Home-Based Augmented Reality Gait-and-Balance Therapy in Parkinson Disease: An examination of exercise intensity

Lotte Hardeman; Jara van Bergem; Annejet van Dam; Cathelijne E. Snethlage; E.E.H.  van Wegen; K.H.L. Gerrits; Jorik Nonnekes; Daphne Geerse; Melvyn Roerdink

doi:10.1016/j.apmr.2025.12.008

Home-Based Augmented Reality Gait-and-Balance Therapy in Parkinson Disease: An examination of exercise intensity

Lotte Hardeman^*
, Jara van Bergem
, Annejet van Dam
, Cathelijne E. Snethlage
, E.E.H. van Wegen
, K.H.L. Gerrits
, Jorik Nonnekes
, Daphne Geerse
, Melvyn Roerdink

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objectives
Objectives to evaluate whether Strolll—an individually-tailored gamified augmented reality gait-and-balance therapy for people with Parkinson disease—meets intensity thresholds to qualify as aerobic exercise were to (1) quantify exercise intensity of a representative 30 active-minute Strolll gait-and-balance therapy session at home and (2) examine if Strolll exercise settings (type of gamified exercise and its difficulty level and duration) could influence exercise intensity.

Design
Within-subject experimental design.

Setting
Home environment.

Participants
A convenience sample of fifteen individuals (N=15) with Parkinson disease (Hoehn & Yahr stages 1-3, 12 men and 3 women, 46-84y of age) familiar with Strolll exercises.

Interventions
On separate days, participants completed a representative 30 active-minute gait-and-balance therapy session at home and performed 5 different gait-and-balance exercise types at various difficulty levels and durations.

Main Outcome Measures
Exercise intensity was expressed as percentage heart rate reserve and rate of perceived exertion.

Results
The 30 active-minute gait-and-balance therapy session reached moderate-to-vigorous exercise intensity levels for 9 (based on heart rate reserve) and 14 (based on rate of perceived exertion) of the 15 participants. Exercise intensity varied over the 5 gamified exercise types. Varying the level and duration of exercise types had a smaller influence on exercise intensity.

Conclusions
Strolll, designed to target aspects of gait, balance, and fall risk, showed potential to be applied as a moderate-to-vigorous exercise intensity program (meeting moderate-to-vigorous intensity levels for most participants). Exercise settings to (further) influence exercise intensity levels of augmented reality exercises were identified. With the proper exercise settings prescribed, Strolll may also qualify as moderate-or-higher intensity aerobic exercise, creating opportunities for multimodal therapy facilitating multiple rehabilitation targets simultaneously in the future.

Original language	English
Pages (from-to)	1-10
Number of pages	10
Journal	Archives of Physical Medicine and Rehabilitation
DOIs	https://doi.org/10.1016/j.apmr.2025.12.008
Publication status	E-pub ahead of print - 29 Dec 2025

Funding

Supported by EMIL-XR financial support to third parties, which was funded by the European Union. Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union. Neither the European Union nor the granting authority can be held responsible for them. Disclosures: Melvyn Roerdink is a scientific advisor with share options for Strolll Ltd., a digital therapeutics company building AR software for physical rehabilitation, for 1 day a week ancillary to his main positions as associate professor Technology in Motion at Vrije Universiteit Amsterdam and Senior Scientist at Maastricht University. Erwin E.H. van Wegen has received financial support for other unrelated projects from ParkinsonNL, ZonMw, Dutch Brain Foundation, and NWO-TTW. Jorik H. Nonnekes has received financial support for other unrelated projects from ZonMW Vidi Grant, Michael J Fox Foundation, Gossweiler Foundation, and is a medical advisor for Cue2Walk. Karin H.L. Gerrits, Daphne J. Geerse, and Annejet T. van Dam were supported (partly) by the EMIL-XR grant. The other authors have nothing to disclose. Disclosures: Melvyn Roerdink is a scientific advisor with share options for Strolll Ltd., a digital therapeutics company building AR software for physical rehabilitation, for 1 day a week ancillary to his main positions as associate professor Technology in Motion at Vrije Universiteit Amsterdam and Senior Scientist at Maastricht University. Erwin E.H. van Wegen has received financial support for other unrelated projects from ParkinsonNL, ZonMw, Dutch Brain Foundation, and NWO-TTW. Jorik H. Nonnekes has received financial support for other unrelated projects from ZonMW Vidi Grant, Michael J Fox Foundation, Gossweiler Foundation, and is a medical advisor for Cue2Walk. Karin H.L. Gerrits, Daphne J. Geerse, and Annejet T. van Dam were supported (partly) by the EMIL-XR grant. The other authors have nothing to disclose. Supported by EMIL-XR financial support to third parties, which was funded by the European Union. Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union. Neither the European Union nor the granting authority can be held responsible for them.

Funders
Universiteit Maastricht
ParkinsonNL
NWO-TTW
ZonMw
European Commission
Dutch Brain Foundation
Toegepaste en Technische Wetenschappen, NWO
Michael J Fox Foundation
Michael J. Fox Foundation for Parkinson's Research
EMIL-XR

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Hardeman, L., van Bergem, J., van Dam, A., Snethlage, C. E., van Wegen, E. E. H., Gerrits, K. H. L., Nonnekes, J., Geerse, D., & Roerdink, M. (2025). Home-Based Augmented Reality Gait-and-Balance Therapy in Parkinson Disease: An examination of exercise intensity. Archives of Physical Medicine and Rehabilitation, 1-10. Advance online publication. https://doi.org/10.1016/j.apmr.2025.12.008

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title = "Home-Based Augmented Reality Gait-and-Balance Therapy in Parkinson Disease: An examination of exercise intensity",

abstract = "Objectives Objectives to evaluate whether Strolll—an individually-tailored gamified augmented reality gait-and-balance therapy for people with Parkinson disease—meets intensity thresholds to qualify as aerobic exercise were to (1) quantify exercise intensity of a representative 30 active-minute Strolll gait-and-balance therapy session at home and (2) examine if Strolll exercise settings (type of gamified exercise and its difficulty level and duration) could influence exercise intensity. Design Within-subject experimental design. Setting Home environment. Participants A convenience sample of fifteen individuals (N=15) with Parkinson disease (Hoehn \& Yahr stages 1-3, 12 men and 3 women, 46-84y of age) familiar with Strolll exercises. Interventions On separate days, participants completed a representative 30 active-minute gait-and-balance therapy session at home and performed 5 different gait-and-balance exercise types at various difficulty levels and durations. Main Outcome Measures Exercise intensity was expressed as percentage heart rate reserve and rate of perceived exertion. Results The 30 active-minute gait-and-balance therapy session reached moderate-to-vigorous exercise intensity levels for 9 (based on heart rate reserve) and 14 (based on rate of perceived exertion) of the 15 participants. Exercise intensity varied over the 5 gamified exercise types. Varying the level and duration of exercise types had a smaller influence on exercise intensity. Conclusions Strolll, designed to target aspects of gait, balance, and fall risk, showed potential to be applied as a moderate-to-vigorous exercise intensity program (meeting moderate-to-vigorous intensity levels for most participants). Exercise settings to (further) influence exercise intensity levels of augmented reality exercises were identified. With the proper exercise settings prescribed, Strolll may also qualify as moderate-or-higher intensity aerobic exercise, creating opportunities for multimodal therapy facilitating multiple rehabilitation targets simultaneously in the future.",

author = "Lotte Hardeman and \{van Bergem\}, Jara and \{van Dam\}, Annejet and Snethlage, \{Cathelijne E.\} and \{van Wegen\}, E.E.H. and K.H.L. Gerrits and Jorik Nonnekes and Daphne Geerse and Melvyn Roerdink",

year = "2025",

month = dec,

day = "29",

doi = "10.1016/j.apmr.2025.12.008",

language = "English",

pages = "1--10",

journal = "Archives of Physical Medicine and Rehabilitation",

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TY - JOUR

T1 - Home-Based Augmented Reality Gait-and-Balance Therapy in Parkinson Disease

T2 - An examination of exercise intensity

AU - Hardeman, Lotte

AU - van Bergem, Jara

AU - van Dam, Annejet

AU - Snethlage, Cathelijne E.

AU - van Wegen, E.E.H.

AU - Gerrits, K.H.L.

AU - Nonnekes, Jorik

AU - Geerse, Daphne

AU - Roerdink, Melvyn

PY - 2025/12/29

Y1 - 2025/12/29

N2 - Objectives Objectives to evaluate whether Strolll—an individually-tailored gamified augmented reality gait-and-balance therapy for people with Parkinson disease—meets intensity thresholds to qualify as aerobic exercise were to (1) quantify exercise intensity of a representative 30 active-minute Strolll gait-and-balance therapy session at home and (2) examine if Strolll exercise settings (type of gamified exercise and its difficulty level and duration) could influence exercise intensity. Design Within-subject experimental design. Setting Home environment. Participants A convenience sample of fifteen individuals (N=15) with Parkinson disease (Hoehn & Yahr stages 1-3, 12 men and 3 women, 46-84y of age) familiar with Strolll exercises. Interventions On separate days, participants completed a representative 30 active-minute gait-and-balance therapy session at home and performed 5 different gait-and-balance exercise types at various difficulty levels and durations. Main Outcome Measures Exercise intensity was expressed as percentage heart rate reserve and rate of perceived exertion. Results The 30 active-minute gait-and-balance therapy session reached moderate-to-vigorous exercise intensity levels for 9 (based on heart rate reserve) and 14 (based on rate of perceived exertion) of the 15 participants. Exercise intensity varied over the 5 gamified exercise types. Varying the level and duration of exercise types had a smaller influence on exercise intensity. Conclusions Strolll, designed to target aspects of gait, balance, and fall risk, showed potential to be applied as a moderate-to-vigorous exercise intensity program (meeting moderate-to-vigorous intensity levels for most participants). Exercise settings to (further) influence exercise intensity levels of augmented reality exercises were identified. With the proper exercise settings prescribed, Strolll may also qualify as moderate-or-higher intensity aerobic exercise, creating opportunities for multimodal therapy facilitating multiple rehabilitation targets simultaneously in the future.

AB - Objectives Objectives to evaluate whether Strolll—an individually-tailored gamified augmented reality gait-and-balance therapy for people with Parkinson disease—meets intensity thresholds to qualify as aerobic exercise were to (1) quantify exercise intensity of a representative 30 active-minute Strolll gait-and-balance therapy session at home and (2) examine if Strolll exercise settings (type of gamified exercise and its difficulty level and duration) could influence exercise intensity. Design Within-subject experimental design. Setting Home environment. Participants A convenience sample of fifteen individuals (N=15) with Parkinson disease (Hoehn & Yahr stages 1-3, 12 men and 3 women, 46-84y of age) familiar with Strolll exercises. Interventions On separate days, participants completed a representative 30 active-minute gait-and-balance therapy session at home and performed 5 different gait-and-balance exercise types at various difficulty levels and durations. Main Outcome Measures Exercise intensity was expressed as percentage heart rate reserve and rate of perceived exertion. Results The 30 active-minute gait-and-balance therapy session reached moderate-to-vigorous exercise intensity levels for 9 (based on heart rate reserve) and 14 (based on rate of perceived exertion) of the 15 participants. Exercise intensity varied over the 5 gamified exercise types. Varying the level and duration of exercise types had a smaller influence on exercise intensity. Conclusions Strolll, designed to target aspects of gait, balance, and fall risk, showed potential to be applied as a moderate-to-vigorous exercise intensity program (meeting moderate-to-vigorous intensity levels for most participants). Exercise settings to (further) influence exercise intensity levels of augmented reality exercises were identified. With the proper exercise settings prescribed, Strolll may also qualify as moderate-or-higher intensity aerobic exercise, creating opportunities for multimodal therapy facilitating multiple rehabilitation targets simultaneously in the future.

U2 - 10.1016/j.apmr.2025.12.008

DO - 10.1016/j.apmr.2025.12.008

M3 - Article

SN - 0003-9993

SP - 1

EP - 10

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

ER -

Home-Based Augmented Reality Gait-and-Balance Therapy in Parkinson Disease: An examination of exercise intensity

Abstract

Funding

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