A Pilot Tolerance Study of Dynamic Stepping Compared To Static Standing in PD

Veterans Health Administration, Decatur PA

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Abstract

DESCRIPTION (provided by applicant): It has become increasingly well recognized that optimal management of Parkinson disease (PD) involves both pharmacologic treatment and encouragement of physical activity. Axial motor dysfunctions in PD - that are least responsive to dopaminergic therapy - incline many patients towards a sedentary lifestyle with deleterious effects. This is further complicated by significant barriers to exercise in this patient population. Recent advances in physical activity research tout non-exercise activity thermogenesis (NEAT) approaches to promote healthy lifestyle modifications. In its most rudimentary form, upright standing improves health by combating the negative effects of physical inactivity due to prolonged sitting. For subjects with PD, it may be a ideal form of low-intensity physical activity because of lower extremity muscle and postural activity that can be easily incorporated in many routines of daily living. However, commitment to standing regimens may be limited due to symptoms of musculoskeletal discomfort that will readily develop during prolonged standing in the absence of facilitated weight shifting. We have developed a tabletop system that oscillates in the horizontal plane, which cues users to make body weight shifting adjustments (dynamic standing). Our preliminary data show that unlike regular standing where musculoskeletal discomfort develops within 30 minutes or less, ratings of ankle and knee joint discomfort do not differ from sitting and do not increase for at least the first 60-90 minutes of dynamic standing. We propose a proof of concept study of dynamic standing to facilitate lower extremity and body weight shifting movements in subjects with PD. We will test the primary hypothesis that dynamic standing system permits users more comfortable and thereby longer duration of upright activities compared to regular or static standing. If proven, dynamic standing would provide a more tolerable and practical approach to benefit from the motor and health effects of standing that can be easily incorporated in daily routines of living in veterans with PD.