Objective: This study investigated whether Ambulosono motivational training could lead to clinically important improvements in motor function in Parkinson’s disease (PD).

Background: Declining motivational vigour is a key mechanism underlying PD. Ambulosono is a motivational walking program designed to achieve sustained motivational system activation over long distance ambulation in a naturalistic environment. During Ambulosono, a wearable device contingently links the user’s step amplitude to pleasurable music play. Uninterrupted music delivery requires an enduring level of mental and physical vigour to maintain step initiation, amplitude, and walking speed.

Methods: We prospectively monitored changes in UPDRS-III score among 54 Ambulosono users from two academic centers (mean disease duration = 7.3 years). Covariate adjusted Ambulosono usage information was used for clustering users into different Ambulosono “dosing” groups. UPDRS-III score changes were compared with the benchmark threshold of minimum clinical important difference (CID) (i.e. annual increase of 2.5 points).

Results: The average UPDRS-III score in our study population, assessed over 16.6 months, decreased by -0.3 points, significantly lower than the CID threshold (p<0.05). Sub-group analysis showed that in nearly 40% of patients who belonged to high dosage users, i.e. a group average of about 146 walks, 89 hours of training, and 9.2 walks/month over 15.6 months, their mean UPDRS-III score decreased by just over -3 points over a 13.4 month period (p<0.05), significantly better than both baseline scores and the CID benchmark. These patients had greater motor impairment at baseline and tended to be have a longer disease duration than other users. In <10% of high dosage users, UPDRS-III scores exhibited the expected annual increase. Ambulosono low dosage users comprised roughly 45% of study patients who had on average around 45 walks, 23 hours of training, and 2.4 walks/month over a 17.6 month period. Their UPDRS-III scores showed no significant decline or CID during follow-up.

Conclusions: Ambulosono is a safe home-based exercise program, well suited for patients with PD. A Randomized Control Trial is warranted to further determine whether targeted motivational system training can indeed produce clinically important improvements in a larger patient population.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-the-clinical-efficacy-of-motivational-system-training-in-parkinsons-disease/