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


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.


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



Allgemeine Depressions-Skala


Healthy control subject


Degenerative ataxia


Dynamic Gait Index


Falls efficacy scale-international


Montreal Cognitive Assessment


Neurodegenerative disease


Physical activity


Parkinson’s disease


Progressive supranuclear palsy


Unified Multiple System Atrophy Rating Scale



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.


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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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