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Brazilian Journal of Motor Behavior
Special issue:
“Control of Gait and Posture: a tribute to Professor Lilian T. B.
Gobbi”
!
Sirico et al.
2023
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N.4
118 of 125
The effects of social isolation on gait parameters of older people with Parkinson’s
disease
THIAGO M. SIRICO
1
| DIEGO ORCIOLI-SILVA
1
| VINICIUS C. ZAMPIER
1
| GABRIEL A. G. MORACA
1
| EMERSON F.
O. SANTOS
1
| VICTOR S. BERETTA
1,2
| LILIAN T. B. GOBBI
1
(in memoriam)
1
São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
2
São Paulo State University (Unesp), School of Technology and Sciences, Physical Education Department, Presidente Prudente, Brazil.
Correspondence to:!Thiago Martins Sirico. São Paulo State University. Av. 24A, 1515, Bela Vista, Rio Claro, SP – Brazil; Phone: +55 19 3526-4365.
email: thsirico@gmail.com
https://doi.org/10.20338/bjmb.v17i4.367
HIGHLIGHTS
• The SI period negatively affected the mobility of people
with PD.
• Stride length and velocity are the main parameters
reduced after SI period.
• People with PD decrease their functionality after a
period of SI.
ABBREVIATIONS
CNS Central nervous system
COVID-19 Coronavirus disease
H&Y Hoehn & Yahr scale
MDS – UPDRS III Movement Disorder Society -
Unified Parkinson’s Disease Rating
Scale
MMSE Mini-Mental State Examination
PD Parkinson’s disease
pwPD People with Parkinson’s disease
SI Social isolation
WHO World Health Organization
PUBLICATION DATA
Received 26 05 2023
Accepted 19 06 2024
Published 20 06 2023
BACKGROUND: The COVID-19 disease acquired pandemic proportions in 2020. To deal
with the scenario, social isolation (SI) was adopted, which configures a lack of contact with
people and places. The impediments of this measure, however, can bring risks to older people
with Parkinson's disease (PD), such as impairments in gait parameters.
AIM: To verify the effects of SI on gait parameters in people with Parkinson's disease.
METHOD: Thirty-three people with PD were recruited. Gait assessment was conducted in two
periods: February 2020 and March 2022 (before and after the SI, respectively). For that,
participants were invited to walk on a 5.74m mat with pressure sensors under two conditions:
preferred walking speed and fast walking speed. Three trials were performed for each
condition. The gait parameters analyzed were Stride Length, Stride Time, Double Support
Time, Stride Velocity, Stride Width, and Cadence. Statistical Analysis was performed by
paired t-tests for the comparison of gait parameters between moments (pre and post-SI).
RESULTS: In the preferred walking speed condition, the participants reduced their Stride
Length (t
15
= 3.88, p = 0.001) and Stride Velocity (t
15
= 3.63, p = 0.002) in the post-SI period.
In the fast-walking speed condition, the participants also reduced their Stride Length (t
15
=
3.73, p = 0.002) and Stride Velocity (t
15
= 2.86, p = 0.012) in the post-SI period.
INTERPRETATION: The SI period reduced the stride length and velocity of people with PD. A
possible explanation is the lack of physical activity resulting from this public safety measure.
KEYWORDS: Walking | COVID-19 | Neurodegenerative disease
INTRODUCTION
Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus that took pandemic proportions in
2020. COVID-19 led to more than 761 million cases of infection, which resulted in ~6.8 million deaths worldwide until March 2023
1
.
COVID-19 primarily affects the respiratory system, causing symptoms such as breathing difficulties, headaches, dry cough, and fever
2
.
At the moment, several vaccines have been approved by the World Health Organization (WHO) and regulatory agencies; moreover, the
vaccination process is ongoing in several countries, thus, helping to prevent more infections as well as the aggravation
3
of symptoms.
However, at the beginning of the pandemic, when vaccines were not available and COVID-19 spread rapidly in many countries, public
health measures, such as social isolation (SI), had to be adopted in 2020.
The SI is an imposing measure generally implemented to stop certain threats to the population, such as the virus responsible
for COVID-19
4
. This type of isolation is defined as a state in which an individual refrains from being in any social group and certain
places, regarding proximity or physical contact. Therefore, SI leads to difficulties in maintaining several activities as well as quality
relationships
5
. Despite being an effective measure against the SARS-CoV-2 virus spread, the SI presents some risks, especially in older
populations
5,6
, such as the decline in motor function
7
and an increase of mortality
6
, dementia
8
, gait impairments
9
, and in the number of
falls
10
. Although several studies have verified the effects of SI on physical health components of older people
11
, studies that focus on the
effects of SI on gait parameters, especially in populations such as older people who have mobility impairments (e.g., people with
Parkinson's disease - PD), are still necessary.
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PD is the second most common neurodegenerative disease in the world
12
, ranging from 57 (0.057%) to 230 (0.23%) cases for
each group of 100,000 people
13
, mainly affecting the population over 50 years of age
14
. PD is a pathology that affects the central
nervous system (CNS), caused by progressive and asymmetrical degeneration of dopaminergic neurons in the substantia nigra pars
compacta
15
. These neurons are responsible for the production of dopamine – a neurotransmitter that regulates cortex activity
16
. Such
degeneration causes abnormalities in the neurotransmission from the basal ganglia to the different cortical and subcortical areas, such as
the motor cortex
17
. As a result, people with Parkinson’s Disease (PwPD) present motor symptoms, which include tremor, rigidity,
bradykinesia, hypometria, and postural instability
18
. In addition, previous studies have reported gait impairments in PwPD – for example,
a decrease in step length and gait speed, and a longer double support time
19-22
.
Due to the progressive nature of the disease, it is expected that walking impairments in PwPD become worse over time.
Although SI was necessary as a public health measure, this may reduce the physical activity level in PwPD, which may contribute to the
disease progression and lead to negative motor behavior outcomes, including in the gait parameters. In fact, previous studies have
revealed that physical inactivity/sedentary behavior are associated with slower gait speed
23,24
. In addition, the analysis of walking under
different conditions has shown promising results. For example, an analysis of preferred walking speed may estimate physical function,
risk for adverse events (e.g., hospitalization, falls, fractures, or death), and chronic diseases
25-27
, while an analysis of fast walking speed
may estimate the individual’s overall health, skeletal muscle mass quantity, and risk of falls
25
. Thus, studies that verify the effects of SI on
the gait parameters, especially under different conditions, are necessary to deepen the knowledge of this type of situation (lockdown) and
to prevent the worsening of some motor deficits. In this context, the present study aimed at analyzing the effect of SI on the gait
parameters during preferred and fast waking speed in PwPD. Furthermore, in order to identify the factors such as clinical/cognitive
characteristics and physical activity levels that may influence the decline in gait parameters, we also investigated the association between
the change in gait parameters and clinical, cognitive, and physical activity levels characteristics of PwPD. We expected that PwPD with
worse clinical and cognitive characteristics as well as a lower level of physical activity would present a higher decline in gait parameters.
METHODS
Participants
Thirty-three individuals diagnosed with PD who regularly attended the Physical Activity Program for Patients with Parkinson’s
Disease (PROPARKI) prior to the COVID-19 pandemic were selected for this study. For inclusion criteria, the individuals should have a
PD diagnosis based on UK Brain Bank criteria, be of age >50 years, take their PD medication, and have independent locomotion. The
exclusion criteria were: to present musculoskeletal, vestibular, or visual impairments that could affect the performance in the experimental
protocol; to present a score above III in the adapted Hoehn & Yahr scale (H&Y); and cognitive decline indicated by a score <24 in Mini-
Mental State Examination (MMSE)
28
. Seventeen PwPD did not participate in the experimental protocol after the SI. Thus, 16 participants
were analyzed before and after SI (Figure 1). Study approval was obtained from the research ethics committee at São Paulo State
University (n. 3936). All participants gave their signed informed consent before their participation.
Figure 1. Study flowchart.
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Experimental procedures
All experimental procedures were performed at the Posture and Gait Studies Laboratory (LEPLO), Sao Paulo State University
(Unesp), Rio Claro. Clinical, cognitive, and gait assessments were performed before (i.e., February 2020) and after SI (i.e., March 2022).
In addition, the physical activity level was measured at the post-SI moment. Participants were tested during the ‘ON’ state of
dopaminergic medication in both periods.
Clinical, cognitive, and physical activity level assessments
Firstly, the participants answered an anamnesis, and anthropometric data was obtained for characterization. An experienced
researcher assessed the motor severity and the stage of PD using the motor section of the Movement Disorder Society Unified
Parkinson’s Disease Rating Scale (MDS-UPDRS III) and the adapted Hoehn and Yahr scale, respectively. The MMSE was used as a
screening tool for cognitive assessment. To evaluate the physical activity levels of the participants during SI, the Modified Baecke
Questionnaire
29
was applied in the post-SI period. This questionnaire considered the habitual physical activity in the last 12 months in
three dimensions: occupational physical activity, physical exercises/sports in leisure, and leisure and commuting activities.
Gait evaluation
Each individual was asked to walk 8m in a straight line in two conditions: (i) preferred and (ii) fast walking speed. Three trials
were performed for each condition. A 5.74m long carpet with pressure sensors (GAITRite
®
, CIR Systems Inc., Sparta, USA), with a
sampling frequency of 200 Hz, was placed in the middle of the straight line to record the gait parameters. All steps recorded by the
system were considered for the calculation of the dependent variables, which included stride length, stride time, double support time,
stride velocity, stride width, and cadence.
Statistical analysis
SPSS 26.0 (SPSS, Inc) was used for statistical analysis. The level of significance was set at p<0.05 for all analyses. The
Shapiro-Wilk and Levene’s tests were applied to verify the normality and homogeneity of the data, respectively. Paired t-tests were used
for the gait parameters comparison between moments (pre vs. post-SI). Cohen’s d statistic provided estimates of the effect sizes for the t-
test (d: 0.2 = small, 0.5 = moderate, 0.8 = large)
30
. Pearson’s correlation coefficient was used between gait parameters (considering the
difference between post- and pre-SI; Δ) and the scores from MDS-UPDRS III, MMSE, and The Modified Baecke Questionnaire to verify if
there were significant relations between gait parameters and clinical, cognitive, and physical activity level data.
RESULTS
The demographics and clinical characteristics of the participants are shown in Table 1.
Table 1. Participants characteristics. The parametric variables are shown as mean and standard deviations, and the non-
parametric variables as medians and 25-75 percentile.
Sample size = 16
Age (years)
69.37±7.79
Weight (kg)
72.46±12.10
Height (cm)
165.02±7.35
MDS-UPDRS III (0-132)
33.5 (26.75-40.25)
H&Y stage (1/1.5/2/2.5/3)
0/0/9/4/3
MMSE (0-30)
28 (25.00-29.00)
Baecke (score)
7.66 (6.41-10.12)
MDS-UPDRS III: Movement Disorder Society Unified Parkinson’s Disease Rating Scale part III; H&Y: Hoehn & Yahr
Scale; MMSE: Mini-Mental State Examination.
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In the Preferred Walking Speed condition, the t-test revealed that the participants decreased stride length (t
15
= 3.88, p = 0.001,
d = 0.614; Figure 2A) and stride velocity (t
15
= 3.63, p = 0.002, d = 0.647; Figure 2B) after the SI. No significant statistic was shown for
stride time (t
15
= -1.61, p = 0.128), double support time (t
15
= -1.49, p = 0.156), stride width (t
15
= -1.46, p = 0.166) or cadence (t
15
= 1.9, p
= 0.077) (Table 2).
Figure 2. Pre and post-SI stride length and stride velocity in both preferred and fast walking speed conditions.
Table 2. Mean and standard deviations of gait parameters during Preferred Walking Speed condition.
Preferred Walking Speed
Pre-SI
Post-SI
Cohen's d
Stride Time (s)
1.04 ± 0.07
1.08 ± 0.12
0.348
Double Support (%)
30 ± 5.23
31.8 ± 5.38
0.373
Stride Width (cm)
11.92 ± 2.66
12.73 ± 3.7
0.252
Cadence (step/min)
115.99 ± 7.68
112.31 ± 11.15
0.384
SI: Social Isolation.
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In the Fast-Walking Speed condition, the t-test revealed that the participants also decreased stride length (t15 = 3.74, p =
0.002, d = 0.624; Figure 2C) and stride velocity (t15 = 2.87, p = 0.012, d = 0.489; Figure 2D) after the SI period. No significant statistic
was shown for stride time (t15 = 0.29, p = 0.775), double support time (t15 = -2.01, p = 0.062), stride width (t15 = -1.38, p = 0.189) or
cadence (t15 = 0.36, p = 0.727) (Table 3).
There were no correlations between the delta (Post – Pre-SI) of gait parameters in both preferred and fast walking speed
conditions and the scores of MDS-UPDRS III, MMSE, and The Modified Baecke Questionnaire (Table 4).
Table 3. Mean and standard deviations of gait parameters during Fast Walking Speed condition.
Fast Walking Speed
Pre-SI
Post-SI
Cohen's d
Stride Time (s)
0.92 ± 0.09
0.92 ± 0.13
0.050
Double Support (%)
25.3 ± 3.86
27.6 ± 5.27
0.364
Stride Width (cm)
12.1 ± 2.94
12.77 ± 3.63
0.202
Cadence (step/min)
131.21 ± 13.8
132.12 ± 16.98
0.059
SI: Social Isolation.
Table 4. Correlations between gait parameters and clinical, cognitive, and physical activity level.
Gait Parameters
MDS-UPDRSIII
MMSE
Baecke
Preferred Walking Speed
∆Stride Length
r= -0.010; p= 0.971
r= -0.126; p= 0.641
r= 0.015; p= 0.956
∆Stride Velocity
r= -0.037; p= 0.893
r= -0.102; p= 0.708
r= 0.011; p= 0.967
Fast Walking Speed
∆Stride Lenght
r= -0.152; p= 0.575
r= 0.141; p= 0.603
r= 0.157; p= 0.562
∆Stride Velocity
r= -0.217; p= 0.420
r= 0.324; p= 0.221
r= 0.016; p= 0.953
∆: post – pre-Social Isolation; MDS-UPDRS III: Movement Disorder Society Unified Parkinson’s Disease Rating Scale part III; MMSE: Mini-Mental State
Examination; Baecke: The Modified Baecke Questionnaire.
DISCUSSION
We aimed at verifying the effects of SI as a public safety measure on the gait parameters of PwPD. Our findings revealed that
the participants presented a decrease of 10% and 8.8% in stride length and 12.7% and 8.6% in stride velocity during Preferred and Fast
Walking Speed, respectively, after approx. 22 months of SI (Figures 2A-2D). This impairment of gait parameters in PwPD by SI is
relevant, as walking can be a predictor of loss of functionality and of an increase in the number of falls, hospitalizations, and deaths
7,31
.
However, changes in gait parameters were not associated with participant characteristics.
Our results corroborate previous studies that have shown a decrease in functionality of older adults after a period of SI
7,11
. A
study by Fastame et al. (2021) assessed functional components (e.g., gait parameters) of older people with and without cognitive decline
before and past two months of lockdown. This study demonstrates a decrease in stride length and walking speed after the SI in people
with preserved cognition, who were also more physically active prior to the lockdown
32
. With regard to PwPD, previous studies have also
demonstrated similar effects of the SI on the mobility of this specific group
9,33
. A study conducted by Wolff et al. (2023) verified the effects
of the COVID-19 pandemic on parkinsonian symptoms of 342 PwPD through online, nationwide surveys. In addition, the number of
individuals reporting worsening of symptoms or the development of new ones has increased during the pandemic, and the most
commonly affected symptoms were rigidity, gait impairments, and bradykinesia
9
.
A possible explanation for the decrease in stride length and stride velocity shown in this study is the relationship between SI
and physical activity. Older adults tend to increase the time in sedentary behavior when they are deprived of access to places that
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stimulate the practice of physical activity (e.g., gym, parks, and clubs), as well as the support of people working as mediators of this
practice
32,34,35
. This corroborates The Modified Baecke Questionnaire scores of this study’s sample, which ranged from low to moderate
levels of physical activity
36
. This period of low or even inexistent practice of physical activity may bring negative consequences, such as
loss of muscle mass and muscle strength
7,34,37
, lack of joint mobility
35
, loss of dynamic balance
38
, and worse neuromuscular
performance, contributing to the observed deficits in such gait parameters
32,39
. Thus, the adoption of interventions that contribute to an
improvement of gait parameters of PwPD is important even in the SI context. Actions that overcome the lack of access of these
individuals to certain places, such as the adoption of digital tools, and the use of a training program for a wide range of motor and non-
motor components (e.g., muscle strength, balance, coordination, executive function, and attention), can be beneficial for PwPD
7,40,41
.
We can also speculate that the SI fragmentation of social relationships may increase the symptoms of depression
7
, which
impact the mobility of PwPD
42
. Higher levels of depression are associated with poor practice of physical activity
43
, and they also produce
a feeling of insecurity, leading to changes in motor behavior, characterized by a slower walking speed and a shorter step length. In
cognition, depression levels may cause attention and executive function deficits, which are also factors intrinsically linked to gait
parameters
42,44
. In PwPD who already have a depletion of neurotransmitters, such as dopamine and serotonin, the increase in
depression levels may be more pronounced
32,34
, thus, affecting the gait parameters. Therefore, the association of a training program with
greater social support, such as dance, not only increases physical activity levels, which is beneficial for motor impairments, but also can
better handle depression levels linked to SI as well, contributing to the health of PwPD in general
35,45
.
It is also worth mentioning that, despite not having participated in the second part of the research, 17 eligible individuals from
the pre-SI period were found in negative situations such as loss of independent locomotion or death, making it impossible to continue in
the present study. This could indicate a worsening of some motor deficits due to the SI impediments.
Unexpectedly, the declined gait parameters were not associated with participant characteristics. Although previous studies
have demonstrated the role of physical activity level and cognition/clinical features for gait parameters
46
, our results showed that the gait
progression was not related to these variables. Gait is a complex task, which depends on several factors, not only cognition, clinical
features, and physical activity level. There are several studies that found an association between gait parameters and depression,
anxiety, PD medication, atrophy/loss of muscle strength, and sensorial functions, among other factors
42
. Therefore, further studies should
consider such factors to understand which variables are associated with changes in gait parameters.
The current findings should be carefully interpreted, as this study presented some limitations, such as a great loss of
participants during the pandemic and a limited number of non-motor parameters. Despite the small sample size, this study moves
towards a better understanding of the SI as a protective measure in public health, considering its risks to more vulnerable populations
such as those with gait impairments, in order to collaborate on the creation of appropriate interventions to deal with this scenario.
CONCLUSION
The SI period caused by the COVID-19 pandemic negatively affected the mobility of PwPD, reducing stride length and stride
velocity.
REFERENCES
1. World Health Organization. WHO COVID-19 dashboard. World Health Organization. Published February 28, 2023. https://covid19.who.int/
2. Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect
Dis. 2020;20(4):425 434. doi:10.1016/S1473-3099(20)30086-4
3. Zheng C, Shao W, Chen X, Zhang B, Wang G, Zhang W. Real-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis. Int
J Infect Dis. 2022;114:252-260. doi:10.1016/j.ijid.2021.11.009
4. Malay DS. COVID-19, pandemic, and social distancing. J Foot Ankle Surg. 2020;59(3):447-448. doi:10.1053/j.jfas.2020.03.010
5. Nicholson NR. A review of social isolation: an important but underassessed condition in older adults. J Prim Prev. 2012;33(2-3):137-152.
doi:10.1007/s10935-012-0271-2
6. Eng PM, Rimm EB, Fitzmaurice G, Kawachi I. Social ties and change in social ties in relation to subsequent total and cause-specific mortality and
coronary heart disease incidence in men. Am J Epidemiol. 2002;155(8):700-709. doi:10.1093/aje/155.8.700
7. Pelicioni PHS, Santos AD, Tako KV, Santos PCR. COVID-19 and its impact on human motor control. Brazilian Journal of Motor Behavior.
2021;15(1):9-19. doi:10.20338/bjmb.v15i1.196
8. Fratiglioni L, Wang HX, Ericsson K, Maytan M, Winblad B. Influence of social network on occurrence of dementia: a community-based longitudinal
study. Lancet. 2000;355(9212):1315-1319. doi:10.1016/S0140-6736(00)02113-9
BJMB! ! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Sirico et al.
2023
VOL.17
N.4
124 of 125
Special issue:
“Control of Gait and Posture: a tribute to Professor Lilian T. B. Gobbi”
9. Wolff AW, Haller B, Demleitner AF, et al. Long-Lasting Impact of the COVID-19 Pandemic on Patients with Parkinson's Disease and Their
Relatives. Mov Disord Clin Pract. 2023;10(5):819-823. doi:10.1002/mdc3.13727
10. Faulkner KA, Cauley JA, Zmuda JM, Griffin JM, Nevitt MC. Is social integration associated with the risk of falling in older community-dwelling
women?. J Gerontol A Biol Sci Med Sci. 2003;58(10):M954-M959. doi:10.1093/gerona/58.10.m954
11. Sepúlveda-Loyola W, Rodríguez-Sánchez I, Pérez-Rodríguez P, et al. Impact of Social Isolation Due to COVID-19 on Health in Older People:
Mental and Physical Effects and Recommendations. J Nutr Health Aging. 2020;24(9):938-947. doi:10.1007/s12603-020 1469-2
12. Barbosa MT, Caramelli P, Maia DP, et al. Parkinsonism and Parkinson's disease in the elderly: a community-based survey in Brazil (the Bambuí
study). Mov Disord. 2006;21(6):800-808. doi:10.1002/mds.20806
13. Muangpaisan W, Mathews A, Hori H, Seidel D. A systematic review of the worldwide prevalence and incidence of Parkinson's disease. J Med Assoc
Thai. 2011;94(6):749-755.
14. Van Den Eeden SK, Tanner CM, Bernstein AL, et al. Incidence of Parkinson's disease: variation by age, gender, and race/ethnicity. Am J Epidemiol.
2003;157(11):1015-1022. doi:10.1093/aje/kwg068
15. Kalia LV, Lang AE. Parkinson's disease. Lancet. 2015;386(9996):896-912. doi:10.1016/S0140-6736(14)61393-3
16. Kandel ER, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ, Mack S. eds. Principles of Neural Science, Fifth Edition. McGraw Hill; 2014.
17. Blandini F, Nappi G, Tassorelli C, Martignoni E. Functional changes of the basal ganglia circuitry in Parkinson's disease. Prog Neurobiol.
2000;62(1):63-88. doi:10.1016/s0301-0082(99)00067-2
18. Lewek MD, Poole R, Johnson J, Halawa O, Huang X. Arm swing magnitude and asymmetry during gait in the early stages of Parkinson's
disease. Gait Posture. 2010;31(2):256-260. doi:10.1016/j.gaitpost.2009.10.013
19. Sofuwa O, Nieuwboer A, Desloovere K, Willems AM, Chavret F, Jonkers I. Quantitative gait analysis in Parkinson's disease: comparison with a
healthy control group. Arch Phys Med Rehabil. 2005;86(5):1007-1013. doi:10.1016/j.apmr.2004.08.012
20. Mirelman A, Bonato P, Camicioli R, et al. Gait impairments in Parkinson's disease. Lancet Neurol. 2019;18(7):697-708. doi:10.1016/S1474-
4422(19)30044-4
21. Orcioli-Silva D, Barbieri FA, Simieli L, et al. Walking behavior over multiple obstacles in people with Parkinson's disease. Gait Posture. 2017;58:510-
515. doi:10.1016/j.gaitpost.2017.09.021
22. Orcioli-Silva D, Vitório R, Nóbrega-Sousa P, et al. Cortical Activity Underlying Gait Improvements Achieved With Dopaminergic Medication During
Usual Walking and Obstacle Avoidance in Parkinson Disease. Neurorehabil Neural Repair. 2021;35(5):406-418. doi:10.1177/15459683211000736
23. Willey JZ, Moon YP, Kulick ER, et al. Physical Inactivity Predicts Slow Gait Speed in an Elderly Multi-Ethnic Cohort Study: The Northern Manhattan
Study. Neuroepidemiology. 2017;49(1-2):24-30. doi:10.1159/000479695
24. Busch Tde A, Duarte YA, Pires Nunes D, et al. Factors associated with lower gait speed among the elderly living in a developing country: a cross-
sectional population-based study. BMC Geriatr. 2015;15:35. Published 2015 Apr 1. doi:10.1186/s12877-015-0031-2
25. Kim HJ, Park I, Lee HJ, Lee O. The reliability and validity of gait speed with different walking pace and distances against general health, physical
function, and chronic disease in aged adults. J Exerc Nutrition Biochem. 2016;20(3):46-50. doi:10.20463/jenb.2016.09.20.3.7
26. White DK, Neogi T, Nevitt MC, et al. Trajectories of gait speed predict mortality in well-functioning older adults: the Health, Aging and Body
Composition study. J Gerontol A Biol Sci Med Sci. 2013;68(4):456-464. doi:10.1093/gerona/gls197
27. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50-58. doi:10.1001/jama.2010.1923
28. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr
Res. 1975;12(3):189-198. doi:10.1016/0022-3956(75)90026-6
29. Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr.
1982;36(5):936-942. doi:10.1093/ajcn/36.5.936
30. J. Cohen, Statistical Power Analysis for the Behavioral Sciences, 2nd edition, Routledge, New York, 1988
31. Middleton A, Fritz SL, Lusardi M. Walking speed: the functional vital sign. J Aging Phys Act. 2015;23(2):314-322. doi:10.1123/japa.2013-0236
32. Fastame MC, Mulas I, Putzu V, et al. The Impact of SARS-CoV-2 (COVID-19) and its Lockdown Measures on the Mental and Functional Health of
Older Individuals. Psychiatr Q. 2021;92(4):1759-1769. doi:10.1007/s11126-021-09943-6
33. Subramanian I, Farahnik J, Mischley LK. Synergy of pandemics-social isolation is associated with worsened Parkinson severity and quality of
life. NPJ Parkinsons Dis. 2020;6:28. doi:10.1038/s41531-020-00128-9
34. Pelicioni PHS, Schulz-Moore JS, Hale L, Canning CG, Lord SR. Lockdown During COVID-19 and the Increase of Frailty in People With Neurological
Conditions. Front Neurol. 2020;11:604299. doi:10.3389/fneur.2020.604299
35. Moratelli JA, Sonza A, Haas AN, Passos-Monteiro E, Corrêa CL, Peyré-Tartaruga LA, et al. Physical activity of individuals with Parkinson’s in social
isolation before and during the pandemic COVID-19. Revista Brasileira De Atividade Física & Saúde. 2022;26: 1-8. doi:10.12820/rbafs.26e0237
36. Hertogh EM, Monninkhof EM, Schouten EG, Peeters PH, Schuit AJ. Validity of the modified Baecke questionnaire: comparison with energy
expenditure according to the doubly labeled water method. Int J Behav Nutr Phys Act. 2008;5:30. doi:10.1186/1479-5868-5-30
37. Moro T, Paoli A. When COVID-19 affects muscle: effects of quarantine in older adults. Eur J Transl Myol. 2020;30(2):9069.
doi:10.4081/ejtm.2019.9069
BJMB! ! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Sirico et al.
2023
VOL.17
N.4
125 of 125
Special issue:
“Control of Gait and Posture: a tribute to Professor Lilian T. B. Gobbi”
38. Sepúlveda-Loyola W, Ganz F, Maciel RPT, Lopes RDS, Negri PS, Solorza EM, et al. Social participation is associated with better functionality,
health status and educational level in elderly women / A participação social está associada a melhor funcionalidade, estado de saúde e nível
educacional em mulheres idosas. Brazilian Journal of Development. 2020; 6(4):20690-20701. doi:10.34117/bjdv6n4-299
39. Teixeira-Salmela LF, Santiago L, Lima RC, Lana DM, Camargos FF, Cassiano JG. Functional performance and quality of life related to training and
detraining of community-dwelling elderly. Disabil Rehabil. 2005;27(17):1007-1012. doi:10.1080/09638280500030688
40. Mian OS, Baltzopoulos V, Minetti AE, Narici MV. The impact of physical training on locomotor function in older people. Sports Med. 2007;37(8):683-
701. doi:10.2165/00007256-200737080-00003
41. Horbinski C, Zumpf KB, McCortney K, Eoannou D. Longitudinal observational study of boxing therapy in Parkinson's disease, including adverse
impacts of the COVID-19 lockdown. BMC Neurol. 2021;21(1):326. doi:10.1186/s12883-021-02359-6
42. Brandler TC, Wang C, Oh-Park M, Holtzer R, Verghese J. Depressive symptoms and gait dysfunction in the elderly. Am J Geriatr Psychiatry.
2012;20(5):425-432. doi:10.1097/JGP.0b013e31821181c6
43. Pérez LM, Castellano-Tejedor C, Cesari M, et al. Depressive Symptoms, Fatigue and Social Relationships Influenced Physical Activity in Frail Older
Community-Dwellers during the Spanish Lockdown due to the COVID-19 Pandemic. Int J Environ Res Public Health. 2021;18(2):808.
doi:10.3390/ijerph18020808
44. Amanzio M, Canessa N, Bartoli M, Cipriani GE, Palermo S, Cappa SF. Lockdown Effects on Healthy Cognitive Aging During the COVID-19
Pandemic: A Longitudinal Study. Front Psychol. 2021;12:685180. doi:10.3389/fpsyg.2021.685180
45. Craft LL, Perna FM. The Benefits of Exercise for the Clinically Depressed. Prim Care Companion J Clin Psychiatry. 2004;6(3):104-111.
doi:10.4088/pcc.v06n0301
46. Morris R, Lord S, Bunce J, Burn D, Rochester L. Gait and cognition: Mapping the global and discrete relationships in ageing and neurodegenerative
disease. Neurosci Biobehav Rev. 2016;64:326-345. doi:10.1016/j.neubiorev.2016.02.012
ACKNOWLEDGMENTS
We would like to immensely thank Professor Lilian Teresa Bucken Gobbi, who passed away unexpectedly on October 20,
2022. Prof. Lilian T.B. Gobbi had immense intellectual participation and provided tools for this study to happen. The authors also thank all
members of the Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, for their assistance with
data collection.
Citation: Sirico TM, Orcioli-Silva D, Zampier VC, Moraca GAG, Santos EFO, Beretta VS, Gobbi LTB. (2023).!The effects of social isolation on gait parameters of older
people with Parkinson’s disease. Brazilian Journal of Motor Behavior, 17(4):118-125.
Editor-in-chief: Dr Fabio Augusto Barbieri - São Paulo State University (UNESP), Bauru, SP, Brazil. !
Associate editors: Dr José Angelo Barela - São Paulo State University (UNESP), Rio Claro, SP, Brazil; Dr Natalia Madalena Rinaldi - Federal University of Espírito Santo
(UFES), Vitória, ES, Brazil; Dr Renato de Moraes – University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
Guest editors: Dr Fabio Augusto Barbieri - São Paulo State University (UNESP), Bauru, SP, Brazil; Dr Lucas Simieli; Dr Victor Spiandor Beretta - São Paulo State
University (UNESP), Presidente Prudente, SP, Brazil.!
Copyright:© 2023 Sirico, Orcioli-Silva, Zampier, Moraca, Santos, Beretta and Gobbi and BJMB. This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Funding: This study was supported by Brazilian National Council for Scientific and Technological Development, Brazil (CNPq) [grant numbers #165572/2021-3], and the
Pró-Reitoria de Pesquisa (PROPe) from São Paulo State University (Unesp), Rio Claro.
Competing interests: The authors have declared that no competing interests exist.
DOI:!https://doi.org/10.20338/bjmb.v17i4.367