There has been increasing interest from researchers, dance artists and health professionals regarding the physical and psychological benefits of dance for people with Parkinson’s, particularly as a possible adjunct therapeutic intervention to medication. Studies examining the effect of dance on health outcomes such as parameters of movement have typically used brief, snap-shot assessments that limit understanding of movement to the timeframe in which the test or self-report measure is administered. Furthermore, such measures may be influenced by mood and cognitive capabilities. Accelerometry has been used to study the effect of various health interventions on the physical activity levels of people with Parkinson’s, but the types of activities studied have not yet included dance.
The present thesis aimed to investigate the application of wrist-worn accelerometers as an objective measure of movement to dance for Parkinson’s research. Specifically, this work intended to advance current knowledge regarding the uses of accelerometers with people with Parkinson’s by exploring i) the feasibility of using wrist-worn devices to measure movement parameters during and after participation in a dance class, ii) participant adherence to a wrist-worn device , iii) the validity of wrist-placement in the assessment of movement, iv) the usefulness of volume of movement as a single summary metric of movement, and v) how values for the assessment of physical activity intensity derived from a wrist-worn accelerometer compare to previously published values obtained from other device placements.
A series of exploratory studies were undertaken to address these aims. The first study addressed the gap in the literature regarding the use of accelerometry in the measurement of the level and pattern of movement made by people with and without Parkinson’s during a dance class. Participant triads, consisting of one person with Parkinson’s, an age-matched control and a young adult attending the same class at the University of Hertfordshire, wore a GENEActiv accelerometer on their wrist for an hour dance session and the following hour rest session. The results showed that the accelerometers accurately tracked the movement of the participant triads and detected between-group differences across all triads, such that young adults were significantly more active over the two hours compared to the participants with Parkinson’s and age-matched controls. The second study examined whether an objective measure of movement, derived from the accelerometers, supported the anecdotal reports of people with Parkinson’s of maintained levels of movement during the hours and days following attendance to a dance class. To this end, people with Parkinson’s and age-matched dancers (PD-D and AM-D, respectively) were asked to wear an accelerometer on their wrist over six consecutive days following attendance to a class, a free-living setting, and on a week when they did not attend a class. Accelerometer-derived movement and sleep metrics were compared between these two groups and to a separate control group of people with Parkinson’s who had never attended dance classes (PD-C). All participants were compliant with wearing the accelerometer over the consecutive days and very few removed the device. No significant differences were found between participant groups in terms of volume of movement and sleep quality. Though non-significant, PD-Ds and AM-Ds were 7% and 10% less physically active, respectively, on a Friday afternoon on a no-dance week compared to a dance week. No significant difference was found when movement was examined as a daily average, indicating that if there is an effect of dance on movement, it is likely to be short-lived. The final study focused on the development of values that can be used to interpret raw acceleration data derived from wrist-worn accelerometers in terms of physical activity intensity levels, specifically for use with people with Parkinson’s. Volume of movement (derived from a wrist, hip and ankle-worn device) and physiological energy expenditure (derived from a spiroergometry device) were calculated for people with Parkinson’s and age-matched controls as they undertook a variety of exercises and household activities in a sports laboratory. Corroborating the findings of previous research, the results showed that volume of movement derived from a wrist-worn device significantly predicted energy expenditure, but the addition of a second hip-worn accelerometer increased accuracy. Though no differences were found between the participant groups for volume of movement and energy expenditure, people with Parkinson’s rated all activities as significantly more exerting. This finding indicates that physiological exertion was similar between the two groups and that the symptoms of Parkinson’s may play a role in perceived exertion.
Taken together, these studies demonstrate that wrist-worn accelerometers are acceptable and sensitive devices that can be used to investigate the engagement of people with and without Parkinson’s in activities such as dance. Volume of movement as an accelerometer-derived outcome is useful when physical activity is monitored under observable and predictable conditions, however future exploratory studies should consider incorporating a measure of physical activity intensity to further interpret acceleration data in light of government physical activity guidelines, particularly when monitoring movement in a free-living context
