Wearable System, Music and Multi-Domain Exercise for People Living with Parkinson’s Disease
At the WPC 2013 in Montreal, my laboratory presented a series of abstracts on using wearable device and smart phone App to improve diagnostic testing and exercise interventions for people living with Parkinson’s disease (PD). Since then we have made some important progress along this line of research (see the review article here) particularly as it relates to the use of wearable system to enable music-based multi-domain exercise (MDE).
Many studies have shown that for Parkinson’s disease, certain types of complex exercise such as tango dancing, boxing, or treadmill walking with concurrent virtual reality or video display can be particularly engaging, enjoyable and clinically beneficial. One possible explanation is that these activities have created an environment of multi-domain interactions, comprising not only physical but strong components of emotional and social stimuli. I believe MDE can be viewed as a form of “behavioral state” induction method, in which a rich repertoire of sensorimotor, cognitive and social stimuli is integrated with a specific type of conventional exercise (e.g. brisk walking) and utilized, mechanistically, to activate multiple brain functional networks, and cardiovascular and musculoskeletal system in a coherent, motivational and mutually reinforcing manner.
In our research, we have experimented the idea that MDE can be created on a wearable device (e.g. an iPod Touch) for home-based personal training. We dubbed such a system Ambulosono (“walking-song”), because research shows that walking, when combined with motivational music enriched with rhythm, vocal singing and uplifting emotional salience, could become a powerful way to stimulate midbrain circuits for dopamine release and gait speed control as well as to inhibit brain networks that mediate fear and anxiety. The design of Ambulosono MDE also includes a component of incentive learning, in which we made music delivery contingent upon the size of each walking step; shuffling steps or unintentional slowing down, which can be picked up by the iPod sensor over the knee, quickly led to a stoppage of music play and reminds patients to take larger steps. In this way, auditory cues and stepping become instrumentally conditioned and behaviorally reinforced. It is hoped that such an MDE system can motivate and invigorate people in early and mid-stages of Parkinson’s disease to undertake large-stride walking exercise over long distances and, overtime, transform monotonous walking into a pleasurable daily activity and habit.
Our published and unpublished results from multi-center trials have shown that the Ambulosono MDE can lead to clinically important improvement in UPDRS motor scores over a 12-24 month period which is positively correlated with the amount of walking time and accompanied by changes in brain functional connectivity in the midbrain locomotion region [1]. Surprisingly a 12-week Ambulosono MDEcan lead to significant improvement in depression and anxiety scores (even in the absence of motor improvement) [2]. Patients who participated Ambulosono studies seemed to genuinely enjoy and embrace the program as evidenced by rare voluntary dropout, frequent device utilization, increased peer referrals and enthusiasm in supporting this research (see this patient-made video).
Despite these research progresses, like many exercises related clinical studies, there are important scientific questions that remain to be answered. For example, we cannot be certain about a direct causality relationship between the Ambulosono intervention and the observed outcomes because our intervention was not blinded and controlled by placebos. Despite these challenges, wearable technology will likely continue to play an increasingly important role in enabling new diagnostic test and intervention for PD.
References:
1: Hu B, Chomiak T. Wearable technological platform for multidomain diagnostic and exercise interventions in Parkinson's disease. Int Rev Neurobiol. 2019;147:75-93. doi:10.1016/bs.irn.2019.08.004
2: Jacqueline Burt, Einat Ravid, Sandra Bradford, Nancy J Fisher, Yiye Zeng, Taylor Chomiak, Lesley Brown, Martin J McKeown, Bin Hu, Richard Camicioli. The effects of music-contingent gait training on cognition and mood in parkinson disease: a feasibility study. Neurorehabilitation and Neural Repair 34 (1), 82-92
Bin Hu MD, PhD is a Suter Professor for Parkinson’s Research at the Department of Clinical Neurosciences at University of Calgary in Canada.
This research was first shared as an abstract at the WPC 2013 in Montreal, Canada. WPC is pleased to support abstract authors by sharing their ongoing work. Digital files of WPC abstract books can be downloaded from the past three Congresses HERE.
Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not necessarily reflect the opinions of the World Parkinson Coalition®