Multidimensional Assessment of Fatigability in Older Adults Living in Southern Switzerland and Elderly With Parkinson's Disease

Condition(s) studied

Study summary

With our study, the investigators aim to assess the impact of the fatigue experienced during daily life activities (tiredness) and whether there is a relationship with muscle fatigue during an exercise task.

The results of this study may be used to improve the assessment of fatigue in older adults and enhance clinical management.

1. General information An increase in fatigue is considered one of the main causes of reduced quality of life in older adults and in people suffering from chronic diseases. However, the investigators still know little about the mechanisms underlying fatigue in older adults, mainly because most of the available tools were developed to assess this symptom in younger populations with specific diseases, without proper adjustments for physical activity or age.

In 2015, the Pittsburgh Fatigability Scale (PFS) was developed as a self-administered questionnaire to assess both physical and mental fatigue in older adults. The PFS consists of 10 questions describing activities of varying duration and intensity. The other scale the investigators will ask participants to complete is called the Fatigue Severity Scale (FSS): a 9-item questionnaire that evaluates fatigue intensity in various situations over the past week.

Participants' fatigue will also be assessed during two motor tasks simulating daily activities: a handgrip test and a seated leg exercise mimicking walking.

If participants decide to take part in our research project, participants will complete the PFS and FSS questionnaires once (5-10 minutes) and perform two brief motor exercises to determine the onset and progression of muscle fatigue. The exercises will last about 20 minutes, with an additional 10 minutes for preparation. Each contraction will last a maximum of 2 minutes.

The project will last 12 months (Swiss section) and will be conducted at \[(1) the nursing homes of the Multistruttura di Bellinzona, the Fondazione Parco San Rocco facilities in Morbio Inferiore and Coldrerio, and the Opera Charitas nursing home in Sonvico\] (period: December 2024 - May 2025); and (2) at the \[San Raffaele University Research Institute\] in Milan, Italy, where 40 older adults with Parkinson's disease will participate (September 2026 - March 2027).

This research project is conducted in accordance with Swiss legislation and current international ethical guidelines. It has been reviewed and approved by the Ethics Committee of the Canton of Ticino.
2. Study procedure

The testing session will last a maximum of 30 minutes and will include the following steps:

Discussion of the study procedures.

Verification of appropriate leg clothing. The exercise can be performed either by wearing shorts or by rolling up long trousers to expose the upper half of the thigh.

Review of the completed Pittsburgh Fatigability Scale (PFS) questionnaire and completion of the Fatigue Severity Scale (FSS), both available in Italian.

Performance of two motor exercises (a surrogate walking test and a handgrip test).

1. First, participants will be instructed on how to perform the surrogate walking test, which evaluates leg muscle fatigue.

During the exercise, participants will push with their legs and foot on a movable platform that slides along rails within the device. The sliding motion is resisted by elastic bands that stretch and shorten as participants push. The exercise will be repeated for several cycles until participants are told to stop. To measure muscle fatigue, surface electrodes (non-invasive) will be placed on the skin over two thigh muscles.
2. After a 5-minute rest, participants will be asked to perform the handgrip test with participants' right hand (see Figure 3). The maximal handgrip test will be performed while seated, with participants' forearm resting on a table. The test will be repeated several times until participants are instructed to stop.

Eligibility

Primary outcome measure(s)

• PFS_mental subscale — Baseline
  The score of the Pittsburgh Fatigability Scale (PFS) mental subscale. Mental Fatigability Score: Calculated by summing the mental fatigue rating for each activity (a-j). Score range (0-50) with higher score=greater mental fatigability.
• PFS_physical subscale — Baseline
  The score of the physical subscale. Physical Fatigability Score: Calculated by summing the physical fatigue rating for each activity (a-j). Score range (0-50) with higher score=greater physical fatigability.
• FSS — Baseline
  the total score of the Fatigue Severity Scale (FSS). Each question is graded on a 7-point Likert scale ranging from 1 ("completely disagree") to 7 ("completely agree"). Score range (9-63) with higher score=greater fatigue.
• EMG variables — Baseline
  variables extracted from the surface EMG signal will be used to measure the variations of performance fatigability
• Torque — Baseline
  Torque signal will be used to measure the intensity of performance fatigability

Trial sites (5)

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