University:
Boston University
Course:
MED MD 121 | Doctoring 1
Academic year:

2024
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470

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13
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fwlsodtqx0

Chapter 2 Step Activity Classification Adults Physical Activity Level Criterion (steps / day) Basal Activity < 2,500 Limited Activity 2,500-4,999 Low Active 5,000-7,499 Somewhat Active 7,500-9,999 Active 10,000-12,499 Highly Active >12,500 Sedentary Progression of Disability in PD Effect Sizes Effects Size: Cohen's d 0.35 0.30 0.25 0.20 0.15 0.10 0.05 0.00 6 months 12 months PDQ-39 9-HPT 18 months MDS-UPDRS TMW 24 months FGA Changes in Walking in Persons with Parkinson Disease over 1-year Variable Steps* Moderate intensity minutes* % change / effect size -12 / 0.28 -40 / 0.30 Accuracy of Activity Trackers • • • • Fitbit Zip Fitbit Surge Jawbone UP2 Jawbone Up Move Accuracy of Activity Trackers • • • • Fitbit Zip Fitbit Surge Jawbone UP2 Jawbone Up Move Peer Coaching Program Peer Coaching Program Peer Mentee: Changes in Amount of Walking 14000 12000 10000 8000 6000 4000 2000 0 PM1 PM2 PM3 Initial 7 day step average PM4 PM5 Post 7 day step average Steps per day increased by 31% from 5,428 to 7115 steps. Study Design Baseline Assessment 1 Week Step Activity Monitor Randomization mHealth PT + Ex 1-2 PT Visits mHealth Exercise Platform: • Tailored Exercise Videos • Monitoring by a PT • Visual Feedback • Fitbit Exercise 1-2 PT Visits Home Exercise Program: • Tailored Photos of Exercise • Written Instruction • Pedometer • Calendars 1-Year Assessment 1 Week Step Activity Monitor Exercise Intervention • Walking with pedometer • Strengthening Mobile Health Technology Wellpepper App: User Version Promoting Exercise Theoretical Approach Tailored Exercise Videos Self-efficacy √ Intervention Components Adaptations Monitoring Progress Adherenc to Exercise by a PT Towards e Graphs Program Goals: over time by Visual PT Feedback √ √ √ √ Outcome expectations Motivation Knowledge √ Social Persuasion Motivational content (videos) Automated Reminders and Rewards √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ Outcomes  Feasibility, safety, acceptability and adherence  Physical Activity: measured during a one-week period following the baseline and 12-month assessment sessions using the StepWatch™ Activity Monitor (SAM)  HRQOL, walking endurance, balance  Self-Efficacy, outcome expectation Satisfaction & Safety Survey mHealth Active Control Satisfaction Rating (mean, SD) (0=Not satisfied - 10=Highly satisfied) 8.7 (+/- 1.3) 8.5 (+/- 1.6) “Would you like to continue doing the program?” 85% Yes 75% Yes “Would you recommend this program?” 100% Yes 100% Yes Safety: No serious adverse events related to the intervention 46 Making Exercise a Habit Mean % Adherence (3x/week) Adherence per Quarter 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 All Subjects 76% 64% 55% 50% >75% 1st Qtr 89% 84% 81% 76% <75% 1st Qtr 57% 38% 27% 23% Mean Daily Steps N = 44 Mean Daily Steps Mean Daily Steps All Subjects N=44 Moderate Intensity Steps Moderate Intensity Steps Moderate-intensity Minutes Between Group Analysis N=23 N=21 Changes in Walking in Persons with Parkinson Disease over 1-year Variable Steps* Moderate intensity minutes* % change / effect size -12 / 0.28 -40 / 0.30 Steps ✔ The suggestion is that the mobile health technology may have differentially benefitted less active participants.  “Low Active” (<7500) Mean Daily Steps More noticeable (yet still nonsignificant) between-group differences over time were observed when the original dataset was divided according to the baseline level of physical activity. N=8 N=12 mHealth: Increase in 5495 steps per week Exercise: Increase in 2856 steps per week Moderate Intensity Minutes Results ✔ This result raises the possibility that the mHealth technology was differentially beneficial for less active participants.  Low Active (< 7500 per day) N=12 mHealth: increase from 35 to 95 mod intensity minutes per week Control: increase from 35 to 49 mod intensity minutes per week N=8 Exercise Case Study: Case Study: Outcomes Measures Since Initial Diagnosis Functional Outcome Measure 2011 2012 2013 2014 2015 PDQ-39 MOCA MDS-UPDRS Part I MDS-UPDRS Part II MDS-UPDRS Part III 5 times sit to stand MiniBEST test FGA 8 27/30 2 18 34 9.5 26/28 28/30 8 27/30 1 15 32 7.6 26/28 28/30 12 25/30 3 15 32 10.2 27/28 28/30 16 25/30 6 13 34 10.0 27/28 27/30 12 23/30 9 13 31 13.4 24/28 27/30 10 meter: Comfortable 10 meter: Fast 1.5 m/s 1.5 m/s 1.6 m/s 1.4 m/s 1.4 m/s 2.0 m/s 2.0 m/s 1.8 m/s 1.8 m/s 1.7 m/s 6 MWT 529m 570m 567m 553m 554m 9 Hole Peg Test R 30 L 23 R 27 L 22 R 28 L 24 R 30 L 28 R 31 L 27

Update on Exercise in Parkinson Disease Ch 2

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