Changes in Walking Activity and Endurance Following Rehabilitation for People With Parkinson Disease

Abstract 

White DK, Wagenaar RC, Ellis TD, Tickle-Degnen L. Changes in walking activity and endurance following rehabilitation for people with Parkinson disease.

Objective

To investigate changes in walking activity and endurance after interdisciplinary rehabilitation in people with Parkinson disease (PD).

Design

Randomized controlled trial.

Setting

Clinic, home, and community.

Participants

Mild to moderate PD (Hoehn and Yahr stage 2–3).

Interventions

Three experimental conditions lasting 6 weeks in duration: (1) no active rehabilitation; (2) 3.0 hours of interdisciplinary rehabilitation a week; or (3) 4.5 hours of interdisciplinary rehabilitation a week. Participants had stable medication regimes during the study.

Main Outcome Measures

Walking activity was estimated with an activity monitor (AM) (time spent walking and number of 10-second walking periods) in the home and community settings over a 24-hour period. Walking endurance was measured in the clinic with the two-minute walk test (2MWT). Linear contrast analyses were applied to examine changes in walking activity and endurance after higher doses of rehabilitation, and 2-way analysis of variance models with interaction were applied to examine the effect of high and low baseline walking levels on changes.

Results

The 2MWT was completed by 108 people with PD (mean age, 66.53y; with PD, 6.59y), and AM data were used from 74 of these people (mean age, 66.7y; with PD, 5.8y). Improvement in AM measures and the 2MWT did not significantly change across increasing dosages of interdisciplinary rehabilitation. Higher doses of rehabilitation resulted in significant improvements in the 2MWT for subjects with low baseline walking endurance (P=.001), and in AM measures for subjects with high baseline walking activity (P<.02).

Conclusions

Interdisciplinary rehabilitation can improve walking activity and endurance depending on baseline walking levels.

Key Words: Ambulatory monitoring, Parkinson disease, Rehabilitation

List of Abbreviations: AM, activity monitor, ANOVA, analysis of variance, CI, confidence intervals, ES, effect sizes, ICC, intraclass correlation coefficient, MCID, minimum clinically important differences, PD, Parkinson disease, 2MWT, Two-minute walk test, UPDRS, Unified Parkinson Disease Rating Scale