Predictors of physical activity levels in individuals with Parkinson's disease: a cross-sectional study.

BACKGROUND: To investigate whether modifiable predictors (depressive symptoms, impairment in behavior and mood, balance impairments, and knee extensor muscle strength) are determinants of the physical activity level in Parkinson's disease. MATERIALS AND METHODS: A cross-sectional study with individuals diagnosed with idiopathic Parkinson's disease. Regression analysis of the data was used to investigate whether depressive symptoms, impairments in behavior and mood, balance impairments, or dominant knee extensor muscle strength are predictors of physical activity levels in Parkinson's disease. RESULTS: A total of 50 individuals with mild to moderate Parkinson's disease participated in this study, with a mean age of 67 ± 8 years and 68% male. Balance impairments explained 29% of the variation in the physical activity levels. The explained variance increased to 34% when depressive symptoms were included in the model. CONCLUSION: Among the predictor variables investigated in our study, only balance impairments and depressive symptoms explained the variance in physical activity levels in individuals with Parkinson's disease.

Predictors of balance in individuals with Parkinson's disease: A cross-sectional study.

INTRODUCTION: Some previous studies investigated predictors of balance in individuals with Parkinson's Disease (PD). However, outcomes commonly evaluated in the rehabilitation of individuals with PD that could predict balance deficits have not yet been investigated. OBJECTIVE: To determine whether the variables muscle strength, physical activity and depression are predictors of balance in individuals with PD. MATERIAL AND METHODS: This is a cross-sectional study in which the investigated variables included: trunk and knee extensors' muscle strength (modified sphygmomanometer test - MST), physical activity level (Adjusted Human Activity Profile score) and depression (Patient Health Questionnaire-9 - PHQ-9). The outcome variable was balance, as assessed by the Mini-BESTest. Multiple regression analysis was used to determine which predictor variables explain the outcome variable. RESULTS: A total of 50 individuals with PD, mean age 67 ± 8.8 years, 68% male, 40% HY 2.5 were included. The mean value of the dominant limb extensor muscle strength was 139 ± 45 mmHg, and the mean trunk extensor muscle strength value was 81.9 ± 19 mmHg. More than half of the sample (52%, n = 26) was classified as moderately active. Most of the sample (78%) had mild depression. The average Mini-BESTest score was 21 ± 5.4. The physical activity level explained 29% of the balance variance. When depression was included in the model, the explained variance increased to 35%. The other independent variables were not included in the model. CONCLUSION: The findings of the present study showed that the physical activity level and depression were able to explain 35% of the balance variation.

Validity of mHealth devices for counting steps in individuals with Parkinson's disease.

BACKGROUND: Step quantification is a good way to characterize the mobility and functional status of individuals with some functional disorder. Therefore, a validation study may lead to the feasibility of devices to stimulate an increase in the number of steps and physical activity level of individuals with Parkinson's Disease (PD). AIM: To investigate the validity of mHealth devices to estimate the number of steps in individuals with PD and compare the estimate with a standard criterion measure. METHOD: An observational study in a university laboratory with 34 individuals with idiopathic PD. The number of steps was measured using mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit INC®), and compared against a criterionstandard measure during the Two-Minute Walk Test using habitual speed. RESULTS: Our sample was 82% men with a Hoehn and Yahr mean of 2.3 ± 1.3 and mean walking speed of 1.2 ± 0.2 m/s. Positive and statistically significant associations were found between Google Fit (r = 0.92; p < 0.01), STEPZ (r = 0.91; p < 0.01), Pacer (r = 0.77; p < 0.01), Health (r = 0.54; p < 0.01), and Fitbit Inc® (r = 0.82; p < 0.01) with the criterion-standard measure. CONCLUSIONS: GoogleFit, STEPZ, Fitbit Inc.®, Pacer, and Health are valid instruments to measure the number of steps over a given period of time with moderate to high correlation with the criterion-standard in individuals with PD. This result shows that technology such as smartphone applications and activity monitor can be used to assess the number of steps in individuals with PD, and allows the possibility of using this technology for assessment and intervention purposes.

Validity of the modified sphygmomanometer test for the assessment of tip pinch strength in Parkinson's disease.

BACKGROUND: The tip pinch is one of the most delicate and precise movement of the hand, and it is used to manipulate small objects, commonly observed in the activities of daily living of any individuals. Individuals with Parkinson Disease (PD) with impaired manual dexterity, manipulative skills, and hand weakness have an important barrier for activities of daily life. However, the dynamometer usually used for measuring the tip pinch have a high cost, so, validate a sphygmomanometer can make this assessment more accessible. OBJECTIVE: To investigate the validity of the modified sphygmomanometer test in the evaluation of tip pinch strength when compared to the gold standard. METHODS: 50 individuals with idiopathic PD took part in the study. The muscle strength of tip pinch on the dominant and non-dominant side was measured by the modified sphygmomanometer test and the gold standard, the dynamometer. Concurrent validity was analyzed using Pearson's correlation coefficient. RESULTS: 50 individuals diagnosed with idiopathic PD, mean age of 67 ± 8.0 years, 68% male, mean time of diagnosis in months of 84 ± 66 and Hoehn and Yahr mean of 2.5 ± 0.6. There was a significant correlation of moderate magnitude between the modified sphygmomanometer test and the dynamometer in dominant side (r = 0.44; p < 0.01) and non-dominant side (r = 0.48; p < 0.01). CONCLUSION: The modified sphygmomanometer test showed adequate validity for assessing the muscle strength of the tip pinch in individuals with PD.

The Mini-BESTest is an independent predictor of falls in Parkinson Disease.

BACKGROUND: Falls in Parkinson Disease (PD) are a complex health problem, with multidimensional causes and consequences. OBJECTIVES: To identify the fall predictors in individuals with PD and compare fallers and non-fallers considering their socio-demographic, anthropometric, clinical and functional status. METHODS: A multicenter cross-sectional design was employed. Variables included: age, sex, body mass index, PD progression, levodopa dosage, activities limitation and motor impairments (UPDRS ADL/Motor), level of physical activity (human activity profile - HAP), fear of falls (Falls Efficacy Scale-International-FES-I), freezing of gait (Freezing of Gait Questionnaire - FOG-Q), gait speed (10 meters walk test - 10-MWT), lower limb functional strength (Five Times Sit-to-Stand Test - FTSST), balance (Mini-BESTest), mobility (Timed "Up & Go" - TUG) and dual-task dynamic (TUG-DT). Seventeen potential predictors were identified. Logistic regression and ROC curve were applied. RESULTS: Three-hundred and seventy individuals (44.87% fallers and 55.13% non-fallers) completed the study. Fallers presented worse performance in UPDRS motor/ADL/Total, FES-I, FOG-Q, Mini-BESTest, HAP, TUG and TUG-DT and the majority were inactive. The Mini-BESTest Total was the main independent predictor of falls (OR=0.92; p<0.001; 95% CI=0.89, 0.95). For each one-unit increase in the Mini-BESTest, there was an average reduction of 8% in the probability of being a faller. A cut-off point of 21.5/28 (AUC=0.669, sensitivity 70.7% and specificity 55.1%) was determined. CONCLUSION: Besides characterizing and comparing fallers and non-fallers, this study showed that the Mini-BESTest was the strongest individual predictor of falls in individuals with PD, highlighting the importance of evaluating dynamic balance ability during fall risk assessment.