武田 和也

In individuals with Parkinson’s disease (PD), bradykinesia severity is related to physical activity (PA) inside homes. We aimed to investigate the effectiveness of the Lee Silverman Voice Treatment (LSVT)® BIG intervention in increasing at-home PA in individuals with PD. To evaluate the effect of the intervention, we compared pre- and post-intervention scores on the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Parts 3 and 2, as well as the time spent at home in three categories of PA intensity. For statistical testing, paired t-tests were used when the data met the assumptions of normality, and the Wilcoxon signed-rank test was applied otherwise. Differences were considered statistically significant at p < 0.05. This preliminary retrospective observational study included 10 eligible individuals with PD (4 males). The participants’ mean age was 71.0 ± 10.8 years, with median Hoehn and Yahr stage 3 [interquartile range: 1 to 4]. The MDS-UPDRS Part 3 score, bradykinesia score calculated from a part of that score, and the MDS-UPDRS Part 2 score significantly improved after the intervention (Wilcoxon signed-rank test, p < 0.05). The time spent in sedentary behavior (SB) significantly decreased from 516.4 ± 72.6 to 484.0 ± 70.0 min, whereas that spent in light PA (LPA) significantly increased from 137.8 ± 46.2 to 169.5 ± 32.1 min (paired t-test, p < 0.05). The time spent on moderate-to-vigorous PA (MVPA) did not change significantly (paired t-test, p = 0.533). The results suggested that LSVT® BIG is an effective intervention for increasing at-home PA in individuals with PD. In addition, regarding the specific details of the increase, the time spent on MVPA may not change, and the increase may be mainly attributed to increased LPA and reduced sedentary time.

BACKGROUND: Patients with Parkinson's disease (PwPDs) experience a progressive decline in their sit-to-stand (STS) ability, including a prolonged STS time, rising failure, and seat-off failure. The clinical and biomechanical factors contributing to this decline are unclear. OBJECTIVES: We investigated clinical and biomechanical factors associated with the different stages of STS decline in PwPDs. METHODS: This cross-sectional study included 23 healthy controls (HCs) plus 40 PwPDs who we categorized by STS ability: 18 successful STS (SS), 12 failure-to-rise (FR), and 10 failure-to-seat-off (FS). Clinical assessments included motor symptoms (Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale), balance (Mini-Balance Evaluation Systems Test), and lower-limb strength. Biomechanical parameters measured using force plates included repetitive movements, slope of first-peak loading, and amplitude and temporal parameters. We conducted group comparisons and determined the age-adjusted area under the receiver operating characteristic curve (AAUC) and Spearman's correlations with the STS time (P < 0.05). RESULTS: In the SS group, prolonged STS time was significantly correlated with amplitude and temporal parameters (rs = -0.849 to 0.986), for example, first-peak feet loading and its slope, reflecting impaired weight shifting from the buttocks onto the soles. These parameters effectively differentiated FR from SS (AAUC = 0.778-0.884) and FS from FR (AAUC = 0.758-0.992). Lower-limb bradykinesia differentiated FR from SS (AAUC = 0.870). All balance-related measures also strongly distinguished FS from FR (AAUC = 0.817-0.925). CONCLUSIONS: These findings highlight that weight-shifting impairments, along with bradykinesia in the earlier stages and balance deficits in the later stages, play pivotal roles in the progressive STS decline in PwPDs. Interventions targeting weight shifting, as well as bradykinesia, and postural control, could potentially help mitigate this decline.

Background/Objectives: Individuals with Parkinson's disease (PD) often experience four major motor symptoms-tremor, rigidity, bradykinesia, and postural instability/gait disorder. Although these symptoms have been shown to affect activities of daily living, their impact on the level of at-home physical activity (PA) in this population remains unexplored. We aimed to investigate the relationship between the four major motor symptoms of PD and at-home PA in these individuals. Methods: This retrospective cross-sectional study included 17 individuals with PD. We examined the relationship between the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale Part 3 score and the time spent in three PA intensities (sedentary behavior, light PA [LPA], and moderate-to-vigorous PA) within the home. Pearson's correlation coefficient was used for statistical analysis. Results: In the initial step analysis, a significant negative correlation was observed between the overall motor symptom score and the time spent in LPA inside the home (rs [95% confidence interval]: -0.72 [-0.93 to -0.25]; p < 0.01). In the second step analysis, a significant negative correlation was observed between the bradykinesia score and the time spent in LPA inside the home (rs: -0.74 [-0.92 to -0.30]; p < 0.01). Conclusions: Among the four major motor symptoms, only the severity of bradykinesia influenced the time spent in LPA inside the home. Thus, rehabilitation treatment focusing on bradykinesia may be beneficial for increasing the time spent in LPA inside the home for individuals with PD.

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.