Objective: This study investigated whether Ambulosono, a multi-domain exercise platform, could serve as a disease modifying therapy for Parkinson’s disease (PD).

Background: Regular exercise has many benefits including a significant reduction in all-cause mortalities in PD. Partly inspired by the musical effect in relieving freezing of gait (FOG), we have designed a new exercise platform, Ambulosono, in which a walker can use his or her own step amplitudes, captured through the motion sensors, Ambulosono App and a mobile device, to control music play. As such, walking is transformed into a form of goal-directed activity, enriched with multi-domain physiological stimuli that are linked to and offered by motivational music, bio-feedback control of gait automaticity, contingency learning and aerobic exercise.

Method: This open-label study enrolled 98 PD patients and 58 age-matched controls via three academic centers in Canada and China. Training was divided into short (<30 min) and mid (mean=12 weeks) and long (13-28 months) Ambulosono groups.

Results: 1) Short duration Ambulosono training substantially reduced the FOG incidences both in terms of frequency of occurrence (P<0.05) and in FOG duration (P<0.05). 2). In long duration Ambulosono training the average UPDRS-III scores, assessed over 16.6 months, were reduced by -0.3 points comparing to controls which is significantly lower than the threshold of clinically important difference (CID; p<0.05). Sub-group analysis showed that in nearly 40% of patients, who walked much more than the others (super-walkers), their mean UPDRS-III score decreased by just over -3 points over a 13.4 month period (p<0.05). 3) Finally, resting state fMRI revealed that the connectivity is decreased in the left pedunculopontine nucleus which is significantly correlated with improvement in UPDRS-III in a walking dose dependent manner.

Conclusion: Digital health technology and Ambulosono MDE can significantly expand the training domains of conventional aerobic exercise, which could be adapted as a disease modifying therapy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/enabling-multi-domain-exercise-training-in-parkinsons-disease-through-wearable-and-digital-health-technology/