor and non-motor symptoms, and cognitive and psychological assessments in PwPD. A total of 80 PwPD were included in this study, 40% of whom experienced fatigue. PwPD with fatigue were associated with being female, dyskinesia, and higher levels of levodopa equivalent daily dose, as well as increased severity of depression, apathy and sleep disturbances, in addition to lower quality of life. Fatigue in PwPD is a symptom that warrants clinical attention, as it is linked to multiple risk factors, indicating the need for further intervention studies that incorporate the perspective of personalized medicine.

Measurement of Physical Activity Divided Into Inside and Outside the Home in People With Parkinson's Disease: A Feasibility Study

RATIONALE

In people with Parkinson's disease (PD), quantitative assessment of activities inside and outside the home is crucial for planning effective rehabilitation tailored to a person's living conditions and characteristics.

AIMS AND OBJECTIVES

We examined the feasibility of combining a physical activity metre and a daily activity diary for people with PD.

METHODS

Physical activity was evaluated using a triaxial accelerometer and recorded in a daily activity diary by the participant. The feasibility outcome was the data adoption rate, which was the physical activity rate calculated from the activity metre wearing time and the missing times from the daily activity diary.

RESULTS AND CONCLUSION

Of the 10 participants, nine had a complete data set (adoption rate 90%). The mean physical activity metre wearing time was 14.12 ± 2.26 h/day, with a mean missing time of 25.7 ± 18.1 min/day in the daily activity diary. Combining a physical activity metre and a daily activity diary is feasible in people with PD, particularly when planning rehabilitation protocols to enhance daily physical activity.

Association of real life postural transitions kinematics with fatigue in neurodegenerative and immune diseases

Fatigue is prevalent in immune-mediated inflammatory and neurodegenerative diseases, yet its assessment relies largely on patient-reported outcomes, which capture perception but not fluctuations over time. Wearable sensors, like inertial measurement units (IMUs), offer a way to monitor daily activities and evaluate functional capacity. This study investigates the relationship between sit-to-stand and stand-to-sit transitions and self-reported physical and mental fatigue in participants with Parkinson's, Huntington's, rheumatoid arthritis, systemic lupus erythematosus, primary Sjögren's syndrome and inflammatory bowel disease. Over 4 weeks, participants wore an IMU and reported fatigue levels four times daily. Using mixed-effects models, associations were identified between fatigue and specific kinematic features, such as 5th and 95th percentiles of sit-to-stand performance, suggesting that fatigue alters the control and effort of movement. These kinematic features show promise as indicators for fatigue in these patient populations.

Factors Associated With Physical Activity and Sedentary Behavior in People With Parkinson Disease: A Systematic Review and Meta-Analysis

OBJECTIVE

The goal of this review was to investigate factors associated with physical activity and sedentary behavior in people with Parkinson disease (PD). The magnitude of these associations was investigated in line with the International Classification of Functioning, Disability and Health components.

METHODS

A systematic literature review was conducted until February 2023, searching four databases (PubMed, EMBASE, Web of Science, and Scopus) for original articles investigating associations with physical activity or sedentary behavior in people with PD. Two independent researchers performed data extraction, and the risk of bias in the included studies was assessed using the Quality in Prognosis Studies tool. Meta-analyses were conducted to determine the magnitude of the associations, and significant regression models from the included studies were described.

RESULTS

Forty-two studies were included. Twenty-one factors associated with overall physical activity were identified. Higher levels of physical activity had a small association with cognition and body mass index and a fair association with 17 factors related to self-efficacy, physical function, mobility, quality of life, age, PD symptoms, and more. Better manual dexterity and functional gait had moderate to good associations with higher levels of physical activity. The regression model with the higher magnitude was composed mostly of contextual factors, except for the body max index. The magnitude of factors associated with physical activity intensity or sedentary behavior could not be identified.

CONCLUSION

Functional gait and manual dexterity were the strongest factors related to physical activity in people with PD. Further investigation is needed to understand the factors associated with physical activity intensity and sedentary behavior.

IMPACT

This study emphasizes the significance of considering contextual factors alongside body function and structure, activity and participation, and the health condition to enhance physical activity improvement during the rehabilitation process. By adopting such a holistic approach, rehabilitation professionals can optimize the overall health and well-being of individuals with Parkinson disease.

Real-World Measures of Cardiorespiratory Function Can Stratify Primary Sjogren's Syndrome Participants with Persistent Fatigue

Many individuals with various chronic diseases experience debilitating fatigue that substantially impacts their quality of life. Currently, assessments of fatigue rely on patient reported outcomes (PROs), which are subjective and prone to recall bias. Wearable devices, however, can provide valid and continuous estimates of human activity and physiology, which are essential components of health, and may provide objective evidence of fatigue. This study aims to stratify primary Sjogren's syndrome (PSS) patients with different fatigue levels using real-world measures of activity and cardiorespiratory function. 72 participants with PSS wore a VitalPatch sensor on the chest for two 7-day continuous periods. Concurrently, the participants completed PROs relating to fatigue up to 4 times a day. The mean, standard deviation, minimum, and maximum of the heart rate (HR) and respiratory rate (RR), both overall and during periods of walking, sitting, and standing were calculated, along with the difference in HR and RR between these activities, and the time spent in each activity. The Mann-Whitney U test and four machine learning classifiers were used to assess if the digital measures could separate the participants categorised as "persistent" or "non-persistent" fatigue. The categorization of these two groups were tested using 5 different thresholds.None of the activity-time measures were statistically different and very few of the RR measures were statistically different between the groups (p<0.05). However, 64% of HR measures differentiated persistent fatigue from non-persistent fatigue participants (p<0.05). Machine learning also found that HR measures could separate the fatigue persistency groups with accuracies up to 77%. Therefore, this analysis has shown that real-world measures from a digital wearable are able to stratify PSS participants with persistent and non-persistent fatigue. Thus, leading to an objective, single-device approach to identifying fatigue severity in an immune-mediated inflammatory disease.

Fatigue-Related Changes of Daily Function: Most Promising Measures for the Digital Age

Background

Fatigue is a prominent symptom in many diseases and is strongly associated with impaired daily function. The measurement of daily function is currently almost always done with questionnaires, which are subjective and imprecise. With the recent advances of digital wearable technologies, novel approaches to evaluate daily function quantitatively and objectively in real-life conditions are increasingly possible. This also creates new possibilities to measure fatigue-related changes of daily function using such technologies.

Summary

This review examines which digitally assessable parameters in immune-mediated inflammatory and neurodegenerative diseases may have the greatest potential to reflect fatigue-related changes of daily function.

Key Messages

Results of a standardized analysis of the literature reporting about perception-, capacity-, and performance-evaluating assessment tools indicate that changes of the following parameters: physical activity, independence of daily living, social participation, working life, mental status, cognitive and aerobic capacity, and supervised and unsupervised mobility performance have the highest potential to reflect fatigue-related changes of daily function. These parameters thus hold the greatest potential for quantitatively measuring fatigue in representative diseases in real-life conditions, e.g., with digital wearable technologies. Furthermore, to the best of our knowledge, this is a new approach to analysing evidence for the design of performance-based digital assessment protocols in human research, which may stimulate further systematic research in this area.

Association between physical activity and health literacy in patients with Parkinson's disease: an online web survey

BACKGROUND

For patients with Parkinson's disease (PwPD), promotion of habitual physical activity (PA) assists in the prevention of disease progression. Patients' health literacy (HL) is integral for meeting PA standards and turning it into a habit. This study evaluated the association between PA level and each HL domain in PwPD.

METHODS

Online web-based assessment instruments and self-administered questionnaires, including the PA Questionnaire (IPAQ) Short Form and the Functional, Communicative, and Critical Health Literacy (FCCHL) scale, were used to assess PA levels and health literacy domains of PwPD.

RESULTS

The mean age of PwPD (n = 114) was 65.9 (SD = 11.6) years; 59.6% female, and the mean duration of disease was 6.4 (SD = 5.1) years. Of participants, 47.4% met the recommended criteria for PA. When comparing each HL domain by PA level, participants with lower PA had significantly lower critical HL (p = 0.03). Logistic regression analysis revealed that PA level correlated with critical HL (OR = 2.46; 95% CI = 1.16-5.19; p = 0.02).

CONCLUSIONS

Adherence to recommended PA standards was associated with critical HL, but not other HL domains. Proactive attitudes to critically evaluate and utilize as well as understand health information may positively influence the promotion of PA.