Christiansen Cory, Moore Charity, Schenkman Margaret, Kluger Benzi, Kohrt Wendy, Delitto Anthony, Berman Brian, Hall Deborah, Josbeno Deborah, Poon Cynthia, Robichaud Julie, Wellington Toby, Jain Samay, Comella Cynthia, Corcos Daniel, Melanson Ed
Department of Physical Medicine and Rehabilitation (C.C., M.S.), Department of Neurology (B.K., B.B.), Division of Geriatric Medicine (W.K., T.W., E.M.), and Division of Endocrinology, Metabolism, and Diabetes (E.M.), University of Colorado School of Medicine, Aurora, Colorado; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado (C.C.); Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, North Carolina (C.M.); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania (A.D., D.J.); Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois (D.H., C.C.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.P., D.C.); Department of Physical Therapy, University of Illinois at Chicago, Chicago Illinois (J.R.); and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (S.J.).
J Neurol Phys Ther. 2017 Apr;41(2):93-100. doi: 10.1097/NPT.0000000000000169.
Objective ambulatory activity during daily living has not been characterized for people with Parkinson disease prior to initiation of dopaminergic medication. Our goal was to characterize ambulatory activity based on average daily step count and examine determinants of step count in nonexercising people with de novo Parkinson disease.
We analyzed baseline data from a randomized controlled trial, which excluded people performing regular endurance exercise. Of 128 eligible participants (mean ± SD = 64.3 ± 8.6 years), 113 had complete accelerometer data, which were used to determine daily step count. Multiple linear regression was used to identify factors associated with average daily step count over 10 days. Candidate explanatory variable categories were (1) demographics/anthropometrics, (2) Parkinson disease characteristics, (3) motor symptom severity, (4) nonmotor and behavioral characteristics, (5) comorbidities, and (6) cardiorespiratory fitness.
Average daily step count was 5362 ± 2890 steps per day. Five factors explained 24% of daily step count variability, with higher step count associated with higher cardiorespiratory fitness (10%), no fear/worry of falling (5%), lower motor severity examination score (4%), more recent time since Parkinson disease diagnosis (3%), and the presence of a cardiovascular condition (2%).
Daily step count in nonexercising people recruited for this intervention trial with de novo Parkinson disease approached sedentary lifestyle levels. Further study is warranted for elucidating factors explaining ambulatory activity, particularly cardiorespiratory fitness, and fear/worry of falling. Clinicians should consider the costs and benefits of exercise and activity behavior interventions immediately after diagnosis of Parkinson disease to attenuate the health consequences of low daily step count.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A170).
在开始使用多巴胺能药物之前，帕金森病患者日常生活中的客观动态活动尚未得到描述。我们的目标是根据平均每日步数来描述动态活动，并研究初发帕金森病且不运动的患者步数的决定因素。
我们分析了一项随机对照试验的基线数据，该试验排除了进行常规耐力运动的人群。在128名符合条件的参与者（平均±标准差=64.3±8.6岁）中，113人有完整的加速度计数据，用于确定每日步数。采用多元线性回归来确定与10天内平均每日步数相关的因素。候选解释变量类别包括：（1）人口统计学/人体测量学，（2）帕金森病特征，（3）运动症状严重程度，（4）非运动和行为特征，（5）合并症，以及（6）心肺适能。
平均每日步数为每天5362±2890步。五个因素解释了每日步数变异性的24%，步数较多与较高的心肺适能（10%）、不害怕/担心跌倒（5%）、较低的运动严重程度检查评分（4%）、帕金森病诊断后更近的时间（3%）以及存在心血管疾病（2%）相关。
参与这项针对初发帕金森病的干预试验且不运动的患者的每日步数接近久坐不动的生活方式水平。有必要进一步研究以阐明解释动态活动的因素，特别是心肺适能以及对跌倒的恐惧/担心。临床医生应在帕金森病诊断后立即考虑运动和活动行为干预的成本与收益，以减轻低每日步数对健康造成的后果。可获取视频摘要以了解作者的更多见解（见视频，补充数字内容1，http://links.lww.com/JNPT/A170）。
