Objective: To determine feasibility and estimate effect of a remote behavioral intervention on daily steps and motor symptoms in Veterans with PD

Background: Many types of exercise improve PD symptoms in clinical trials but strategies to increase physical activity (PA) in real life settings are not well-studied. Behavioral economics based gamification interventions that leverage loss-aversion may be well-suited to changing behavior by targeting well-described risk aversion seen in PD.

Method: All study activities were conducted remotely as described below, resulting in a “touchless” clinical trial where subjects were not required to attend in-person visits. Using administrative data, we invited Veterans with PD living in a five-state area to participate via mail with screening and consent via phone. Survey assessments and step counts (using Fitbits) were acquired using Way to Health, a web-based digital health platform, housed at the University of Pennsylvania. Subjects underwent a 2-week baseline step collection, 6-week gamification period (targeting 20% step increase) and 4-week followup. Subjects began the study with a bank of points and then lost or gained points based on goal achievement. Motor symptoms were monitored at the end of each study period with Parkinson’s Kinetigraph (PKG).

Results: We consented 88 subjects with 75 (85%) completing all baseline assessments and 74 (99%) then completing the full study protocol. The cohort had a mean (SD) age of 71 (6.1), disease duration of 5.2 (3.8) years and lived 222 (344) miles from the medical center. Participants averaged 4829 (2745) steps at baseline with a mean increase of 28% (p<0.001) during the gamification intervention and 12% (p<0.01) during followup. Bradykinesia (-0.22 (1.9) vs. +1.11(2.2)) and immobility (-0.4(5.0) vs. +2.8 (5.1)) PKG scores were significantly improved (p<0.05) in subjects meeting their step goal on >50% of days while tremor scores did not change.

Conclusion: A remotely deployed gamification intervention allowed recruitment of people with PD living over 200 miles from the study site, increased PA and improved symptoms. Scalable interventions leveraging wearables and remote monitoring platforms have wide reach and are a promising pathway for improving activity levels in people with PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/increasing-physical-activity-in-parkinsons-disease-via-a-remotely-deployed-gamification-intervention/