Post-PT Extension of In-Home Dynamic Standing Table Use in Parkinson Disease

帕金森病(PD)患者的轴运动功能障碍对多巴胺能治疗的反应最小，并使许多患者倾向于久坐不动的生活方式。这使帕金森病患者面临更大的风险，因为缺乏运动会带来负面后果。当帕金森病患者出现姿势失衡和步态困难(PIGD)，包括摔倒时，他们通常会被建议进行物理治疗(PT)以获得最佳处理。尽管Cochrane的一项综述证实了物理治疗对具有PIGD运动特征的PD患者的(短期)益处，但在PT疗程结束后下一步该如何做的临床实践中仍存在一个严重的缺口。临床经验表明，大多数患者恢复久坐不动的生活方式，迫切需要对具有PIGD特征的帕金森病患者进行PT后的家庭体育活动计划，以保持活动功能。体力活动研究的最新进展吹捧非运动性体力活动(NEPA)方法，以促进健康的生活方式改变。对于患有PIGD的PD患者，正常的直立和较长时间的移重(踏步)可能是NEPA的理想形式。它能激活腿部肌肉，并鼓励姿势活动。为了促进这种类型的NEPA，我们开发了一种坐-站式办公桌系统，通过重心转移来增强直立活动。“动态站立桌”有一个在水平面上摆动的桌面，提示使用者进行周期性的身体内侧体重转移调整。与坐姿相比，动态站立代表的是最低水平的体力活动，而坐姿在有PIGD运动特征的帕金森病患者中普遍存在。动态站立桌的使用可以很容易地与日常的桌面活动相结合，例如使用电脑、阅读或看电视，并可能促进身体活动。初步数据显示，中度帕金森病患者能够在没有明显困难的情况下完成至少3小时的治疗，并可能从使用该表中获得运动和认知方面的好处。我们提出了一项探索性对照试验，在PD和PIGD患者中进行PT后家庭内体力活动计划的扩展，包括PT后标准护理(即每周体力活动小组会议)与家庭动态站立桌椅使用与单独PT后护理标准的组合。与单独使用护理标准相比，增加动态餐桌的使用有望更有效地减少PT后的久坐行为。我们将验证探索性假设，即与对照组相比，在家中使用动态站立床将更好地保存具有PIGD特征的PD患者PT后活动功能的收益。

Axial motor dysfunctions in Parkinson disease (PD) are least responsive to dopaminergic therapy and incline many patients towards a sedentary lifestyle. This places PD patients at increased risk for the negative consequences of physical inactivity. When PD patients develop postural imbalance and gait difficulties (PIGD), including falls, they are generally referred to physical therapy (PT) for optimal management. Although a Cochrane review confirms the (short-term) benefit of physical therapy in PD with PIGD motor features there is a critical gap in clinical practice on what to do next once the PT sessions are over. Clinical experience shows that most patients return to a sedentary lifestyle indicating an urgent need for post-PT in-home physical activity programs in PD with PIGD features to preserve mobility functions. Recent advances in physical activity research tout non-exercise physical activity (NEPA) approaches to promote healthy lifestyle modifications. For PD patients with PIGD, normal upright standing and weight-shifting (stepping) for longer periods of time may be an ideal form of NEPA. It activates lower extremity muscles and encourages postural activity. To promote this type of NEPA, we have developed a sit-stand desk system that enhances upright standing activity with weight-shifting movements. The "dynamic standing table" has a tabletop that oscillates in the horizontal plane, which cues users to make periodic mediolateral body weight shifting adjustments. Dynamic standing would represent a minimal level of physical activity compared to sitting, which is pervasive in PD subjects with PIGD motor features. Use of the dynamic standing table can easily be incorporated with routine desktop activities, such as computer use, reading, or watching TV and may promote physical activity. Preliminary data shows that patients with moderate PD are able to complete sessions of at least 3 hours without significant difficulty and may have motor and cognitive benefits from using this table. We propose an exploratory controlled trial of a post-PT in-home extension of a physical activity program in patients with PD and PIGD consisting of combined post-PT standard of care (i.e., weekly physical activity group sessions) with in-home dynamic standing table use versus the post-PT standard of care alone. The incremental addition of the dynamic table use is expected to more effectively reduce post-PT sedentary behavior compared to the standard of care alone. We will test the exploratory hypothesis that post-PT gains in mobility functions in PD patients with PIGD features will be preserved better with in-home dynamic standing table use compared to a control group.