How we walk is important for many reasons. Safe and independent walking is fundamental to daily living, quality of life and social roles in home and society.  Small changes in our walking can lead to significant challenges that affect how we feel, function, socialise, and our safety. How we walk (such as walking speed and number of steps) is also important for another reason - it gives important insights into health. Collectively, we can think of walking as an indicator or signature of health and well-being. 

People with Parkinson’s (PwP) routinely identify mobility loss (the way we walk – our gait, and how much we walk) as one of their top research priorities.  Despite best efforts, mobility decline continues. Understanding what causes this, how best to measure it, what we can learn from the measures and how to manage it is central to our work in Newcastle (https://www.bam-ncl.co.uk/). For example, changes in discrete gait characteristics are evident even before clinical signs appear (prodromal stage). Early gait impairments also underlie falls risk from a very early stage. Not all gait characteristics are affected in the same way, suggesting discrete patterns or signatures in Parkinson’s that could enhance the diagnosis, monitoring, risk of developing PD, and predict falls risk.  This makes mobility a priority to measure and treat.

The ability to walk is far more than a simple physical task. Relating discrete gait outcomes to brain imaging, eye tracking, cognitive and functional tests has allowed us to understand the multiple underlying factors that contribute to gait disturbance. For example, dopaminergic loss, cholinergic disturbances, and sarcopenia challenge the quality and quantity of gait and affect the amount and pattern of walking.  These findings inform a multi-modal approach to manage gait impairments and falls risk in PD that ideally start as early as possible for a more preventative approach.

These insights are largely informed through work carried out in a specialised movement laboratory.  For this to be useful, measurement must be easy to implement in the clinic and home in a way that is simple for people to use – healthcare professional, PwP or carer.  We also know that real-world walking places greater challenges on gait due to the increased complexity of the environment.  Measuring walking as people go about their everyday activities therefore offers the potential to gain new insights previously not possible.  Over 20 years ago I was introduced to digital health technology (wearables to monitor mobility). The potential to measure mobility in the clinic and in people’s own homes was clear even then.  Therefore, the opportunity of wearables to deliver the precision of a gait laboratory with the convenience of real-world monitoring formed a core component of our work.  Early findings showed digital gait and physical activity outcomes (collectively termed digital mobility outcomes – DMOs) could discriminate and monitor early PD, detect prodromal risk of PD, and were sensitive to severity of PD and effects of therapy. Moreover, the inclusive nature of these methods from insights gained in Africa highlighted the relevance of this approach broadly.

These early approaches using wearables presented some challenges that limited their uptake in research and clinical care.  The last decade however has marked an intense effort to develop and validate real-world digital mobility assessment methods. Identifying the best digital mobility outcomes that ultimately may help drive modernization, standardization and efficiency for research and personalized care in Parkinson’s and other conditions. The Mobilise-D consortium (https://www.mobilise-d.eu;), an academic/industry collaboration, has made a significant contribution in developing and validating real-world mobility assessment and digital mobility outcomes (e.g. real-world walking speed and other outcomes) for use in drug discovery and clinical care. Part of the process was to ensure that all work was fully informed by the patient voice and lived experience of Parkinson’s.  Extensive efforts working with PwP have been undertaken to ensure acceptability of using the device and meaningfulness of the mobility outcomes, capturing what is important to patients (e.g. https://mobilise-d.eu/beyond-mobility-exploring-and-capturing-the-physical-emotional-and-social-experiences-of-walking/). This means we can ensure we measure what matters, when and where it matters to those people who will use the information. 

Not only has Mobilise-D developed and validated new methods to measure mobility, but ongoing efforts are also underway to obtain regulatory approval for widespread use – a vital step to make mobility assessment a common standard in research and care.  Promising first steps indicate support for this from regulatory authorities in the EU and USA, with areas for further evidence generation identified to allow the conditions for approval to be fully met.

What does the future hold? Next generation digital tools with the reliability and precision to measure and monitor mobility are poised to inform the way we identify, measure, understand PD and treat mobility loss. Technical companies are already implementing Mobilise-D digital outcomes, allowing use in clinical trials. Other large scale clinical trials are also being set up that will implement the same methods, allowing for these exploratory outcomes to be used in putative disease-modifying trials. Collectively this will produce vital evidence required by regulators to approve the use of these tools.  Similar methods are being used to explore other aspects of movement, function and health conditions and combined with other technology are forming approaches to enhance home based monitoring. The approach is also informing ways to monitor the effects of medication on mobility directly with the aim of optimizing medication use, mobility and minimizing falls risk. Collectively this may drive momentum to establish mobility monitoring as a standard of care and a sensitive signature of health and well-being.

Lynn Rochester, PhD, PT is Professor of Human Movement Science in the Translational and Clinical Research Institute, Newcastle University, an honorary consultant physiotherapist and she holds two NIHR Senior Investigators Awards (2020-2024 & 2024-2028). She has spoken at past World Parkinson Congresses and has sat on the WPC Program Committee. Professor Rochester will join the WPC Research Spotlight 2025 series on Tuesday, Oct 21, 2025. Register here for the series..

Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not reflect the opinions or positions of the World Parkinson Coalition®