Håkan Nero

The Effects of Highly Challenging Balance Training in Elderly With Parkinson’s Disease A Randomized Controlled Trial

Background. Highly challenging exercises have been suggested to induce neuroplasticity in individuals with Parkinson’s disease (PD); however, its effect on clinical outcomes remains largely unknown. Objective. To evaluate the short-term effects of the HiBalance program, a highly challenging balance-training regimen that incorporates both dual-tasking and PD-specific balance components, compared with usual care in elderly with mild to moderate PD. Methods. Participants with PD (n = 100) were randomized, either to the 10-week HiBalance program (n = 51) or to the control group (n = 49). Participants were evaluated before and after the intervention. The main outcomes were balance performance (Mini-BESTest), gait velocity (during normal and dual-task gait), and concerns about falling (Falls Efficacy Scale–International). Performance of a cognitive task while walking, physical activity level (average steps per day), and activities of daily living were secondary outcomes. Results. A total of 91 participants completed the study. After the intervention, the between group comparison showed significantly improved balance and gait performance in the training group. Moreover, although no significant between group difference was observed regarding gait performance during dual-tasking; the participants in the training group improved their performance of the cognitive task while walking, as compared with the control group. Regarding physical activity levels and activities of daily living, in comparison to the control group, favorable results were found for the training group. No group differences were found for concerns about falling. Conclusions. The HiBalance program significantly benefited balance and gait abilities when compared with usual care and showed promising transfer effects to everyday living. Long-term follow-up assessments will further explore these effects.

Levels and Patterns of Physical Activity and Sedentary Behavior in Elderly People With Mild to Moderate Parkinson Disease

Background Decreased movement ability, one of the hallmarks of Parkinson disease (PD), may lead to inadequate physical activity (PA) and excessive time spent in sedentary behaviors—2 factors associated with an elevated risk for lifestyle-related diseases, poor management of PD, and premature death. To identify the extent to which people with PD are physically active, a comprehensive characterization of PA in this population is needed. Objective The study objective was to describe levels and patterns of PA and sedentary behaviors in elderly people with PD. Design This cross-sectional study involved a free-living setting and 53 men and 42 women (mean age=73.4 years) with mild to moderate idiopathic PD. Methods Time spent in PA and sedentary behaviors was assessed for 1 week with accelerometers. Results Mean daily step counts were 4,765; participants spent 589 minutes in sedentary behaviors, 141 minutes in low-intensity activities, 30 minutes in moderate-intensity lifestyle activities, and 16 minutes in moderate- to vigorous-intensity ambulatory activities. No differences were found between weekdays and weekend days. Patterns were characterized by a rise in total PA in the morning, peaking between 10 am and 3 pm, and a gradual decline toward the late evening. The proportion achieving 150 minutes of moderate- to vigorous-intensity PA per week was 27%, and 16% achieved 7,000 or more steps per day. Limitations Nonrandomized selection of participants may limit the generalizability of the results. Conclusions Physical activity levels were generally low, in terms of both total volume and intensity, with only minor variations over the course of a day or between days. These results emphasize the need to develop strategies to increase PA and reduce time spent in sedentary behaviors in elderly people with mild to moderate PD.

Calibration and cross-validation of a wrist-worn Actigraph in young preschoolers

To calibrate the Actigraph GT3X+ accelerometer for wrist‐worn placement in young preschoolers by developing intensity thresholds for sedentary, low‐ and high‐intensity physical activity. Furthermore, to cross‐validate the developed thresholds in young preschoolers.

Objectively measured physical activity in two-year-old children - levels, patterns and correlates.

BackgroundThe aim was to describe levels, patterns and correlates of physical activity and sedentary behavior in a sample of Swedish children, two years of age, with normal weight, overweight and obese parents.MethodsData from 123 children, 37 with normal-weight parents and 86 with overweight/obese parents, enrolled in the Early Stockholm Obesity Prevention Project study was used. Children wore an Actigraph GT3X+ accelerometer for seven days. Average activity (counts per minute), number of steps and time spent in low and high-intensity physical activity and in sedentary was assessed. Differences between weekdays and weekend days were examined as were correlations with sex, body mass index (BMI), motor skills and family-related factors.ResultsChildren were active at high intensity 11% of the day. On average 55% of the day was spent being sedentary. Number of steps and time in low-intensity physical activity differed between weekdays and weekend days: on weekdays, 363 more steps (p = 0.01) and six more minutes in low physical activity (p = 0.04). No differences were found for any physical activity or sedentary behavior variable by sex, BMI, motor skills or any family-related variable (p = 0.07 – 0.95).ConclusionsTwo-year-old children have an intermittent activity pattern, that is almost similar on weekdays and they spend about half of the daytime active. The absence of any association with sex, BMI, motor skills or parental factors indicates that the individual variation in this age group is primarily due to endogenous factors.Trial registrationClinicaltrials.gov: NCT01198847.

Comparison of two accelerometer filter settings in individuals with Parkinson's disease.

This study compared common free-living physical activity (PA) outcomes, assessed with the Actigraph GT3X+ accelerometer and processed with two different filter settings, in a sample of elderly individuals with Parkinson´s disease (PD). Sixty-six individuals (73.1  ±  5.8 years) with mild to moderate idiopathic PD carried an accelerometer for 7 d. Data were processed with the default filter setting and a low frequency extension filter (LFE). Significantly larger values were obtained with the LFE for mean counts and steps per day, and for minutes per day in low intensity- and lifestyle activities at moderate intensity, but not for moderate-to vigorous intensity ambulatory activities. The largest difference was observed for mean ± SD steps per day (default = 4730  ±  3210; LFE = 11 117  ±  4553). Intraclass correlation confidence intervals and limits of agreement were generally wide, indicating poor agreement. A sub-study, in which 15 individuals with PD performed a self-paced 3 min walk, demonstrated that neither filter setting differed from video-recorded steps (p ≥ 0.05). This suggests that the LFE might overestimate PA-outcomes in free-living conditions. Until new evidence supporting an extension of the lower filter-band is presented, it is recommended that the default filter setting be used when assessing PA in elderly individuals with PD.

Infant growth is associated with parental education but not with parental adiposity : Early Stockholm Obesity Prevention Project

To explore the simultaneous impact of parental adiposity and education level on infant growth from birth to 12 months, adjusting for known early‐life risk factors for subsequent childhood obesity.

Accelerometer Cut Points for Physical Activity Assessment of Older Adults with Parkinson’s Disease

Objective To define accelerometer cut points for different walking speeds in older adults with mild to moderate Parkinson’s disease. Method A volunteer sample of 30 older adults (mean age 73; SD 5.4 years) with mild to moderate Parkinson’s disease walked at self-defined brisk, normal, and slow speeds for three minutes in a circular indoor hallway, each wearing an accelerometer around the waist. Walking speed was calculated and used as a reference measure. Through ROC analysis, accelerometer cut points for different levels of walking speed in counts per 15 seconds were generated, and a leave-one-out cross-validation was performed followed by a quadratic weighted Cohen’s Kappa, to test the level of agreement between true and cut point–predicted walking speeds. Results Optimal cut points for walking speeds ≤ 1.0 m/s were ≤ 328 and ≤ 470 counts/15 sec; for speeds > 1.3 m/s, they were ≥ 730 and ≥ 851 counts/15 sec for the vertical axis and vector magnitude, respectively. Sensitivity and specificity were 61%–100% for the developed cut points. The quadratic weighted Kappa showed substantial agreement: κ = 0.79 (95% CI 0.70–0.89) and κ = 0.69 (95% CI 0.56–0.82) for the vertical axis and the vector magnitude, respectively. Conclusions This study provides accelerometer cut points based on walking speed for physical-activity measurement in older adults with Parkinson’s disease for evaluation of interventions and for investigating links between physical activity and health.

Does a dynamic chair increase office workers' movements? – Results from a combined laboratory and field study

PURPOSE Dynamic chairs have the potential to facilitate movements that could counteract health problems associated with sedentary office work. This study aimed to evaluate whether a dynamic chair can increase movements during desk-based office work. METHODS Fifteen healthy subjects performed desk-based office work using a dynamic office chair and compared to three other conditions in a movement laboratory. In a field study, the dynamic office chair was studied during three working days using accelerometry. RESULTS Equivocal results showed that the dynamic chair increased upper body and chair movements as compared to the conventional chair, but lesser movements were found compared to standing. No differences were found between the conditions in the field study. CONCLUSIONS A dynamic chair may facilitate movements in static desk-based office tasks, but the results were not consistent for all outcome measures. Validation of measuring protocols for assessing movements during desk-based office work is warranted.

Objectively Assessed Physical Activity and its Association with Balance, Physical Function and Dyskinesia in Parkinson's Disease

BACKGROUND The desirable effects of physical activity in individuals with Parkinsons disease are well-known, although according to results from previous studies factors associated with objectively assessed physical activity are not fully investigated. OBJECTIVE To investigate demographic, disease-related and mobility-related factors that associate with objectively measured physical activity, in a sample of older adults with mild to moderate Parkinsons disease. METHODS Demographic, disease-related and mobility-related factors were gathered by interview from a total of 91 older adults with Parkinsons disease, followed by an evaluation of balance control using the Mini-BESTest. After initial testing, participants wore a tri-axial accelerometer during a week of free-living. Correlation analysis and multiple linear regression was used to investigate factors associated with total PA, represented by total activity counts, and time in brisk walking. RESULTS Motor impairment, physical function, body mass index and dyskinesia contributed to the variance of total physical activity, explaining 34 % of the variance, while physical function and balance control were significant factors associated with brisk walking, explaining 22 %. CONCLUSIONS This study identified factors that have not been shown to associate with objectively measured physical activity previously, such as dyskinesia, balance control and self-rated physical function. The findings also demonstrated that associated factors differ, depending on the activity behavior being investigated. However, other factors than those included in this study may also be of importance.