Ambulatory activity in incident Parkinson's: More than meets the eye?

Physical activity is important for people with Parkinson's disease (PD) to improve disease-specific impairment and ameliorate secondary consequences related to deconditioning. Activity may also have a neuroprotective role if instigated early. Ambulatory activity has not been examined in incident PD. Eighty-nine newly diagnosed PD cases [mean (SD) age 67.3 (9.9) years] and 97 controls [mean (SD) 69.2 (7.7) years] wore an activity monitor (activPAL™) for 7 days. Volume, pattern and variability outcomes were compared. Accumulation of activity (α) was classified as short (< 30 s), medium (30 s-2 min) and long (> 2 min) bouts of walking. Associations between sustained walking (> 2 min) and motor, cognitive and affective characteristics were identified. Activity outcomes were considered with respect to global health recommendations. Total steps (volume), accumulation of bout length (α), and variability (S2_w) outcomes were significantly different (all P < 0.001). PD participants (including Hoehn & Yahr (H&Y) stage I) accumulated significantly less time in long bouts (> 2 min) of walking compared with controls, due to performing fewer long bouts, rather than a reduction in time spent in walking per bout. For PD and controls there were weak but significant correlations for a range of characteristics and sustained walking. Fewer people with PD achieved the recommended 30 min of walking per day comprised of bouts > 10 min (P = 0.02) and bouts > 2 min (P < 0.001). People with PD were significantly less active than controls, with an inability to sustain levels of walking, and with differences apparent very early on in the disease process. A focus on increasing general ambulatory activity and exercise from the outset is recommended.