{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T19:53:38Z","timestamp":1783799618368,"version":"3.55.0"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Persons with Parkinson walk slowly, with short steps, reduced arm swing, and altered stride variability. Walking to a metronome or music may increase velocity, stride length, and cadence, yet few studies have directly compared the efficacy of these techniques.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the optimal auditory cue to improve Parkinson gait.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This case-control study was conducted among persons with Parkinson disease (using medication) and healthy older adult controls at University of Florida Applied Neuromechanics laboratory in 2017. Changes in gait in participants with Parkinson disease and controls were compared with walking with no cue: walking to a regular metronome, walking to a fractal metronome, and walking to music. Condition order was randomized. Cueing frequency was set to natural cadence. Post hoc analyses restricted to participants with Parkinson disease were performed in 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Auditory cueing with a regular metronome, fractal metronome, or music while walking.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Outcomes of interest were stride time detrended fluctuation analysis (DFA), velocity, stride length, and arm swing velocity. Spatiotemporal gait measures and DFA of stride time were compared using repeated measures multivariate analysis of variance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Analyses included 15 participants with Parkinson disease (mean [SD] age, 69 [6] years; 11 [73%] male; mean [SD] Hoehn and Yahr Parkinson disease stage. 2.3 [0.6]; mean [SD] age of onset, 63 [7] years) and 15 controls (mean [SD] age, 69 [5] years; 11 [73%] male). Stride time DFA was increased during the fractal metronome condition (\u03b1\u2009=\u20090.200; SE, 0.024;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) vs no cue, the regular metronome (\u03b1\u2009=\u20090.320; SE, 0.032;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and music (\u03b1\u2009=\u20090.219; SE, 0.030;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001); worsened with the regular metronome vs no cue (\u03b1\u2009=\u2009\u22120.120; SE, 0.037;\n P<\/jats:italic>\n \u2009=\u2009.003); and was not statistically different during music vs no cue (\u03b1\u2009=\u2009\u22120.019; SE, 0.031;\n P<\/jats:italic>\n \u2009=\u2009.54). Music was associated with increased velocity (mean [SE] change, 0.041 [0.015] m\/s;\n P<\/jats:italic>\n \u2009=\u2009.01), stride length (mean [SE] change, 0.047 [0.013] m;\n P<\/jats:italic>\n \u2009=\u2009.001), and arm swing velocity (mean [SE] change, 27.10 [7.33] \u00b0\/s;\n P<\/jats:italic>\n \u2009=\u2009.001) compared with no cue; velocity (mean [SE] change, 0.030 [0.011] m\/s;\n P<\/jats:italic>\n \u2009=\u2009.03), stride length (mean [SE] change, 0.034 [0.009] m;\n P<\/jats:italic>\n \u2009=\u2009.002), and arm swing velocity (mean [SE] change, 34.7 [8.5] \u00b0g\/s;\n P<\/jats:italic>\n \u2009=\u2009.001) compared with the regular metronome; and increased stride length (mean [SE] change, 0.028 [0.009] m;\n P<\/jats:italic>\n \u2009=\u2009.01) and arm swing velocity (mean [SE] change, 37.52 [7.89] \u00b0\/s;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) compared with the fractal metronome. Analyses restricted to participants with Parkinson disease found similar trends, with reduced levels of significance due to the smaller sample.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this case-control study, walking to the fractal metronome was associated with improved stride time fluctuations compared with the regular metronome or music. Walking to music was associated with improved velocity, stride length, and arm swing velocity compared with either metronome condition.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.2744","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:30:20Z","timestamp":1776353420000},"page":"e262744","source":"Crossref","is-referenced-by-count":1,"title":["Regular Metronome, Fractal Metronome, and Music for Parkinson Gait"],"prefix":"10.1001","volume":"9","author":[{"given":"Kristen L.","family":"Sowalsky","sequence":"first","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Okun","sequence":"additional","affiliation":[{"name":"Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Terza","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Enrique","family":"Martinez-Nunez","sequence":"additional","affiliation":[{"name":"Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyokeun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Sports Convergence Science, Kwangwoon University, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus R.","family":"McFarland","sequence":"additional","affiliation":[{"name":"Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Stergiou","sequence":"additional","affiliation":[{"name":"Department of Biomechanics, University of Nebraska Omaha, Omaha"},{"name":"Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece"},{"name":"Center for Research in Human Movement Variability, University of Nebraska Omaha, Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Almeida","sequence":"additional","affiliation":[{"name":"Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris J.","family":"Hass","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"issue":"11","key":"zoi260118r1","doi-asserted-by":"publisher","first-page":"1552","DOI":"10.1002\/mds.25675","article-title":"Clinical syndromes: parkinsonian gait.","volume":"28","author":"Ebersbach","year":"2013","journal-title":"Mov Disord"},{"issue":"7","key":"zoi260118r2","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/S1474-4422(19)30044-4","article-title":"Gait impairments in Parkinson\u2019s disease.","volume":"18","author":"Mirelman","year":"2019","journal-title":"Lancet Neurol"},{"issue":"1","key":"zoi260118r3","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1152\/jappl.1995.78.1.349","article-title":"Is walking a random walk: evidence for long-range correlations in stride interval of human gait.","volume":"78","author":"Hausdorff","year":"1995","journal-title":"J Appl Physiol (1985)"},{"issue":"6","key":"zoi260118r4","doi-asserted-by":"publisher","first-page":"3287","DOI":"10.1073\/pnas.78.6.3287","article-title":"Random walks with self-similar clusters.","volume":"78","author":"Hughes","year":"1981","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"3","key":"zoi260118r5","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1097\/01.NPT.0000281949.48193.d9","article-title":"Optimal movement variability: a new theoretical perspective for neurologic physical therapy.","volume":"30","author":"Stergiou","year":"2006","journal-title":"J Neurol Phys Ther"},{"issue":"2","key":"zoi260118r6","doi-asserted-by":"publisher","DOI":"10.1063\/1.3147408","article-title":"Gait dynamics in Parkinson\u2019s disease: common and distinct behavior among stride length, gait variability, and fractal-like scaling.","volume":"19","author":"Hausdorff","year":"2009","journal-title":"Chaos"},{"issue":"4","key":"zoi260118r7","doi-asserted-by":"publisher","first-page":"657","DOI":"10.3233\/JPD-140399","article-title":"The significance of walking from the perspective of people with Parkinson\u2019s disease.","volume":"4","author":"Hammarlund","year":"2014","journal-title":"J Parkinsons Dis"},{"issue":"10","key":"zoi260118r8","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.1002\/mds.22121","article-title":"Predictors and course of health-related quality of life in Parkinson\u2019s disease.","volume":"23","author":"Forsaa","year":"2008","journal-title":"Mov Disord"},{"issue":"6","key":"zoi260118r10","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1002\/mds.10259","article-title":"The power of cueing to circumvent dopamine deficits: a review of physical therapy treatment of gait disturbances in Parkinson\u2019s disease.","volume":"17","author":"Rubinstein","year":"2002","journal-title":"Mov Disord"},{"issue":"1","key":"zoi260118r11","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1038\/s41598-017-16232-5","article-title":"Effect of rhythmic auditory cueing on parkinsonian gait: A systematic review and meta-analysis.","volume":"8","author":"Ghai","year":"2018","journal-title":"Sci Rep"},{"issue":"6","key":"zoi260118r12","doi-asserted-by":"publisher","first-page":"685","DOI":"10.3390\/brainsci11060685","article-title":"The impact of exercise intervention with rhythmic auditory stimulation to improve gait and mobility in Parkinson disease: an umbrella review.","volume":"11","author":"Forte","year":"2021","journal-title":"Brain Sci"},{"issue":"3","key":"zoi260118r13","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1016\/j.apmr.2012.10.026","article-title":"Cueing and gait improvement among people with Parkinson\u2019s disease: a meta-analysis.","volume":"94","author":"Spaulding","year":"2013","journal-title":"Arch Phys Med Rehabil"},{"issue":"7","key":"zoi260118r14","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1191\/0269215505cr906oa","article-title":"Effects of external rhythmical cueing on gait in patients with Parkinson\u2019s disease: a systematic review.","volume":"19","author":"Lim","year":"2005","journal-title":"Clin Rehabil"},{"key":"zoi260118r15","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.clineuro.2014.06.026","article-title":"Effects of external cues on gait parameters of Parkinson\u2019s disease patients: a systematic review.","volume":"124","author":"Rocha","year":"2014","journal-title":"Clin Neurol Neurosurg"},{"issue":"2","key":"zoi260118r16","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1002\/mds.870110213","article-title":"Rhythmic auditory stimulation in gait training for Parkinson\u2019s disease patients.","volume":"11","author":"Thaut","year":"1996","journal-title":"Mov Disord"},{"issue":"4","key":"zoi260118r17","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1191\/0269215503cr621oa","article-title":"Auditory cues can modify the gait of persons with early-stage Parkinson\u2019s disease: a method for enhancing parkinsonian walking performance?","volume":"17","author":"Howe","year":"2003","journal-title":"Clin Rehabil"},{"issue":"2","key":"zoi260118r18","doi-asserted-by":"publisher","first-page":"113","DOI":"10.2217\/nmt-2021-0050","article-title":"The effect of auditory cues on gait variability in people with Parkinson\u2019s disease and older adults: a systematic review.","volume":"13","author":"Harrison","year":"2023","journal-title":"Neurodegener Dis Manag"},{"issue":"8","key":"zoi260118r19","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.1007\/s10439-012-0654-9","article-title":"Gait variability is altered in older adults when listening to auditory stimuli with differing temporal structures.","volume":"41","author":"Kaipust","year":"2013","journal-title":"Ann Biomed Eng"},{"key":"zoi260118r20","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.gaitpost.2016.09.020","article-title":"Biologically-variable rhythmic auditory cues are superior to isochronous cues in fostering natural gait variability in Parkinson\u2019s disease.","volume":"51","author":"Dotov","year":"2017","journal-title":"Gait Posture"},{"key":"zoi260118r21","doi-asserted-by":"publisher","first-page":"562","DOI":"10.3389\/fphys.2020.00562","article-title":"Assessing the temporal organization of walking variability: a systematic review and consensus guidelines on detrended fluctuation analysis.","volume":"11","author":"Ravi","year":"2020","journal-title":"Front Physiol"},{"key":"zoi260118r22","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/S0065-2601(08)00404-8","article-title":"Affect as a psychological primitive.","volume":"41","author":"Barrett","year":"2009","journal-title":"Adv Exp Soc Psychol"},{"issue":"Suppl 2","key":"zoi260118r23","doi-asserted-by":"publisher","first-page":"10430","DOI":"10.1073\/pnas.1301228110","article-title":"From perception to pleasure: music and its neural substrates.","volume":"110","author":"Zatorre","year":"2013","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"20","key":"zoi260118r24","doi-asserted-by":"publisher","first-page":"11818","DOI":"10.1073\/pnas.191355898","article-title":"Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion.","volume":"98","author":"Blood","year":"2001","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"2","key":"zoi260118r25","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1038\/nn.2726","article-title":"Anatomically distinct dopamine release during anticipation and experience of peak emotion to music.","volume":"14","author":"Salimpoor","year":"2011","journal-title":"Nat Neurosci"},{"issue":"1","key":"zoi260118r26","doi-asserted-by":"publisher","first-page":"207","DOI":"10.3758\/s13415-011-0071-9","article-title":"Emotional state affects gait initiation in individuals with Parkinson\u2019s disease.","volume":"12","author":"Naugle","year":"2012","journal-title":"Cogn Affect Behav Neurosci"},{"key":"zoi260118r27","doi-asserted-by":"publisher","first-page":"l4378","DOI":"10.1136\/bmj.l4378","article-title":"CONSORT 2010 statement: extension to randomised crossover trials.","volume":"366","author":"Dwan","year":"2019","journal-title":"BMJ"},{"key":"zoi260118r28","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.gaitpost.2017.04.013","article-title":"Validity and repeatability of inertial measurement units for measuring gait parameters.","volume":"55","author":"Washabaugh","year":"2017","journal-title":"Gait Posture"},{"issue":"9","key":"zoi260118r29","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6579\/ab4023","article-title":"Validity of Mobility Lab (version 2) for gait assessment in young adults, older adults and Parkinson\u2019s disease.","volume":"40","author":"Morris","year":"2019","journal-title":"Physiol Meas"},{"issue":"3","key":"zoi260118r30","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1037\/0022-3514.57.3.493","article-title":"Affect grid: a single-item scale of pleasure and arousal.","volume":"57","author":"Russell","year":"1989","journal-title":"J Pers Soc Psychol"},{"issue":"2","key":"zoi260118r31","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1080\/02699930802204677","article-title":"Measures of emotion: a review.","volume":"23","author":"Mauss","year":"2009","journal-title":"Cogn Emot"},{"key":"zoi260118r32","doi-asserted-by":"publisher","first-page":"5879","DOI":"10.1038\/srep05879","article-title":"The influence of auditory-motor coupling on fractal dynamics in human gait.","volume":"4","author":"Hunt","year":"2014","journal-title":"Sci Rep"},{"issue":"8","key":"zoi260118r33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0042337","article-title":"Quantitative normative gait data in a large cohort of ambulatory persons with Parkinson\u2019s disease.","volume":"7","author":"Hass","year":"2012","journal-title":"PLoS One"},{"key":"zoi260118r34","doi-asserted-by":"publisher","first-page":"007","DOI":"10.4172\/2155-9538.S1-007","article-title":"Mobility lab to assess balance and gait with synchronized body-worn sensors.","author":"Mancini","year":"2011","journal-title":"J Bioeng Biomed Sci"},{"issue":"1","key":"zoi260118r35","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1063\/1.166141","article-title":"Quantification of scaling exponents and crossover phenomena in nonstationary heartbeat time series.","volume":"5","author":"Peng","year":"1995","journal-title":"Chaos"},{"key":"zoi260118r36","doi-asserted-by":"publisher","first-page":"2466","DOI":"10.1073\/pnas.012579499","article-title":"Fractal dynamics in physiology: alterations with disease and aging.","volume":"99","author":"Goldberger","year":"2002","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"1","key":"zoi260118r37","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1152\/jappl.1997.82.1.262","article-title":"Altered fractal dynamics of gait: reduced stride-interval correlations with aging and Huntington\u2019s disease.","volume":"82","author":"Hausdorff","year":"1997","journal-title":"J Appl Physiol (1985)"},{"issue":"6","key":"zoi260118r38","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1016\/j.humov.2012.05.004","article-title":"Persistent and anti-persistent pattern in stride-to-stride variability of treadmill walking: influence of rhythmic auditory cueing.","volume":"31","author":"Terrier","year":"2012","journal-title":"Hum Mov Sci"},{"issue":"10 Pt 2","key":"zoi260118r39","doi-asserted-by":"publisher","first-page":"2564","DOI":"10.1016\/j.neubiorev.2013.08.003","article-title":"Into the groove: can rhythm influence Parkinson\u2019s disease?","volume":"37","author":"Nombela","year":"2013","journal-title":"Neurosci Biobehav Rev"},{"key":"zoi260118r40","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3389\/fnhum.2014.00811","article-title":"Individual differences in beat perception affect gait responses to low- and high-groove music.","volume":"8","author":"Leow","year":"2014","journal-title":"Front Hum Neurosci"},{"key":"zoi260118r41","doi-asserted-by":"publisher","first-page":"894","DOI":"10.3389\/fpsyg.2014.00894","article-title":"What musicians do to induce the sensation of groove in simple and complex melodies, and how listeners perceive it.","volume":"5","author":"Madison","year":"2014","journal-title":"Front Psychol"},{"key":"zoi260118r9","volume-title":"Methods of the Treatment in Post-Encephalitic Parkinson\u2019s","author":"Von Wilzenben","year":"1942"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2847806\/sowalsky_2026_oi_260118_1775754412.14655.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:30:22Z","timestamp":1776353422000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2847806"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":41,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.2744","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}