Digital gait biomarkers in Parkinson's disease: susceptibility/risk, progression, response to exercise, and prognosis

Martina Mancini; Mitra Afshari; Quincy Almeida; Sommer Amundsen-Huffmaster; Katherine Balfany; Richard Camicioli; Cory Christiansen; Marian L Dale; Leland E Dibble; Gammon M Earhart; Terry D Ellis; Garett J Griffith; Madeleine E Hackney; Jammie Hopkins; Fay B Horak; Kelvin E Jones; Leah Ling; Joan A O'Keefe; Kimberly Kwei; Genevieve Olivier; Ashwini K Rao; Anjali Sivaramakrishnan; Daniel M Corcos

doi:10.1038/s41531-025-00897-1

Digital gait biomarkers in Parkinson's disease: susceptibility/risk, progression, response to exercise, and prognosis

NPJ Parkinsons Dis. 2025 Mar 21;11(1):51. doi: 10.1038/s41531-025-00897-1.

Authors

Martina Mancini¹, Mitra Afshari², Quincy Almeida³, Sommer Amundsen-Huffmaster⁴, Katherine Balfany⁵, Richard Camicioli⁶, Cory Christiansen⁵, Marian L Dale⁷, Leland E Dibble⁸, Gammon M Earhart⁹, Terry D Ellis¹⁰, Garett J Griffith¹¹, Madeleine E Hackney^{12

13}, Jammie Hopkins¹⁴, Fay B Horak⁷, Kelvin E Jones¹⁵, Leah Ling⁸, Joan A O'Keefe¹⁶, Kimberly Kwei¹⁷, Genevieve Olivier⁸, Ashwini K Rao¹⁷, Anjali Sivaramakrishnan¹⁸, Daniel M Corcos¹¹

Affiliations

¹ Department of Neurology, Oregon Health & Science University, Portland, OR, USA. mancinim@ohsu.edu.
² Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA.
³ Carespace Health & Wellness, Waterloo, ON, Canada.
⁴ Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
⁵ Department of Physical Medicine & Rehabilitation, University of Colorado, Aurora, CO, USA.
⁶ Department of Medicine (Neurology) and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
⁷ Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
⁸ Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake, UT, USA.
⁹ Program in Physical Therapy, Washington University School of Medicine in St. Louis, St Louis, MO, USA.
¹⁰ Department of Physical Therapy, Boston University, Boston, MA, USA.
¹¹ Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, USA.
¹² Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, USA.
¹³ VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA.
¹⁴ Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
¹⁵ Department of Medicine, Faculty of Kinesiology, Sport, & Recreation and Neuroscience and Mental Health Institute, University of Alberta, Alberta, AB, Canada.
¹⁶ Departments of Anatomy & Cell Biology and Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
¹⁷ Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), and GH Sergievsky Center, Columbia University, New York, NY, USA.
¹⁸ Department of Physical Therapy at the School of Health Professions at UT Health San Antonio, San Antonio, TX, USA.

Abstract

This narrative review examines the utility of gait digital biomarkers in Parkinson's disease (PD) research and clinical trials across four contexts: disease susceptibility/risk, disease progression, response to exercise, and fall prediction. The review of the literature to date suggests that upper body characteristics of gait (e.g., arm swing, trunk motion) may indicate susceptibility/risk of PD, while pace aspects (e.g., gait speed, stride length) are informative for tracking disease progression, exercise response, and fall likelihood. Dynamic stability aspects (e.g., trunk regularity, double-support time) worsen with disease progression but can improve with exercise. Gait variability emerges as a sensitive biomarker across all 4 contexts but with low specificity. The lack of standardized gait testing protocols and the lack of a minimum set of quantified digital gait biomarkers limit data harmonization across studies. Future studies, using a commonly agreed upon protocol, could be used to demonstrate the utility of specific gait biomarkers for clinical practice.

Publication types

Review