A Remotely-deployed Gamification Intervention Increases Physical Activity and Improves Symptoms in Parkinson’s Disease
Kimberly Waddell1, Ryan Greysen1, Madison Smith2, Stephanie Wood2, James Morley2
1Center for Health Equity Research and Promotion, Crescenz VA Medical Center, 2Parkinson's Disease Research Education and Clinical Center, Crescenz VA Medical Center
Objective:
To test feasibility and estimate efficacy of a remote behavioral intervention to increase daily steps and improve motor symptoms in Veterans with PD 
Background:
A variety of exercises improve PD symptoms in clinical trials but strategies to increase physical activity (PA) in real life settings are not well-studied. 
Design/Methods:

All study activities were conducted remotely as described below, resulting in a “touchless” design where subjects never reported for in-person visits. Using administrative data, we invited Veterans with PD living in a five-state area to participate via mail with screening and consent via phone. Survey assessments and step counts (using Fitbits) were acquired using Way to Health, a web-based digital health platform. Subjects underwent a 2-week baseline step collection, 6-week gamification period (targeting 20% step increase) and 4-week followup. Motor symptoms were monitored at the end of each study period with Parkinson’s Kinetigraph (PKG).

Results:

We consented 88 subjects with 75 (85%) completing all baseline assessments and 74 (99%) then completing the full study protocol. The cohort had a mean (SD) age of 71 (6.1), disease duration of 5.2 (3.8) years and lived 222 (344) miles from the medical center. Participants averaged 4829 (2745) steps at baseline with a mean increase of 28% (p<0.001) during the gamification intervention and 12% (p<0.01) during followup. Bradykinesia (-0.22 (1.9) vs. +1.11(2.2)) and immobility (-0.4(5.0) vs. +2.8 (5.1)) PKG scores were significantly improved (p<0.05) in subjects meeting their step goal on >50% of days while tremor scores did not change.

Conclusions:
A remotely deployed gamification intervention allowed recruitment of people with PD living over 200 miles from the study site, increased PA and improved symptoms. Scalable interventions leveraging wearables and remote monitoring platforms have wide reach and are a promising pathway for improving activity levels in people with PD.
10.1212/WNL.0000000000211751
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.