title: Objective Assessment of Fall Risk in Parkinson's Disease Using a Body-Fixed Sensor Worn for 3 Days Locomotor Training Improves Daily Stepping Activity and Gait Efficiency in Individuals Poststroke Who Have Reached a “Plateau” in Recovery Pathways between physical activity and quality of life in adults with multiple sclerosis. Physical Activity Correlates With Neurological Impairment and Disability in Multiple Sclerosis Quantitative Measurement of Physical Activity in Acute Ischemic Stroke and Transient Ischemic Attack Randomized controlled trial of a teleconference fatigue management plus physical activity intervention in adults with multiple sclerosis: rationale and research protocol Capturing Ambulatory Activity Decline in Parkinson's Disease Reliability of Physical-Activity Measures Over Six Months in Adults with Multiple Sclerosis: Implications for Designing Behavioral Interventions Reactivity in baseline accelerometer data from a physical activity behavioral intervention. Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis Randomized Trial of a Fitbit-Based Physical Activity Intervention for Women. Physical activity and risk of cognitive impairment among oldest-old women. Prediction of Upper Limb Recovery, General Disability, and Rehabilitation Status by Activity Measurements Assessed by Accelerometers or the Fugl-Meyer Score in Acute Stroke Spontaneous arm movement activity assessed by accelerometry is a marker for early recovery after stroke Validity of accelerometry for monitoring real-world arm activity in patients with subacute stroke: evidence from the extremity constraint-induced therapy evaluation trial. Actigraphy – A Useful Tool for Motor Activity Monitoring in Stroke Patients Test-Retest Reliability of 24 Hours of Activity Monitoring in Individuals With Parkinson's Disease in Home and Community Accelerometry Measuring the Outcome of Robot-Supported Upper Limb Training in Chronic Stroke: A Randomized Controlled Trial Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Increasing Physical Activity in Multiple Sclerosis Using a Behavioral Intervention Progressive Adaptive Physical Activity in Stroke Improves Balance, Gait, and Fitness: Preliminary Results Symptom cluster as a predictor of physical activity in multiple sclerosis: preliminary evidence. Self-efficacy and environmental correlates of physical activity among older women and women with multiple sclerosis. The effect of walking mobility on the measurement of physical activity using accelerometry in multiple sclerosis
abstract: Background Patients with Parkinson 's disease ( PD ) suffer from a high fall risk . Previous approaches for evaluating fall risk are based on self-report or testing at a given time point and may , therefore , be insufficient to optimally capture fall risk . We tested , for the first time , whether metrics derived from 3 day continuous recordings are associated with fall risk in PD . Methods and Material s 107 patients ( Hoehn & Yahr Stage : 2.6±0.7 ) wore a small , body-fixed sensor ( 3D accelerometer ) on lower back for 3 days .  Walking quantity ( e.g. , steps per 3-days ) and quality ( e.g. , frequency-derived measures of gait variability ) were determined . Subjects were classified as fallers or non-fallers based on fall history . Subjects were also followed for one year to evaluate predictors of the transition from non-faller to faller . Results The 3 day acceleration derived measures were significantly different in fallers and non-fallers and were significantly correlated with previously vali date d measures of fall risk . Walking quantity was similar in the two groups . In contrast , the fallers walked with higher step-to-step variability , e.g. , anterior-posterior width of the dominant frequency was larger ( p = 0.012 ) in the fallers ( 0.78±0.17 Hz ) compared to the non-fallers ( 0.71±0.07 Hz ) . Among subjects who reported no falls in the year prior to testing , sensor-derived measures predicted the time to first fall ( p = 0.0034 ) , whereas many traditional measures did not . Cox regression analysis showed that anterior-posterior width was significantly ( p = 0.0039 ) associated with time to fall during the follow-up period , even after adjusting for traditional measures . Conclusions / Significance These findings indicate that a body-fixed sensor worn continuously can evaluate fall risk in PD . This sensor-based approach was able to identify transition from non-faller to faller , whereas many traditional metrics were not successful . This approach may facilitate earlier detection of fall risk and may in the future , help reduce high costs associated with falls Background and Purpose — Individuals with chronic stroke often demonstrate a “ plateau , ” or deceleration of motor recovery , which may lead to discharge from physical therapy ( PT ) . However , numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks . We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke , and suggest that further gains can be realized if intensive stepping , or locomotor training ( LT ) is provided after discharge . Methods — Twenty subjects with chronic stroke completed a repeated baseline measures , r and omized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau , followed by 4 weeks of intensive LT and 4 weeks of no intervention . Outcome measures included clinical and physiological ( metabolic ) measures of walking overground and on a treadmill , and measures of daily stepping activity in the home and community , including during clinical PT and subsequent LT sessions . Results — Stepping practice was more than 4-fold higher during LT versus clinical PT sessions , with significant improvements in daily stepping and gait efficiency only after LT . Changes in daily stepping after clinical PT and intensive LT were correlated ( P<0.001 ) with the amount of stepping practice received during these interventions . Conclusions — Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function . These improvements may be related to the amount and intensity of stepping practice OBJECTIVE This prospect i ve study examined symptoms of depression , fatigue , pain , self-efficacy , and social support as possible intermediaries in the pathway between changes in physical activity and quality of life ( QOL ) across a 6-month period in persons with multiple sclerosis ( MS ) . DESIGN AND MAIN OUTCOME MEASURES Adults with a definite diagnosis of MS wore an accelerometer for 7 days and then completed a battery of question naires at baseline ( n = 292 ) and 6-months follow-up ( n = 276 ) . The data were analyzed using panel analysis and covariance modeling in Mplus 3.0 . RESULTS The initial analysis indicated that change in physical activity was associated with a statistically significant and small residual change in QOL ( beta = .07 ) . The subsequent analysis indicated that change in physical activity was associated with residual changes in fatigue ( gamma = -.17 ) , pain ( gamma = -.13 ) , social support ( gamma = .07 ) , and self-efficacy ( gamma = .11 ) , and , in turn , changes in fatigue ( beta = -.13 ) , pain ( beta = -.09 ) , social support ( beta = .18 ) , and self-efficacy ( beta = .10 ) were associated with a residual change in QOL . CONCLUSION The observed pattern of relationships supports the possibility that physical activity is indirectly associated with improved QOL through pathways that include fatigue , pain , social support , and self-efficacy in individuals with MS This study examined the correlation of physical activity with  neurological impairment and disability in persons with multiple sclerosis ( MS ) . Eighty individuals with MS wore an accelerometer for 7 days and completed the Symptom Inventory ( SI ) , Performance Scales ( PS ) , and Exp and ed Disability Status Scale . There were large negative correlations between the accelerometer and SI ( r = −0.56 ; ρ = −0.58 ) and Exp and ed Disability Status Scale ( r = −0.60 ; ρ = −0.69 ) and a moderate negative correlation between the accelerometer and PS ( r = −0.39 ; ρ = −0.48 ) indicating that physical activity was associated with reduced neurological impairment and disability . Such findings provide a preliminary basis for using an accelerometer and the SI and PS as outcome measures in large-scale prospect i ve and experimental examinations of the effect of physical activity behavior on disability and dependence in MS Background and Purpose — The purpose of this study was to quantitatively measure and describe the amount and pattern of physical activity in patients within the first week after acute ischemic stroke and transient ischemic attack using accelerometers . Methods — A total of 100 patients with acute ischemic stroke or transient ischemic attack admitted to our acute stroke unit wore Actical accelerometers attached to both wrists and ankles and the hip for ⩽7 days . Patients were included within 72 hours of symptom onset . Accelerometer output was measured in activity counts ( AC ) . Patients were tested daily with Sc and inavian Stroke Scale . Results — Physical activity peaked in the morning and declined during the rest of the day . In patients with stroke , total AC were 71 % lower than in patients with transient ischemic attack . AC were 80 % lower in the paretic compared with those in the nonparetic arm in patients with ischemic stroke . For the legs AC were 44 % lower on the paretic side and an overall increase in AC with time was found . There was a significant increase in AC with increasing Sc and inavian Stroke Scale and a decrease in AC with increasing age . Conclusions — This study demonstrates the feasibility of using accelerometers to quantitatively and continuously measure physical activity simultaneously from all 4 extremities and the hip in patients with acute ischemic stroke and transient ischemic attack . Our study provides quantitative evidence of physical inactivity in patients with acute ischemic stroke . The method offers a low cost and noninvasive tool for future clinical interventional physiotherapeutic and early mobilization studies . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01560520 Background Chronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis ( MS ) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles . However , no studies to date have systematic ally evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS . This study involves a r and omized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels . Methods / Design A r and omly-allocated , three-parallel group , time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study . Our goal is to recruit 189 ambulatory individuals with MS who will be r and omized into one of three  telehealth interventions : ( 1 ) a contact-control social support intervention , ( 2 ) a physical activity-only intervention , and ( 3 ) a physical activity plus fatigue management intervention . All interventions will last 12 weeks and will be delivered entirely over the phone . Our hypothesis is that , in comparison to the contact-control condition , both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function , with the physical activity plus fatigue management intervention yielding significantly larger improvements . To test this hypothesis , outcome measures will be administered at Weeks 1 , 12 , and 24 . Primary outcomes will be the Fatigue Impact Scale , the Godin Leisure-Time Exercise Question naire ( GLTEQ ) , and Actigraph accelerometers . Secondary outcomes will include the SF-12 Survey , Mental Health Inventory , Multiple Sclerosis Impact Scale , the Community Participation Indicator , and psychosocial constructs ( e.g. , self-efficacy ) . Discussion The proposed study is novel , in that it represents a multi-disciplinary effort to merge two promising lines of research on MS : fatigue management and physical activity promotion . Collectively , the proposed study will be the largest r and omized controlled trial to examine the effects of a lifestyle physical activity intervention in people with MS.Trial registration Background and Purpose : Relatively little is known about the natural evolution of physical activity – related participation restrictions associated with Parkinson 's disease ( PD ) . We examined this issue prospect ively , using continuous monitoring technology to capture the free-living ambulatory activity of persons with PD engaging in life situations . We specifically sought ( 1 ) to explore natural , long-term changes in daily ambulatory activity and ( 2 ) to compare the responsiveness of ambulatory activity parameters to clinical measures of gait and disease severity . Methods : Thirty-three persons with PD participated ( Hoehn and Yahr range of 1–3 ) . Participants wore a step activity monitor for up to 7 days at baseline and again at 1-year follow-up . Mean daily values were calculated for parameters indicative of amount , intensity , frequency , and duration of ambulatory activity . Clinical measures included the Unified Parkinson Disease Rating Scale , the 6-Minute Walk , and Maximal Gait Speed . Parametric tests for paired sample s were used to investigate changes in ambulatory activity parameters and clinical measures . Results : Participants had significant declines in the amount and intensity of daily ambulatory activity but not in its frequency and duration ( P < 0.007 ) . Declines occurred in the absence of changes in clinical measures of gait or disease severity . The greatest 1-year decline occurred in the number of daily minutes participants spent engaging in at least moderate-intensity ambulatory activity . Conclusion : Continuous monitoring of ambulatory activity beyond mere step counts may serve as a distinct and important means of quantifying declining ambulatory behavior associated with disease progression or improved ambulatory behavior result ing from rehabilitation and medical and /or surgical interventions in persons with PD Reliability estimates are important parameters for power analyses and sample -size calculations in behavioral interventions for increasing physical activity among persons with multiple sclerosis ( MS ) . This study involved a secondary data analysis for providing reliability estimates for measures of physical activity over a six-month period in MS . On two occasions separated by six months , participants completed the Godin Leisure-Time Exercise Question naire ( GLTEQ ) and wore an ActiGraph model 7164 accelerometer on a belt around the waist for a seven-day period . The outcomes from the accelerometer were total activity counts and minutes of moderate-to-vigorous physical activity ( MVPA ) per day . The main analyses involved two-way , r and om effects intraclass correlation coefficients ( ICCs ) . The ICCs for GLTEQ scores , total activity counts , and minutes of MVPA were .66 , .84 , and .84 , respectively . Additionally , the sample was less physically active than adults without MS , and correlation analyses supported the validity of the measures , but within a substantially larger sample . Overall , the measures had acceptable , but different , reliability over six months in this sample of mostly women with relapsing – remitting MS . Power analyses using the reliability estimates indicated vastly different sample sizes for the measures of physical activity and when compared with the default parameter in software packages OBJECTIVE This brief report describes the possibility of reactivity in the baseline assessment of physical activity using accelerometry from two separate r and omized controlled trials of a behavior intervention for increasing physical activity in persons with multiple sclerosis ( MS ) . METHOD The sample s included 18 persons with multiple sclerosis ( MS ) from Study 1 and 20 from Study 2 who were r and omized into treatment arms of the intervention . The participants initially wore an accelerometer over a 7-day period for collection of baseline data , and one week later wore a pedometer over a 7-day period for collection of data for self-monitoring and goal setting in week 1 of the 12-week intervention . The accelerometer and pedometer data were both expressed in average steps per day over a 7-day period . RESULTS There was a moderate ( d = .56 ) , statistically significant ( p = .03 ) difference of 1,822 steps per day between baseline and week 1 of the intervention in Study 1 . There was a large ( d = 1.36 ) , statistically significant ( p = .0001 ) difference of 2,338 steps per day in Study 2 . CONCLUSION We are unaware of other research describing a significant change in physical activity between baseline and the first week of a behavioral intervention and believe that this change reflects reactivity in the baseline assessment using accelerometry Background : Exercise training is beneficial , but most persons with multiple sclerosis ( MS ) are sedentary and physically inactive . This has prompted a new focus on the promotion of lifestyle physical activity in MS . We previously design ed , tested , and refined a behavioral intervention delivered through the Internet that successfully increased lifestyle physical activity in MS , but have not evaluated the effects on secondary symptomatic and health-related quality of life ( HRQOL ) outcomes . Objective : We conducted a 6-month r and omized controlled trial ( RCT ) that examined the efficacy of an Internet-delivered , behavioral intervention for improving outcomes of fatigue , depression , anxiety , pain , sleep quality , and HRQOL in 82 ambulatory persons with MS . The secondary aim was to replicate previous results regarding change in free-living physical activity . Results : There was a significant and positive effect of the intervention on fatigue severity ( p=.001 , ηρ2=.15 ) and its physical impact ( p=.008 , ηρ2=.09 ) , depression ( p=.006 , ηρ2=.10 ) , and anxiety ( p=.006 , ηρ2=.10 ) . There were non-significant improvements in pain ( p=.08 , ηρ2=.04 ) , sleep quality ( p=.06 , ηρ2=.05 ) , and physical HRQOL ( p=.06 , ηρ2=.05 ) . We replicated our previous results by demonstrating an increase in self-reported physical activity ( p=.001 , ηρ2=.13 ) . Conclusions : Our results support behavioral interventions targeting lifestyle physical activity as an alternative approach for managing symptoms in MS INTRODUCTION Direct-to-consumer mHealth devices are a potential asset to behavioral research but rarely tested as intervention tools . This trial examined the accelerometer-based Fitbit tracker and website as a low-touch physical activity intervention . The purpose of this study is to evaluate , within an RCT , the feasibility and preliminary efficacy of integrating the Fitbit tracker and website into a physical activity intervention for postmenopausal women . METHODS Fifty-one inactive , postmenopausal women with BMI ≥25.0 were r and omized to a 16-week web-based self-monitoring intervention ( n=25 ) or comparison group ( n=26 ) . The Web-Based Tracking Group received a Fitbit , instructional session , and follow-up call at 4 weeks . The comparison group received a st and ard pedometer . All were asked to perform 150 minutes/week of moderate to vigorous physical activity ( MVPA ) . Physical activity outcomes were measured by the ActiGraph GT3X+ accelerometer . RESULTS Data were collected and analyzed in 2013 - 2014 . Participants were aged 60 ( SD=7 ) years with BMI of 29.2 ( 3.5 ) kg/m(2 ) . Relative to baseline , the Web-Based Tracking Group increased MVPA by 62 ( 108 ) minutes/week ( p<0.01 ) ; 10-minute MVPA bouts by 38 ( 83 ) minutes/week ( p=0.008 ) ; and steps by 789 ( 1,979 ) ( p=0.01 ) , compared to non-significant increases in the Pedometer Group ( between-group p=0.11 , 0.28 , and 0.30 , respectively ) . The Web-Based Tracking Group wore the tracker on 95 % of intervention days ; 96 % reported liking the website and 100 % liked the tracker . CONCLUSIONS The Fitbit was well accepted in this sample of women and associated with increased physical activity at 16 weeks . Leveraging direct-to-consumer mHealth technologies aligned with behavior change theories can strengthen physical activity interventions OBJECTIVES Physical activity may reduce the risk of cognitive decline in the elderly , but its effects among the oldest-old ( i.e. , those aged 85 years and older ) are not well known . Our study assessed the association between very late-life physical activity and 5-year risk of  mild cognitive impairment ( MCI ) or dementia and neuropsychological test performance among oldest-old women . METHODS This prospect i ve study was conducted at three sites . Participants included 1,249 women ( mean [ st and ard deviation ] age : 83.3 [ 2.8 ] years ) .  Baseline physical activity  was measured by self-reported blocks walked per week and analyzed according to tertile . Five years later , surviving participants who were 85 years and older ( oldest-old ) completed neuropsychological testing and underwent adjudication of clinical cognitive status ( normal , MCI , or dementia ) . All analyses were adjusted for baseline age , education , cognition , depression , body mass index , hypertension , smoking , and coronary artery disease . RESULTS Compared with women in the lowest tertile , women in the highest tertile were less likely to develop dementia ( 13.0 % versus 23.2 % ; multivariate adjusted odds ratio : 0.54 [ 95 % confidence interval : 0.36 - 0.82 ] ) . However , risk of MCI was not associated with physical activity . Physical activity was also associated with higher performance 5 years later on tests of global cognition , category fluency , and executive function but not phonemic fluency , memory , or attention . CONCLUSIONS Higher level of very late-life physical activity was associated with a lower risk of subsequent dementia  in oldest-old women . These findings support future studies for late-life physical activity interventions for the prevention of dementia among oldest-old women Objective This study investigated the clinical predictive value of the Fugl-Meyer Assessment ( FMA ) arm score and the upper limb activity assessed by accelerometers in patients with hemiparesis after acute stroke . Design The prospect i ve cohort ( n = 129 ) was recruited from a general hospital ; activity variables and FMA score at intake were related to the FMA , the modified Rankin Scale , and rehabilitation status after 3 mos of follow-up . The prediction model was based on binary logistic regression . Results Although the FMA score at intake has the best overall predictive value for all three outcome measures ( FMA3 , 87.6 % ; modified Rankin Scale , 85.3 % ; RS , 73.6 % ) , the activity of the impaired arm as assessed by the accelerometer has the best predictive value to determine patients who are at risk for continued disability ( modified Rankin Scale score 1 , 95.1 % ) . The most difficult outcome measure for prediction is the rehabilitation status ; specifically , the patients who went home are predicted imprecisely . The ratio variable is the least accurate predictor of all tested variables . Conclusions The  FMA arm score at intake is the best predictor for arm recovery and general disability . The activity of the impaired arm is an excellent predictor for prolonged disability and is an alternative to the FMA score when it is impossible to score the FMA in the acute phase of stroke The factors determining recovery from hemiparetic stroke are manifold . We studied spontaneous arm movement activity in the acute phase after stroke as a predictor of recovery . Included in this prospect i ve study were 25 patients ( 63 ± 10 years ; 9 women , 16 men ) with acute middle cerebral artery stroke and 7 control patients without neurological disease ( 61 ± 14 years ; 3 women , 4 men ) .  Movement activity was measured continuously for 4 days in both arms using Actiwatches and analysed off-line .  Movement activity of the nonaffected arm ranged from < 10 to > 16 h per day in the stroke patients . Nine stroke patients with an initial decline in arm movement activity showed no increase in movement activity in either arm over 4 days after stroke , and the other 16 patients improved steadily after admission ( p < 0.003 ) . C-reactive protein was elevated in the non-recovering patients ( 4.4 ± 4.9 mg/dl ) related to a low number of waking hours ( r = −0.512 , p < 0.01 ) . Stroke severity , location and treatment , as well as arterial blood pressure ( 162 ± 21 mmHg ) and body temperature ( 36.9 ± 06 ° C ) were not different among the groups . The impairment was still different among the two groups 3 months after stroke . Our results support the notion that in the acute stage after middle cerebral artery stroke there are patients with a secondary decline in general motor activity related to an enhanced sleep dem and as assessed with accelerometry . This impairment was related to elevated C-reactive protein OBJECTIVE To examine the psychometric properties of an objective method for assessing real-world arm activity in a large sample with subacute stroke . DESIGN Validation study . SETTING Community . PARTICIPANTS Persons 3 to 9 months poststroke ( N=169 ) with mild to moderate motor impairment of their hemiparetic arm enrolled in a multisite , r and omized clinical trial of constraint-induced movement therapy .  INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Participants wore an accelerometer on each arm outside the laboratory for 3 days before and after treatment or an equivalent no-treatment period . They also completed the Actual Amount of Use Test ( AAUT ) , which is an observational measure of spontaneous more-impaired arm use , and the Motor Activity Log ( MAL ) , which is an interview assessing more-impaired arm use in daily life . RESULTS Low-pass-filtered accelerometer recordings were reliable ( r range , > .8 ) and stable ( P range , > .48 ) . Their validity was also supported . Correlations calculated across all participants at baseline between the ratio of more-impaired to less-impaired arm accelerometer recordings and AAUT and MAL scores were .60 and .52 , respectively . CONCLUSIONS Accelerometry provides an objective , real-world index of more-impaired arm activity with good psychometric properties Aim : The aim of the present study was the evaluation of actigraphy as a tool to objectify the recovery process after motor paresis due to stroke . Methods : The motor activity of both arms of patients suffering from stroke was actigraphically recorded at four different time points during the course of rehabilitation : 24–36 h , 5–7 days , 3 months , and 6 months after stroke . Results : Motor activity monitored by wrist-worn actigraphs located at the impaired side revealed an increase in activity between the first two time points and the subsequent ones . Additionally , actigraphic recordings showed lower total motor activity at the impaired side as compared to the nonimpaired side . A significant positive correlation was found between the actigraphically recorded motor activity and the results of the Sc and inavian Stroke scale , the Barthel Index , the Rankin Scale Score and with the Motoricity Index during the 1st week , which corresponds to the time when neurological deficits were most pronounced . Conclusion : Our results suggest that actigraphy is a useful tool in the objective evaluation of motor activity after stroke . Moreover , actigraphy covers additional aspects that are not reflected by the usual stroke scales in a clinical situation Background / Objective . This study examined the test-retest reliability of an activity monitor ( AM ) in home and community setting s in individuals with Parkinson 's disease ( PD ) . Methods . Nine independent community dwellers with idiopathic PD were recruited ( 8 males and 1 female ; median age = 66 years , range 46 - 71 ; Hoehn & Yahr score 2 ) . Patients wore the AM for 3 separate sessions in the home and community with 7 days between each session . The first 2 sessions lasted 24 hours each , and the third session lasted 48 hours . Reliability indices and measures of variability were obtained by using intraclass correlation coefficients ( ICC ) and generalizability coefficients . The functional activity measures included the percentage of time spent in sleeping positions , sitting , st and ing , and walking ; the number of transitions between sit and st and ; the total number of transitions ; the number of walking periods lasting 5 and 10 seconds ; and stride frequency . Results . The ICCs for functional activities between the first and second consecutive days for the 48-hour session ( third session ) ranged from .76 to .92 . The ICCs for the 7- and 14-day intervals ranged from .45 to .96 , with walking-related measures showing the highest ICCs ( range = .81 to .96 ) . Across the three 24-hour periods ( sessions 1 and 2 , and the first 24 hours of session 3 ) , the ICCs for walking-related measures were again high ranging from .87 to .92 . Walking-related measures demonstrated the highest generalizability coefficients , indicating these measures have the highest test-retest reliability in comparison to other functional activity measures . Conclusions . The present study shows that 24 hours of recording with an AM is a sufficient duration of time to reliably record patients ' functional activity in the home and community setting s. In addition , the highest test-retest reliability for activities across 7- and 14-day intervals were found for walking-related measures in individuals with PD , indicating these measures have the highest stability compared to the other measures of functional activity Purpose This study aims to assess the extent to which accelerometers can be used to determine the effect of robot-supported task-oriented arm-h and training , relative to task-oriented arm-h and training alone , on the actual amount of arm-h and use of chronic stroke patients in their home situation . Methods This single-blind r and omized controlled trial included 16 chronic stroke patients , r and omly allocated using blocked r and omization ( n = 2 ) to receive  task-oriented robot-supported arm-h and training or task-oriented ( unsupported ) arm-h and training . Training lasted 8 weeks , 4 times/week , 2 × 30 min/day using the (T-)TOAT ( (Technology-supported)-Task-Oriented-Arm-Training ) method . The actual amount of arm-h and use , was assessed at baseline , after 8 weeks training and 6 months after training cessation . Duration of use and intensity of use of the affected arm-h and during unimanual and bimanual activities were calculated . Results Duration and intensity of use of the affected arm-h and did not change significantly during and after training , with or without robot-support ( i.e. duration of use of unimanual use of the affected arm-h and : median difference of −0.17 % in the robot-group and −0.08 % in the control group between baseline and after training cessation ; intensity of the affected arm-h and : median difference of 3.95 % in the robot-group and 3.32 % in the control group between baseline and after training cessation ) . No significant between-group differences were found . Conclusions Accelerometer data did not show significant changes in actual amount of arm-h and use after task-oriented training , with or without robot-support . Next to the amount of use , discrimination between activities performed and information about quality of use of the affected arm-h and are essential to determine actual arm-h and performance . Trial Registration Controlled-trials.com IS RCT UNLABELLED Mudge S , Barber PA , Stott NS . Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke : a r and omized controlled trial . OBJECTIVE To determine whether circuit-based rehabilitation would increase the amount and rate that individuals with stroke walk in their usual environments . DESIGN Single-blind r and omized controlled trial . SETTING Rehabilitation clinic . PARTICIPANTS Sixty participants with a residual gait deficit at least 6 months after stroke originally enrolled in the study . Two withdrew in the initial phase , leaving 58 participants ( median age , 71.5y ; range , 39.0 - 89.0y ) who were r and omized to the 2 intervention groups . INTERVENTIONS The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit class design ed to improve walking . The control group received a comparable duration of group social and educational classes . MAIN OUTCOME MEASURES Usual walking performance was assessed using the StepWatch Activity Monitor . Clinical tests were gait speed ( timed 10-meter walk ) and endurance ( six-minute walk test [ 6MWT ] ) , confidence ( Activities-Based Confidence Scale ) , self-reported mobility ( Rivermead Mobility Index [ RMI ] ) , and self-reported physical activity ( Physical Activity and Disability Scale ) . RESULTS Intention-to-treat analysis revealed that the exercise group showed a significantly greater distance for the 6MWT than the control group immediately after the intervention ( P=.030 ) but that this effect was not retained 3 months later . There were no changes in the StepWatch measures of usual walking performance for either group . The exercise and control groups had significantly different gait speed ( P=.038 ) and scores on the RMI ( P=.025 ) at the 3-month follow-up . These differences represented a greater decline in the control group compared with the exercise group for both outcome measures . CONCLUSIONS Circuit-based rehabilitation leads to improvements in gait endurance but does not change the amount or rate of walking performance in usual environments . Clinical gains made by the exercise group were lost 3 months later . Future studies should consider whether rehabilitation needs to occur in usual environments to improve walking performance The present study adopted an interrupted time-series design for identifying the possibility of behavioral reactivity and examining the effect of an Internet-delivered behavioral intervention for increasing self-reported and objective ly-measured physical activity among persons with multiple sclerosis ( MS ) . Participants ( n = 18 ) wore an accelerometer for 7 days and completed a battery of question naires to measure  physical activity  at 3 time points ( before and after a 3-month period of no treatment and again after a 3-month period of treatment ) . There was a small change in objective ly-measured , but not self-reported , physical activity in the period of no treatment , whereas there was a large increase in self-reported and objective ly-measured physical activity in the period of treatment . These findings both complement and extend previous research and further support the efficacy of the current Internet behavioral intervention for increasing physical activity in persons with MS Abstract Purpose : We conducted a noncontrolled pilot intervention study in stroke survivors to examine the efficacy of lowintensity adaptive physical activity to increase balance , improve walking function , and increase cardiovascular fitness and to determine whether improvements were carried over into activity profiles in home and community . Method : Adaptive physical activity sessions were conducted 3 times/week for 6 months . The main outcomes were Berg Balance Scale , Dynamic Gait Index , 6-Minute Walk Test , cardiovascular fitness ( VO2 peak ) , Falls Efficacy Scale , and 5-day Step Activity Monitoring . Results : Seven men and women with chronic ischemic stroke completed the 6-month intervention . The mean Berg Balance baseline score increased from 33.9 ± 8.5 to 46 ± 6.7 at 6 months ( mean ± SD ; p = .006 ) . Dynamic Gait Index increased from 13.7 ± 3.0 to 19.0 ± 3.5 ( p = .01 ) . Six-minute walk distance increased from 840 ± 110 feet to 935 ± 101 feet ( p = 0.02 ) . VO2 peak increased from 15.3 ± 4.1 mL/kg/min to 17.5 ± 4.7 mL/kg/min ( p = .03 ) . There were no significant changes in falls efficacy or free-living ambulatory activity . Conclusion : A structured adaptive physical activity  produces improvements in balance , gait , fitness , and ambulatory performance but not in falls efficacy or free-living daily step activity . R and omized studies are needed to determine the cardiovascular health and functional benefits of structured group physical activity programs and to develop behavioral interventions that promote increased free-living physical activity patterns The present study examined the symptom cluster of fatigue , pain , and depression , and its direct and indirect prediction of physical  activity  behavior in a sample of individuals with multiple sclerosis ( MS ) using a prospect i ve research design and the Theory of Unpleasant Symptoms . The sample included 292 individuals with a definite diagnosis of MS . The participants completed self-report measures of fatigue , depression , pain , self-efficacy , and functional limitations at baseline and six months later , wore an accelerometer for seven days and completed a self-report measure of physical activity behavior .  The data analysis indicated that : 1 ) fatigue , depression , and pain represented a symptom cluster ; 2 ) the symptom cluster had a strong and negative predictive relationship with physical activity behavior ; and 3 ) functional limitations , but not self-efficacy , accounted for the predictive relationship between the symptom cluster and physical activity behavior . Such findings provide preliminary support to the importance of considering symptom clusters as a meaningful correlate of physical activity behavior in persons with MS Physical inactivity is a major health problem in the United States , particularly in elderly and disabled population s. Little research exists examining the relationships between aspects of the built environment and physical activity in older adults and individuals with multiple sclerosis ( MS ) . We adopted a social cognitive perspective to examine the independent roles of perceptions of the environmental , self-efficacy and functional limitations in underst and ing physical activity levels among elderly women and women with MS . Older women ( n=136 ) and women diagnosed with MS ( n=173 ) were recruited to participate in separate cross-sectional studies . Individuals completed a battery of question naires and wore an activity monitor for 7 days . All measures were issued and collected through the mail with the use of self-addressed , pre-paid envelopes . Initial correlational analyses indicated that self-efficacy , functional limitations and environmental perceptions were significantly related to physical activity . Among older women , self-efficacy , functional limitations and street connectivity demonstrated independent contributions to physical activity behavior . Only self-efficacy and functional limitations demonstrated significant associations among women with MS . The prospect i ve contributions of the environment and individual factors to changes in physical activity need to be determined Objective : To examine whether accelerometry provides a measure of physical activity , walking ability or both in a sample of individuals with multiple sclerosis . The secondary purpose was to examine the validity of physical activity measures in people with multiple sclerosis who have ambulatory impairments . Participants : Forty-two individuals with multiple sclerosis without ambulatory impairment ( Exp and ed Disability Status Scale ( EDSS ) score ≤ 4.5 ) and 32 individuals with multiple sclerosis with ambulatory impairment ( EDSS ≥5.0 ) . Method : Participants completed the Multiple Sclerosis Walking Scale-12 and Performance Scales , wore an accelerometer for seven days , and completed the Godin Leisure-Time Exercise Question naire and short-form of the International Physical Activity Question naire . Results : There were significant differences between groups on scores from the five measures . There were large correlations between the accelerometer counts with scores from both the self-report measures of physical activity and the self-report measures of walking mobility in the overall sample . There were large correlations between scores from both measures of physical activity in the overall sample and the sub sample with ambulatory impairment . Conclusion : Our data suggest that accelerometers are measuring both physical activity and walking mobility in individuals with multiple sclerosis , whereas self-report measures are measuring physical activity in individuals with multiple sclerosis , including those with ambulatory impairment
target: Physical activity levels measured by remote monitoring are consistently low in people with MS , stroke and dementia , and patterns of physical activity are altered in PD .
  In MS , decreased ambulatory activity assessed via remote monitoring is associated with greater disability and lower quality of life .
  In stroke , remote measures of upper limb function and ambulation are associated with functional recovery following rehabilitation and goal -directed interventions .
  In PD , remote monitoring may help to predict falls .
  In dementia , remote physical activity measures correlate with disease severity and can detect w and ering .
  Conclusions These studies show that remote physical activity monitoring is feasible in neurological diseases , including in people with moderate to severe neurological disability .
  Remote monitoring can be a psychometrically sound and responsive way to assess physical activity in neurological disease .
background: Objective To perform a systematic review of studies using remote physical activity monitoring in neurological diseases , highlighting advances and determining gaps .