Is There an Association of Physical Activity with Brain Volume, Behavior, and Day-to-day Functioning? A Cross Sectional Design in Prodromal and Early Huntington Disease

Abstract

Background: Huntington disease (HD) is a genetic neurodegenerative disease leading to progressive motor, cognitive, and behavioral decline. Subtle changes in these domains are detectable up to 15 years before a definitive motor diagnosis is made. This period, called prodromal HD, provides an opportunity to examine lifestyle behaviors that may impact disease progression. Theoretical Framework: Physical activity relates to decreased rates of brain atrophy and improved cognitive and day-to-day functioning in Alzheimer disease and healthy aging populations. Previous research has yielded mixed results regarding the impact of physical activity on disease progression in HD and paid little attention to the prodromal phase. Methods: We conducted analyses of associations among current physical activity level, current and retrospective rate of change for hippocampus and striatum volume, and cognitive, motor, and day-to-day functioning variables. Participants were 48 gene-expanded cases with prodromal and early-diagnosed HD and 27 nongene-expanded control participants. Participants wore Fitbit Ultra activity monitors for three days and completed the self-reported International Physical Activity Questionnaire (IPAQ). Hippocampal and striatal white matter volumes were measured using magnetic resonance imaging. Cognitive tests included the Stroop Color and Word Test, and the Symbol Digit Modalities Test (SDMT). Motor function was assessed using the Unified Huntington’s Disease Rating Scale total motor score (TMS). Day-to-day functioning was measured using the World Health Organization Disability Assessment Schedule (WHODAS) version 2.0. Results: Higher Fitbit activity scores were significantly related to better scores on the SDMT and WHODAS in case participants but not in controls. Fitbit activity scores tracked better with TMS scores in the group as a whole, though the association did not reach statistical significance in the case participants. Higher Fitbit activity scores related to less day-to-day functioning decline in retrospective slope analyses. Fitbit activity scores did not differ significantly between cases and controls. Conclusions: This is the first known study examining the associations between activity level and imaging, motor, cognitive, and day-to-day functioning outcomes in prodromal and early HD. Preliminary results suggest physical activity positively correlates with improved cognitive and day-to-day functioning and possibly motor function in individuals in the prodromal and early phase of the condition.

The impact of hypertension, hemorrhage, and other maternal morbidities on functioning in the postpartum period as assessed by the WHODAS 2.0 36-item tool

“…approximately three points higher than controls. 15,16 In our retrospective cohort, we found that there was a statistically significant difference in WHODAS scores between women with and without SMM. 7 However, there are still many gaps in our understanding of such results, as there is no baseline score or threshold to determine the clinical significance of these findings.…”

“…Other instruments have been used to assess specific conditions such as depression, psychiatric morbidity, and anxiety . WHODAS scores among other groups, such as patients with Huntington's disease or dementia, showed that affected individuals have higher WHODAS‐36 scores, approximately three points higher than controls …”

Physical Activity and Brain Health

“…Recent studies have focused on both resistance and endurance exercise training modalities, based on the suggestion that both could be of help in HD patients. All the results showed a significant increase in grey matter volume and significant improvements in verbal learning and memory, after long-training exercise [243,244,245,246,247,248].…”

Psychometric Properties and Validation of the Polish Version of the 12-Item World Health Organization Disability Assessment Schedule 2.0 in Patients with Huntington’s Disease

“…Perhaps this result is associated with a greater level of physical activity of people living in Polish rural areas, the possibility of free mobility and the need to perform various physical tasks in their household. Wallace et al found that a higher level of physical activity positively correlates with lower cognitive and motor deficits, improving cognitive and daily functions and probably also motor functions in people in the prodromal and early stages [ 41 ]. Trembath et al observed that an active lifestyle and environmental factors preventing passivity contribute to the later onset of HD symptoms and can have a positive effect on the course of the disease [ 42 ].…”