Quantifying daily physical activity and determinants in sedentary patients with Parkinson’s disease M.L. Dontje a, b, * , M.H.G. de Greef a, c , A.D. Speelman d , M. van Nimwegen d , W.P. Krijnen a , R.P. Stolk b , Y.P.T. Kamsma c , B.R. Bloem e , M. Munneke d, f , C.P. van der Schans a, g a Hanze University of Applied Sciences, Professorship in Health Care and Nursing, Groningen, The Netherlands b University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands c University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands d Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence-based Practice, Department of Neurology, Nijmegen, The Netherlands e Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands f Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands g University of Groningen, University Medical Center Groningen, Department of Rehabilitation, Groningen, The Netherlands article info Article history: Received 6 December 2012 Received in revised form 11 April 2013 Accepted 20 May 2013 Keywords: Physical activity Parkinson’s disease Physical fitness Health behavior abstract Background: Although physical activity is beneficial for Parkinson’s disease (PD) patients, many do not meet the recommended levels. The range of physical activity among sedentary PD patients is unknown, as are factors that determine this variability. Hence, we aimed to (1) assess daily physical activity in self- identified sedentary PD patients; (2) compare this with criteria of a daily physical activity guideline; and (3) identify determinants of daily physical activity. Methods: Daily physical activity of 586 self-identified sedentary PD patients was measured with a tri- axial accelerometer for seven consecutive days. Physical fitness and demographic, disease-specific, and psychological characteristics were assessed. Daily physical activity was compared with the 30- min activity guideline. A linear mixed-effects model was estimated to identify determinants of daily physical activity. Results: Accelerometer data of 467 patients who fulfilled all criteria revealed that >98% of their day was spent on sedentary to light-intensity activities. Eighty-two percent of the participants were ‘physically inactive’ (0 days/week of 30-min activity); 17% were ‘semi-active’ (1e4 days/week of 30-min activity). Age, gender, physical fitness, and scores on the Unified Parkinson’s Disease Rating Scale explained 69% of the variability in daily physical activity. Conclusions: Performance-based measurements confirmed that most self-identified sedentary PD pa- tients are ‘physically inactive’. However, the variance in daily physical activity across subjects was considerable. Higher age, being female, and lower physical capacity were the most important de- terminants of reduced daily physical activity. Future therapeutic interventions should aim to improve daily physical activity in these high-risk patients, focusing specifically on modifiable risk factors. Ó 2013 Elsevier Ltd. All rights reserved. 1. Introduction Physical activity, which includes exercise as well as daily phys- ical activities [1], is important for patients with Parkinson’s disease (PD). Although physical activity will not cure the disease, it may positively affect functional capacity, physical fitness, health, and several dimensions of quality of life [2,3]. Recommendations state that PD patients should perform at least 30 min of physical activity (moderate-intensity) per day (in bouts of minimal 10 min). This should be done for at least five days per week [4]. Research suggests that many PD patients do not meet this recommendation [2,5,6]. However, it is not clear how far the actual daily physical activity of patients is below the recommended level, or what the range and variability in physical activity is across pa- tients. Therefore, daily physical activity should be quantified with an accelerometer. Compared to questionnaires, such performance- based measurements can provide more accurate and detailed * Corresponding author. Hanze University of Applied Sciences Groningen, Pro- fessorship in Health Care and Nursing, Eysoniusplein 18, 9714 CE Groningen, The Netherlands. Tel.: þ31 50 595 3539; fax: þ31 50 595 7778. E-mail address: m.l.dontje@pl.hanze.nl (M.L. Dontje). Contents lists available at SciVerse ScienceDirect Parkinsonism and Related Disorders journal homepage: www.elsevier.com/locate/parkreldis 1353-8020/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.parkreldis.2013.05.014 Parkinsonism and Related Disorders 19 (2013) 878e882