Partnered Dance Aerobic Exercise as a Neuroprotective, Motor and Cognitive Intervention in Parkinson's Disease

NCT04122690 | Active Not Recruiting

• 2 other identifiers: F2967-RIRB112770
• Study Type: interventional
• Target: 82
• Locations: 1 country
• Sites: 1

Brief Summary

Parkinson's disease (PD) is a difficult to treat condition that impairs mobility and thinking. It is not fully treated by drugs and surgery. Two priority issues for most people with PD are "OFF-time" and Cognitive impairment. Even under best medical management, 74% of people with PD experience "OFF-time," which is when medications are just not working right. OFF-time severely impacts both quality of life and thinking. Cognitive problems are found even in newly diagnosed people with PD and are very difficult to treat. However, the investigators' research has shown that partnered dance-aerobic exercise (PDAE) reduces OFF-time on the official test for OFF-time of the Movement Disorders Society, the Movement Disorders Society Unified Parkinson Disease Rating Scale-IV, (MDS-UPDRS-IV). PDAE improves other symptoms too. Benefits of the therapy have lasted for at least one-month after PDAE sessions stopped. PDAE provides aerobic exercise during an improvisational, cognitively-engaging physical activity. Cognitive engagement is a critical component of PDAE. Previous research showed PDAE improved spatial cognition, the ability to navigate, to mentally picture shapes and paths in the mind and to know the relationships between objects, people and places. Also, the investigators showed with imaging of the brain using a magnet in a scanner that twice weekly PDAE training increases activity in brain regions used in thinking and decision making. The investigators know that exercise benefits mobility and cognitive problems. The investigators even think exercise might protect brain cells in people with PD. But no one has really been able to show with biomarkers that exercise is protective of brain cells in humans.

Conditions

Parkinson's Disease; Exercise Therapy; Cognition

Keywords

motor control; Parkinson disease; exercise; neural imaging; dance; spatial cognition; executive function; substantia nigra; neurodegeneration; rehabilitation

Outcome Measures

Primary Outcomes (3)

• Movement disorders Society Unified Parkinson's Disease Rating Scale Part IV total score

  The primary outcome, the MDS-UPDRS-IV score measures medication related motor fluctuations, including dyskinesias, OFF-time, functional impact and complexity of fluctuations, and dystonia. The investigators will administer a monthly OFF-state diary for corroboration of these scores.

  16 months

• Corsi Blocks product score

  The product score is the product of the span and number of correct trials achieved by the participant. The Corsi Blocks is a test of spatial cognition, specifically visuospatial working memory.

  16 months

• rate of change in iron accumulation in the substantia nigra pars compacta

  The investigators will measure R2\* in the NM-MRI defined SNc using a published image processing and analysis method. This method leverages a standard space SNc atlas developed using control population NM-MRI data, enabling R2\* measurement in SNc with no operator-dependent segmentation steps

  16 months

Secondary Outcomes (9)

• 6 minute walk test (number of meters walked in 6 minutes)

  16 months

• cardiovascular output: V02 maximum

  16 months

• neural measure of spatial cognition (BOLD signal)

  16 months

• rate of change in loss of neuromelanin in substantia nigra pars compacta

  16 months

• Executive function: Tower Of London achievement score

  16 months

Other Outcomes (15)

• Mini BESTest score

  16 months

• Four Square Step Test (time to complete)

  16 months

• Dynamic Gait index

  16 months

Study Arms (2)

Partnered Dance Aerobic Exercise

EXPERIMENTAL

Partnered Dance-Aerobic Exercise (PDAE) is an adapted form of Argentine tango, aka Adapted tango. Participants with PD will dance the follower role only and will dance with new partners (individuals without PD) every 15-20 minutes, a widely practiced method considered by the dance teaching community to enhance learning. Participants will engage in partnering exercises on how to interpret motor goals through touch, exercises to develop understanding of temporal relationship of movement to music, novel step introduction, connecting previously learned and novel step elements. Frequent repetition and musical stereotypes may foster implicit learning or muscle memory (i.e., motor learning, or procedural memory that involves consolidating a specific motor task into memory through repetition). Participants will not be required to memorize specific step patterns but will learn new steps in each class

Behavioral: PDAE

Walking Aerobic Exercise

ACTIVE COMPARATOR

Walking Aerobic Exercise (WAE) Participants in WAE will receive equivalent dose, volume, frequency, intensity and duration of exercise to the PDAE group. The investigators will receive equal contact and monitoring from study staff. WAE participants will report to the same facility and interact with the same interventionist and assistants. The investigators will participate in sessions focused on at least 60 minutes of walking with breaks ad libitum, and 1/2 hour balance and stretching. The investigators have a designated, safe and non-cluttered area for walking. WAE will also take place in groups, with research volunteers and assistants to ensure that PDAE and WAE participants both receive a socially engaging intervention.

Behavioral: WAE

Interventions

PDAE BEHAVIORAL

Participants with PD will dance the follower role only and will dance with new partners (individuals without PD) every 15-20 minutes, a widely practiced method considered by the dance teaching community to enhance learning. Participants will engage in partnering exercises on how to interpret motor goals through touch, exercises to develop understanding of temporal relationship of movement to music, novel step introduction, connecting previously learned and novel step elements. Frequent repetition and musical stereotypes may foster implicit learning or muscle memory (i.e., motor learning, or procedural memory that involves consolidating a specific motor task into memory through repetition). Participants will not be required to memorize specific step patterns but will learn new steps in each class

Partnered Dance Aerobic Exercise

WAE BEHAVIORAL

The participants will receive equal contact and monitoring from study staff. WAE participants will report to the same facility and interact with the same interventionist and assistants. The participants will participate in sessions focused on at least 60 minutes of walking with breaks ad libitum, and 1/2 hour balance and stretching. The investigators have a designated, safe and non-cluttered area for walking. WAE will also take place in groups, with research volunteers and assistants to ensure that PDAE and WAE participants both receive a socially engaging intervention

Walking Aerobic Exercise

Eligibility Criteria

• Age: 40 Years - 89 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age: older than 40 years (40 is upper limit for young onset PD)
• Montreal Cognitive Assessment (MoCA) score \>17
• Able to walk with or without an assistive device at least 10 feet
• Best corrected/aided acuity better than 20/70 in the better eye
• Willingness to be randomized to either group
• H\&Y stages I-III
• Report OFF times (reporting \>0 on item 4.3 of the UPDRS-IV)
• Show clear symptomatic benefit from antiparkinsonian medications
• e.g., alleviated rigidity, bradykinesia, and tremor
• Fluent in English to comprehend and participate

You may not qualify if:

• Untreated Major Depression and major psychiatric illness
• History of stroke, or traumatic brain injury
• Pure-tone threshold average sensitivity at 0.5, 1.0, and 2.0 kHz exceeds 40 dB
• Previous participation in PDAE or WAE classes.
• Alcohol abuse and/or use of antipsychotics
• Lives outside of the study site or is planning to move out of the area in next year or leave the area for \>1 month during the next year
• Taking moderate to high doses of beta-blockers with a resting heart rate below 60 beats/min since exercise intensity is measured through target heart rate.
• Severe cardiac disease, including:
• New York Heart Association (NYHA) Class III or IV congestive heart failure
• clinically significant aortic stenosis
• history of cardiac arrest, use of a cardiac defibrillator
• uncontrolled angina
• as discussed we are not planning to perform routine exercise tolerance tests prior to enrollment
• Other significant co-morbid disease that would impair ability to participate in the exercise-based intervention
• e.g. renal failure on hemodialysis, excessive alcohol use (\>14 drinks per wk)

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (1)

Atlanta VA Medical and Rehab Center, Decatur, GA

Decatur, Georgia, 30033-4004, United States

Location

Related Publications (3)

• Kim H, Rafie F, Nekouei AH, Kazanski ME, Hackney ME. Compliance and Satisfaction for 16 months of Adapted Tango vs. Supervised Walking for People with Parkinson's. NPJ Parkinsons Dis. 2025 Dec 26;12(1):13. doi: 10.1038/s41531-025-01220-8.

  PMID: 41453883 DERIVED

• Ernst M, Folkerts AK, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, Cryns N, Monsef I, Dresen A, Roheger M, Eggers C, Skoetz N, Kalbe E. Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2024 Apr 8;4(4):CD013856. doi: 10.1002/14651858.CD013856.pub3.

  PMID: 38588457 DERIVED

• Ernst M, Folkerts AK, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, Cryns N, Monsef I, Dresen A, Roheger M, Eggers C, Skoetz N, Kalbe E. Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2023 Jan 5;1(1):CD013856. doi: 10.1002/14651858.CD013856.pub2.

  PMID: 36602886 DERIVED

MeSH Terms

Conditions

Parkinson Disease; Motor Activity; Nerve Degeneration

Condition Hierarchy (Ancestors)

Parkinsonian Disorders; Basal Ganglia Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases; Behavior; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Madeleine E. Hackney, PhD

  Atlanta VA Medical and Rehab Center, Decatur, GA

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: PDAE compared with WAE

Study Record Dates

• First Submitted: October 9, 2019
• First Posted: October 10, 2019
• Study Start: January 25, 2021
• Primary Completion (Estimated): December 15, 2026
• Study Completion (Estimated): December 15, 2026
• Last Updated: January 13, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)