Axial motor dysfunctions in Parkinson disease (PD) are least responsive to dopaminergic therapy and incline many patients towards a sedentary lifestyle. This places PD patients at increased risk for the negative consequences of physical inactivity. When PD patients develop postural imbalance and gait difficulties (PIGD), including falls, they are generally referred to physical therapy (PT) for optimal management. Although a Cochrane review confirms the (short-term) benefit of physical therapy in PD with PIGD motor features there is a critical gap in clinical practice on what to do next once the PT sessions are over. Clinical experience shows that most patients return to a sedentary lifestyle indicating an urgent need for post-PT in-home physical activity programs in PD with PIGD features to preserve mobility functions. Recent advances in physical activity research tout non-exercise physical activity (NEPA) approaches to promote healthy lifestyle modifications. For PD patients with PIGD, normal upright standing and weight-shifting (stepping) for longer periods of time may be an ideal form of NEPA. It activates lower extremity muscles and encourages postural activity. To promote this type of NEPA, we have developed a sit-stand desk system that enhances upright standing activity with weight-shifting movements. The dynamic standing table has a tabletop that oscillates in the horizontal plane, which cues users to make periodic mediolateral body weight shifting adjustments. Dynamic standing would represent a minimal level of physical activity compared to sitting, which is pervasive in PD subjects with PIGD motor features. Use of the dynamic standing table can easily be incorporated with routine desktop activities, such as computer use, reading, or watching TV and may promote physical activity. Preliminary data shows that patients with moderate PD are able to complete sessions of at least 3 hours without significant difficulty and may have motor and cognitive benefits from using this table. We propose an exploratory controlled trial of a post-PT in-home extension of a physical activity program in patients with PD and PIGD consisting of combined post-PT standard of care (i.e., weekly physical activity group sessions) with in-home dynamic standing table use versus the post-PT standard of care alone. The incremental addition of the dynamic table use is expected to more effectively reduce post-PT sedentary behavior compared to the standard of care alone. We will test the exploratory hypothesis that post-PT gains in mobility functions in PD patients with PIGD features will be preserved better with in-home dynamic standing table use compared to a control group.
When postural imbalance and gait difficulties emerge in subjects with Parkinson disease, patients are typically referred for a number of physical therapy sessions. However, there is a critical gap in clinical practice on what to do once patients have completed their therapy sessions. We have developed a table-top system which encourages weight shifting during upright standing (?dynamic standing table?) that may be a unique means to increase daily physical activity by integrating the system with routine desktop activities of daily living. We propose a post-physical therapy in-home physical activity program controlled trial using the dynamic standing table (as an adjunct to post-PT standard of care weekly physical activity groups) versus the standard of care alone to better sustain mobility benefits of physical therapy in this population.
| Bohnen, Nicolaas I; Muller, Martijn (2018) Reader response: Odor identification as a biomarker of preclinical AD in older adults at risk. Neurology 90:343 |
