Fall Risk in Relation to Individual Physical Activity Exposure in Patients with Different Neurodegenerative Diseases: a Pilot Study
Falls in patients with neurodegenerative diseases (NDDs) have enormous detrimental consequences. A better understanding of the interplay between physical activity (PA) and fall risk might help to reduce fall frequency. We aimed to investigate the association between sensor-based PA and fall risk in NDDs, using “falls per individual PA exposure time” as a novel measure. Eighty-eight subjects (n = 31 degenerative ataxia (DA), n = 14 Parkinson’s disease (PD), n = 12 progressive supranuclear palsy (PSP) and 31 healthy controls) were included in this pilot study. PA was recorded in free-living environments with three-axial accelerometers (activPAL™) over 7 days. Falls were prospectively assessed over 12 months. Fall incidence was calculated by (i) absolute number of falls per person years (py) and (ii) falls per exposure to individual PA. Absolute fall incidence was high in all three NDDs, with differing levels (DA, 9 falls/py; PD, 14 falls/py; PSP, 29 falls/py). Providing a more fine-grained view on fall risk, correction for individual exposure to PA revealed that measures of low walking PA were associated with higher fall incidence in all three NDDs. Additionally, higher fall incidence was associated with more sit-to-stand transfers in PD and longer walking bouts in PSP. Our results suggest that low walking PA is a risk factor for falls in DA, PD and PSP, indicating the potential benefit of increasing individual PA in these NDDs to reduce fall risk. Moreover, they show that correction for individual exposure to PA yields a more differentiated view on fall risk within and across NDDs.
KeywordsAtaxia Spinocerebellar ataxia Exposure Falls Parkinson’s disease Physical activity Progressive supranuclear palsy
Healthy control subject
Dynamic Gait Index
Falls efficacy scale-international
Montreal Cognitive Assessment
Progressive supranuclear palsy
Unified Multiple System Atrophy Rating Scale
We thank all participants who joined in the study. We are grateful for the help in recruitment of the office of Sport and Exercise, City of Stuttgart, Germany (especially Mrs. Carolin Barz) and the Bosch BKK health insurance.
Dr. Srulijes: design and conceptualization of the study, acquisition of data, analysis of the data, drafting the manuscript, final approval of the version to be submitted
Dr. Klenk: design and conceptualization of the study, analysis of the data, revising the manuscript, final approval of the version to be submitted
Dr. Schwenk, Mrs. Schatton, Mrs. Teubner-Liepert, Mr. Schwickert, Mrs. Meyer, Mrs. K.C.: acquisition of data, analysis of the data, revising the manuscript, final approval of the version to be submitted
Prof. Maetzler, Prof. Becker: conceptualization of the study, analysis of the data, revising the manuscript, final approval of the version to be submitted
Dr. Synofzik: design and conceptualization of the study, acquisition of data, analysis of the data, drafting the manuscript, final approval of the version to be submitted
This study is funded by grants from the Forschungskolleg Geriatrie of the Robert-Bosch-Foundation Stuttgart, Germany (to K.S. and M.Sy.).
Compliance with Ethical Standards
All patients provided written informed consent. The Ethics Committee of the University of Tübingen approved the study (application no. 602/2012BO1).
Conflict of Interest
The authors declare that they have no competing interests.
Dr. Klenk, Dr. Srulijes, Mrs. Schatton, Mrs. Teubner-Liepert and Prof. Becker report no disclosures.
Prof. Maetzler receives funding from the European Union, from the Michael J Fox Foundation, the Neuroalliance and Janssen. He received funding from the Robert Bosch foundation and speaker honoraria from GlaxoSmithKline, Rölke Pharma, Licher and UCB.
Mr. Schwickert received consulting fees from Rölke Pharma.
Dr. Synofzik received consulting fees from Actelion Pharmaceuticals Ltd.
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