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Fall Risk in Relation to Individual Physical Activity Exposure in Patients with Different Neurodegenerative Diseases: a Pilot Study

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Abstract

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.

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Abbreviations

ADS:

Allgemeine Depressions-Skala

CON:

Healthy control subject

DA:

Degenerative ataxia

DGI:

Dynamic Gait Index

FES-I:

Falls efficacy scale-international

MoCA:

Montreal Cognitive Assessment

NDD:

Neurodegenerative disease

PA:

Physical activity

PD:

Parkinson’s disease

PSP:

Progressive supranuclear palsy

UMSARS:

Unified Multiple System Atrophy Rating Scale

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Acknowledgements

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.

Funding

This study is funded by grants from the Forschungskolleg Geriatrie of the Robert-Bosch-Foundation Stuttgart, Germany (to K.S. and M.Sy.).

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Authors and Affiliations

Authors

Contributions

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

Corresponding author

Correspondence to Karin Srulijes.

Ethics declarations

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.

Financial Disclosures

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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Srulijes, K., Klenk, J., Schwenk, M. et al. Fall Risk in Relation to Individual Physical Activity Exposure in Patients with Different Neurodegenerative Diseases: a Pilot Study. Cerebellum 18, 340–348 (2019). https://doi.org/10.1007/s12311-018-1002-x

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