Steps Against the Burden of Parkinson's Disease

NCT ID: NCT07057219

Last Updated: 2025-07-17

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 42 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-07-09
• Study Completion Date: 2026-11-30

Brief Summary

Parkinson's Disease Treadmill Training RCT Summary

Parkinson's disease (PD) affects over 10 million people globally. Despite optimal pharmacological treatment, approximately 70% of individuals experience unstable gait and falls, leading to loss of confidence, social isolation, fractures, and frequent hospitalisations. Treadmill training-especially when augmented by mechanical or virtual-reality perturbations-has shown promise in improving gait and reducing fall risk. However, the mechanisms underlying these benefits remain poorly understood, limiting the ability to personalise interventions effectively.

This randomised controlled trial (RCT) forms part of the broader Steps Against the Burden of Parkinson's Disease project (CT-IDs: 6ef2e427b002, 6ef2e427b003, 6ef2e427b004), comprising three harmonised but independently conducted RCTs. All sites follow a shared core protocol, allowing for pooled data analysis while preserving site-specific perturbation adaptations. Findings from this trial will be reported both independently and as part of the combined dataset.

In this trial, participants with PD will undergo 12 sessions of treadmill training, with or without virtual reality and perturbation-based adaptations. Assessments will be conducted at baseline, post-training, and follow-up. The intervention aims to enhance gait through improved sensorimotor integration and balance control. During the follow-up period, a smartphoneapp "Walking Tall" will be used to encourage continued exercises and long-term retention of training effects.

Biomechanical analyses will focus on changes in foot placement control. Neurophysiological outcomes will be examined using EEG and EMG, targeting reductions in beta-band EEG power and enhanced EEG-EMG coherence as markers of improved gait stability.

Recognising that laboratory-based improvements may not always translate to daily life, this study will also investigate gait self-efficacy as a potential moderator of transfer. Remote monitoring tools will capture real-world mobility outcomes over a week. Machine learning techniques will be employed to identify factors differentiating those who improve in both settings from those who do not. These insights will inform the development of personalised interventions capable of translating training effects into meaningful real-life outcomes.

Detailed Description

i. Rationale The rationale of this trial is that speed-dependent treadmill training (SDTT) improves gait in people with Parkinson's disease (PD) through enhanced sensorimotor integration, with cortical activity changes as underlying neural correlates. Additional benefits may be gained when treadmill training includes perturbations, which help train reactive balance responses. Furthermore, it is hypothesised that improvements in gait quality through SDTT can enhance gait self-efficacy, which may mediate or moderate the transfer of training effects to everyday mobility. Understanding these mechanisms is essential for personalising interventions and maximising real-world outcomes.

ii. Objectives

The objectives of the StepuP project are to:

1. Understand the kinematic and neural mechanisms that underlie improvements in gait due to treadmill training with and without mechanically and VR-triggered gait adaptations in people with PD.

2. Assess the extent to which gait improvements measured in the laboratory transfer to improvements in daily-life mobility.

3. Identify the mechanisms that support or limit the transfer of training effects from lab-based gait improvements to real-world mobility.

4. Determine for whom treadmill training improves gait characteristics in the lab and for whom it does not, and similarly, who benefits in terms of daily-life mobility.

Achieving these objectives will advance understanding of the variability in individual response to treadmill training, allowing more targeted and ultimately personalised interventions to improve outcomes in PD.

iii. Endpoints This trial will evaluate the effects of treadmill training with and without perturbations on gait performance and neural correlates in people with PD.

Primary endpoint:

> Change in gait speed under controlled treadmill conditions.

Secondary endpoints:

• Clinical outcomes: Changes in motor symptoms and function measured through clinical assessments.
• Kinematic outcomes: Changes in gait parameters such as step length and variability from baseline to follow-up.
• Neurophysiological outcomes: EEG and EMG markers, including changes in EEG beta power and EEG-EMG coherence.

Exploratory endpoints:

• Real-world gait metrics assessed via wearable sensors.
• Gait self-efficacy assessed with validated questionnaires to examine psychological influences on transfer.

These outcomes will help identify how and for whom treadmill training leads to meaningful, lasting improvements in mobility.

Conditions

Parkinson Disease (PD)

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: DOUBLE

Study Groups

Speed-dependent treadmill training (SDTT)

SDTT adjusts the treadmill's speed in real time to match an individual's walking pace, creating a dynamic and adaptive training environment. This approach simulates real-world walking conditions, promoting neuromuscular coordination, balance, and functional mobility. By tailoring speed to the user's natural gait, SDTT supports the development of efficient and more natural walking patterns. It has shown promise across clinical populations, including those with neurological disorders, musculoskeletal conditions, or recovering from injury. Its flexibility allows for progressive challenge as walking ability improves, making SDTT a valuable tool for optimising gait and mobility outcomes.

Group Type: ACTIVE_COMPARATOR

Exercise

Intervention Type: OTHER

SDTT adjusts the treadmill's speed in real time to match an individual's walking pace, creating a dynamic and adaptive training environment. This approach simulates real-world walking conditions, promoting neuromuscular coordination, balance, and functional mobility. By tailoring speed to the user's natural gait, SDTT supports the development of efficient and more natural walking patterns. It has shown promise across clinical populations, including those with neurological disorders, musculoskeletal conditions, or recovering from injury. Its flexibility allows for progressive challenge as walking ability improves, making SDTT a valuable tool for optimising gait and mobility outcomes.

SDTT+ perturbations + VR triggered adaptations

The SDTT+ program combines speed-dependent treadmill training with perturbations and VR-triggered adaptations. Reactive gait responses are elicited through controlled accelerations and decelerations of treadmill belts, simulating real-life balance challenges.

Group Type: EXPERIMENTAL

Exercise

Intervention Type: OTHER

The SDTT+ program combines speed-dependent treadmill training with perturbations and VR-triggered adaptations. Reactive gait responses are elicited through controlled accelerations and decelerations of treadmill belts, simulating real-life balance challenges.

Interventions

Exercise

SDTT adjusts the treadmill's speed in real time to match an individual's walking pace, creating a dynamic and adaptive training environment. This approach simulates real-world walking conditions, promoting neuromuscular coordination, balance, and functional mobility. By tailoring speed to the user's natural gait, SDTT supports the development of efficient and more natural walking patterns. It has shown promise across clinical populations, including those with neurological disorders, musculoskeletal conditions, or recovering from injury. Its flexibility allows for progressive challenge as walking ability improves, making SDTT a valuable tool for optimising gait and mobility outcomes.

Intervention Type: OTHER

Exercise

The SDTT+ program combines speed-dependent treadmill training with perturbations and VR-triggered adaptations. Reactive gait responses are elicited through controlled accelerations and decelerations of treadmill belts, simulating real-life balance challenges.

Intervention Type: OTHER

Other Intervention Names

SDTT; Treadmill training; Gait training; SDTT+; VR; perturbation training; Treadmill training; Gait training

Eligibility Criteria

Inclusion Criteria

1. Diagnosis of PD according to the MDS Criteria

2. Hoehn and Yahr stages I to III;

3. Movement Disorder Society-sponsored version of the Unified Parkinson Disease Rating Scale (MDS-UPDRS) gait sub-score of 1 or more

4. Signed informed consent to participation

Exclusion Criteria

• Any known general health condition likely to interfere with or to pose a contraindication to non-medically supervised physical exercise.
• Moderate or severe depression (BDI-II ≥18)
• Cognitive impairment which may preclude the possibility to provide a fully informed consent to enrolment.
• Linguistic comprehension capacity less than 75% in ordinary conversation
• Severe psychiatric comorbidity which may interfere with compliance to the study protocol
• History of or current status of substance dependency
• Unable to walk less than 1 floor
• Thoracic pain in the last 4 weeks
• Currently enrolled in other interventional studies
• Implanted Deep Brain Stimulation device

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Neuroscience Research Australia

OTHER

Sponsor Role: collaborator

VU University of Amsterdam

OTHER

Sponsor Role: collaborator

IRCCS Azienda Ospedaliero-Universitaria di Bologna

OTHER

Sponsor Role: collaborator

Shake it up Australia Foundation

UNKNOWN

Sponsor Role: collaborator

Tel Aviv Medical Center

OTHER

Sponsor Role: collaborator

The University of New South Wales

OTHER

Sponsor Role: lead

Responsible Party

Yoshiro Okubo

Conjoint Senior Lecturer

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Matthew Brodie, PhD

Role: STUDY_CHAIR

University of New South Wales

Yoshiro Okubo, PhD

Role: PRINCIPAL_INVESTIGATOR

Neuroscience Research Australia, University of New South Wales

Daniel Chan, PhD, MD

Role: PRINCIPAL_INVESTIGATOR

University of New South Wales

Luca Modenese, PhD

Role: PRINCIPAL_INVESTIGATOR

University of New South Wales

Frederic von Wegner, PhD, MD

Role: PRINCIPAL_INVESTIGATOR

University of New South Wales

Phu Hoang, PhD, MD

Role: PRINCIPAL_INVESTIGATOR

Neuroscience Research Australia

Husna Razee, PhD

Role: PRINCIPAL_INVESTIGATOR

University of New South Wales

Paulo Silva Pelicioni, PhD

Role: PRINCIPAL_INVESTIGATOR

University of New South Wales

Vicki Miller

Role: PRINCIPAL_INVESTIGATOR

Shake it up Australia Foundation

Carolyn Sue, PhD, MD

Role: PRINCIPAL_INVESTIGATOR

Neuroscience Research Australia

Martin Ostrowski, PhD

Role: PRINCIPAL_INVESTIGATOR

University of New South Wales

Mayna Ratanapongleka

Role: PRINCIPAL_INVESTIGATOR

Neuroscience Research Australia

Locations

Neuroscience Research Australia

Randwick, New South Wales, Australia

Site Status: RECRUITING

Countries

Australia

Central Contacts

Matthew A Brodie, PhD

Role: CONTACT

a.m.brodie@unsw.edu.au

+614 4988 6272

Yoshiro Okubo, PhD

Role: CONTACT

y.okubo@neura.edu.au

+61 293991065

Facility Contacts

Matthew A Brodie, PhD

Role: primary

a.m.brodie@unsw.edu.au

+61 449 886 272

Yoshiro Okubo, PhD

Role: backup

y.okubo@neura.edu.au

+61 293991065 ext. 1065

Other Identifiers

2022885

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

iRECS5114

Identifier Type: -

Identifier Source: org_study_id