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

  • Karin Srulijes
  • Jochen Klenk
  • Michael Schwenk
  • Cornelia Schatton
  • Lars Schwickert
  • Kristin Teubner-Liepert
  • Miriam Meyer
  • Srijana K.C.
  • Walter Maetzler
  • Clemens Becker
  • Matthis Synofzik
Original Paper

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.

Keywords

Ataxia Spinocerebellar ataxia Exposure Falls Parkinson’s disease Physical activity Progressive supranuclear palsy 

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

Notes

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.

Author 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

Funding Information

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

Compliance with Ethical Standards

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.

References

  1. 1.
    Bryant MS, Rintala DH, Hou JG, Protas EJ. Relationship of falls and fear of falling to activity limitations and physical inactivity in Parkinson’s disease. J Aging Phys Act. 2015;23(2):187–93.CrossRefGoogle Scholar
  2. 2.
    Mactier K, Lord S, Godfrey A, Burn D, Rochester L. The relationship between real world ambulatory activity and falls in incident Parkinson’s disease: influence of classification scheme. Parkinsonism Relat Disord. 2015;21(3):236–42.CrossRefGoogle Scholar
  3. 3.
    Lewis ZH, Markides KS, Ottenbacher K, Al Snih S. The role of physical activity and physical function on the risk of falls in older Mexican Americans. J Aging Phys Act. 2015.Google Scholar
  4. 4.
    Butler AA, Lord SR, Taylor JL, Fitzpatrick RC. Ability versus hazard: risk-taking and falls in older people. J Gerontol A Biol Sci Med Sci. 2015;70(5):628–34.CrossRefGoogle Scholar
  5. 5.
    Allen NE, Schwarzel AK, Canning CG. Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis. 2013;2013:906274.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Fonteyn EM, Schmitz-Hubsch T, Verstappen CC, Baliko L, Bloem BR, Boesch S, et al. Prospective analysis of falls in dominant ataxias. Eur Neurol. 2013;69(1):53–7.CrossRefGoogle Scholar
  7. 7.
    Williams DR, Watt HC, Lees AJ. Predictors of falls and fractures in bradykinetic rigid syndromes: a retrospective study. J Neurol Neurosurg Psychiatry. 2006;77(4):468–73.CrossRefGoogle Scholar
  8. 8.
    Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, et al. Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology. 1996;47(1):1–9.CrossRefGoogle Scholar
  9. 9.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55(3):181–4.CrossRefGoogle Scholar
  10. 10.
    Wenning GK, Tison F, Seppi K, Sampaio C, Diem A, Yekhlef F, et al. Development and validation of the unified multiple system atrophy rating scale (UMSARS). Mov Disord. 2004;19(12):1391–402.CrossRefGoogle Scholar
  11. 11.
    Shumway-Cook A. Theory and practical applications. Mot Control. 1995.Google Scholar
  12. 12.
    Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.CrossRefGoogle Scholar
  13. 13.
    Drane DL, Yuspeh RL, Huthwaite JS, Klingler LK. Demographic characteristics and normative observations for derived-trail making test indices. Neuropsychiatry Neuropsychol Behav Neurol. 2002;15(1):39–43.PubMedGoogle Scholar
  14. 14.
    Hautzinger M, Bailer M. Allgemeine Depressions Skala. Manual. Göttingen: Beltz; 1993.Google Scholar
  15. 15.
    Kempen GI, Yardley L, van Haastregt JC, Zijlstra GA, Beyer N, Hauer K, et al. The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing. 2008;37(1):45–50.CrossRefGoogle Scholar
  16. 16.
    Ryan CG, Grant PM, Tigbe WW, Granat MH. The validity and reliability of a novel activity monitor as a measure of walking. Br J Sports Med. 2006;40(9):779–84.CrossRefGoogle Scholar
  17. 17.
    Grant PM, Ryan CG, Tigbe WW, Granat MH. The validation of a novel activity monitor in the measurement of posture and motion during everyday activities. Br J Sports Med. 2006;40(12):992–7.CrossRefGoogle Scholar
  18. 18.
    Lamb SE, Jorstad-Stein EC, Hauer K, Becker C, Prevention of Falls Network E, Outcomes Consensus G. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc. 2005;53(9):1618–22.CrossRefGoogle Scholar
  19. 19.
    Klenk J, Kerse N, Rapp K, Nikolaus T, Becker C, Rothenbacher D, et al. Physical activity and different concepts of fall risk estimation in older people—results of the ActiFE-Ulm study. PLoS One. 2015;10(6):e0129098.CrossRefGoogle Scholar
  20. 20.
    Klockgether T. Sporadic ataxia with adult onset: classification and diagnostic criteria. Lancet Neurol. 2010;9(1):94–104.CrossRefGoogle Scholar
  21. 21.
    Respondek G, Hoglinger GU. The phenotypic spectrum of progressive supranuclear palsy. Parkinsonism Relat Disord. 2016;22(Suppl 1):S34–6.CrossRefGoogle Scholar
  22. 22.
    Fonteyn EM, Schmitz-Hubsch T, Verstappen CC, Baliko L, Bloem BR, Boesch S, et al. Falls in spinocerebellar ataxias: results of the EuroSCA Fall study. Cerebellum. 2010;9(2):232–9.CrossRefGoogle Scholar
  23. 23.
    Weiss A, Herman T, Giladi N, Hausdorff JM. Objective assessment of fall risk in Parkinson’s disease using a body-fixed sensor worn for 3 days. PLoS One. 2014;9(5):e96675.CrossRefGoogle Scholar
  24. 24.
    Pickering RM, Grimbergen YA, Rigney U, Ashburn A, Mazibrada G, Wood B, et al. A meta-analysis of six prospective studies of falling in Parkinson’s disease. Mov Disord. 2007;22(13):1892–900.CrossRefGoogle Scholar
  25. 25.
    Zieschang T, Schwenk M, Becker C, Uhlmann L, Oster P, Hauer K. Falls and physical activity in persons with mild to moderate dementia participating in an intensive motor training: randomized controlled trial. Alzheimer Dis Assoc Disord. 2017;31:307–14.CrossRefGoogle Scholar
  26. 26.
    Ramsey VK, Miszko TA, Horvat M. Muscle activation and force production in Parkinson’s patients during sit to stand transfers. Clin Biomech. 2004;19(4):377–84.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Karin Srulijes
    • 1
    • 3
    • 4
  • Jochen Klenk
    • 1
    • 2
  • Michael Schwenk
    • 1
  • Cornelia Schatton
    • 5
    • 6
  • Lars Schwickert
    • 1
  • Kristin Teubner-Liepert
    • 3
    • 4
  • Miriam Meyer
    • 3
  • Srijana K.C.
    • 3
  • Walter Maetzler
    • 3
    • 4
    • 7
  • Clemens Becker
    • 1
  • Matthis Synofzik
    • 3
    • 4
  1. 1.Department of Clinical GerontologyRobert-Bosch-HospitalStuttgartGermany
  2. 2.Institute of Epidemiology and Medical BiometryUlm UniversityUlmGermany
  3. 3.Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
  4. 4.German Research Center for Neurodegenerative Diseases (DZNE)University of TübingenTübingenGermany
  5. 5.Department of Cognitive Neurology, Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
  6. 6.Centre for Integrative Neuroscience (CIN)TübingenGermany
  7. 7.Department of NeurologyUniversity Hospital Schleswig-Holstein, Christian-Albrechts-UniversityKielGermany

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