Steps Against the Burden of Parkinson's Disease

Comfortable walking speed overground

The number of falls experienced and whether they resulted in injury will be recorded. This includes a 12-month retrospective report at baseline and ongoing reporting throughout the study.

This quality-of-life instrument includes a descriptive profile and a visual analogue scale (VAS) to rate current health. The VAS ranges from 0 (the worst health imaginable) to 100 (the best health imaginable). Higher scores on the VAS indicate better health status.

The Frailty Index assesses physical frailty based on five criteria: shrinking (unintentional weight loss), low physical endurance or energy (self-reported exhaustion), low physical activity, weakness (grip strength), and slow walking speed. Based on the number of criteria met (0 to 5), participants are classified into the following categories:

Non-frail (0 criteria met) Pre-frail (1-2 criteria met) Frail (3 or more criteria met)

The FACIT Fatigue Scale measures self-reported fatigue and its impact on daily activities and functioning over the past week. Each item is scored on a 5-point Likert scale ranging from 0 ("Not at all") to 4 ("Very much"). Total Score Range: 0 to 52. Higher scores indicate less fatigue and better functioning.

The VAS is used to assess subjective pain intensity or other symptom severity.

Three-dimensional motion capture will be used to evaluate gait and movement patterns, specicially the foot placement in relation to the centre of mass.

The TUG test assesses mobility, balance, and walking ability.

This test measures functional exercise capacity by recording the distance walked in two minutes.

The Mini-BESTest evaluates dynamic balance across multiple domains of postural control.

The mGES measures confidence in walking under challenging everyday conditions.

The Short Falls Efficacy Scale International is a 7-item questionnaire assessing concern about falling during a range of physical and social activities. Each item is scored from 1 (not at all concerned) to 4 (very concerned), resulting in a total score ranging from 7 to 28. Higher scores indicate greater concern about falling, which reflects a worse outcome.

The MoCA evaluates cognitive function, including memory, attention, language, and executive functions. The MoCA consists of 30 points, with scores ranging from 0 to 30. Higher scores indicate better cognitive function, reflecting a better outcome.

The CTT assesses cognitive flexibility, visual attention, and processing speed. The CTT consists of two parts (CTT-1 and CTT-2), where participants are required to connect numbered circles in sequence, alternating between colours in the second part. Performance is measured by the time (in seconds) taken to complete each part. shorter completion times indicate better cognitive function, reflecting a better outcome.

The MDS-UPDRS Part III is the motor examination component of the Unified Parkinson's Disease Rating Scale developed by the Movement Disorder Society. It assesses motor signs of Parkinson's disease across 18 items (e.g., tremor, rigidity, bradykinesia, posture, gait), each rated on a 5-point scale from 0 (normal) to 4 (severe impairment).

The total score ranges from 0 to 132. Higher scores indicate greater motor impairment, reflecting a worse outcome.

The NFOGQ is a 9-item patient-reported instrument designed to assess the presence, severity, and impact of freezing of gait (FOG) in individuals with Parkinson's disease. Items are scored on a 5-point Likert scale ranging from 0 (absence or no impact) to 4 (severe or frequent impact).

The total score ranges from 0 to 28, with higher scores reflecting more severe and frequent freezing episodes.

Higher scores indicate worse freezing of gait symptoms, representing a worse outcome.

The average number of steps taken per day will be recorded via wearable sensors.

Duration of uninterrupted walking bouts will be measured using wearable sensors.

Stride-to-stride variability in walking rhythm will be derived from sensor data.

The symmetry of gait parameters between left and right limbs will be calculated.

Participants' acceptability and satisfaction with the intervention will be assessed via the SUS. The SUS is a 10-item questionnaire that assesses user satisfaction and perceived usability of a system or intervention. Each item is rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree).

Raw item scores are converted to a composite score ranging from 0 to 100. Higher scores indicate better perceived usability and greater user satisfaction, reflecting a better outcome.

Participants' acceptability and satisfaction with the intervention will be assessed via the PACES. The PACES is an 18-item questionnaire designed to assess enjoyment of physical activity. Each item is rated on a 7-point Likert scale (e.g., from "I enjoy it" to "I hate it"), with some items reverse-scored.

The total score ranges from 18 to 126, with higher scores indicating greater enjoyment of physical activity, reflecting a better outcome.

The Exercise Self-Efficacy Scale (ESES) will assess changes in attitudes toward physical activity. The ESES is a 10-item questionnaire that assesses confidence in engaging in physical activity despite common barriers. Each item is rated from 1 (not at all confident) to 4 (always confident).

Total scores range from 10 to 40. Higher scores indicate greater confidence in the ability to exercise, reflecting a better outcome.

Semi-structured qualitative interviews will explore participant experiences, perceived barriers, enablers, and reasons for withdrawal. As this is a qualitative assessment, no numerical scale applies, and responses will be analysed using thematic analysis methods.

EEG (electroencephalogram) will be used to measure brain activity by recording electrical signals from the scalp. It will assess beta band activity during walking to examine changes in cortical involvement associated with gait and training.

Coherency between EEG and EMG signals in the beta frequency band will be assessed during walking to evaluate changes in corticomuscular connectivity associated with gait and training.

The number and type of fractures sustained in the 12 months prior to baseline will be recorded.

All current medications (including antiparkinsonian and non-antiparkinsonian drugs) will be recorded at each study visit to monitor changes in use and assess potential side effects.

Changes in medication will be categorised (e.g., dosage adjustments), and the number of participants with any change in medication will be reported.

The use of mobility aids (e.g., cane, walker, rollator) will be documented separately for indoor and outdoor environments.

The number and percentage of participants using walking aids will be reported at each time point.

Grip strength will be assessed using a hand dynamometer as a proxy for overall strength and frailty.