Slowing Cognitive Decline in Alpha-synucleinopathies by Enhancing Physical Activity

NCT ID: NCT07324330

Last Updated: 2026-01-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

130 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-12-04

Study Completion Date

2029-12-01

Brief Summary

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α-Synucleinopathies, including Parkinson's disease and dementia with Lewy bodies, are the second most common neurodegenerative diseases. In addition to progressive motor deterioration, cognitive decline is a key element of the non-motor symptom complex of these diseases. Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) indicates an early stage of α-synucleinopathies, even before relevant motor or cognitive disorders are present. Therapeutic interventions in individuals with iRBD therefore have great preventive potential. In particular, increasing physical activity could have a relevant effect on neurodegenerative processes, including the preservation of cognitive functions.

The aim of the study is therefore to investigate the effects of increased physical activity in everyday life on cognitive functions in individuals with iRBD. In this randomized, double-blind, actively controlled study, an increase in physical activity will be implemented over a period of one year with the help of a motivational smartphone application. The intervention and control conditions are the same as those used in the Slow-SPEED trials, making the connection between the trials concrete. The primary outcome parameter is the change in cognitive performance in a neuropsychological test battery over one year.

Eighty individuals with iRBD and 50 age- and gender-matched individuals are being recruited at the University Hospital Bonn and the "Deutsches Zentrum für Neurodegenerative Erkrankungen" (DZNE) Bonn (German branch only). In addition to classic neuropsychological tests as the primary endpoint, magnetic resonance imaging (MRI) and blood-based markers of brain aging are being examined as secondary endpoints. This study is in close collaboration with the Slow-SPEED study (https://clinicaltrials.gov/study/NCT06993142). In addition, selected data from three separate trials-Alpha-Fit, Slow-SPEED-NL, and a sister trial in Austria currently in preparation-are planned to be synthesized into a meta-analysis.

Detailed Description

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α-Synucleinopathies are the second most common group of neurodegenerative diseases after Alzheimer's disease (AD). Their prevalence is expected to increase significantly, with more than 12 million people worldwide likely to be affected by 2040. Clinical manifestations include Parkinson's disease (PD) and dementia with Lewy bodies (DLB). These diseases are characterized by neuronal inclusions of α-synuclein aggregates and Lewy bodies, which lead to premature aging of the brain. In addition to motor impairments, cognitive decline is a central element of non-motor symptoms, which not only occurs in DLB but also affects up to 80% of people with PD. Cognitive deficits can often occur in the early stages of the disease and significantly impair social functioning and quality of life. Despite their high prevalence, there are currently only a few therapeutic approaches for treating cognitive impairments in α-synucleinopathies. Therefore, easily accessible, early preventive interventions are crucial to counteract cognitive decline.

Isolated REM sleep behavior disorder (iRBD) is considered an early sign of α-synucleinopathy and can be reliably diagnosed using video polysomnography. Over 90% of individuals with iRBD develop either PD or DLB within 20 years of diagnosis, with an approximately equal distribution between the two entities. It is noteworthy that executive functions can often already be impaired in iRBD, which is associated with an increased risk of early conversion to PD or DLB. Thus, iRBD represents a phase of early neurodegeneration in which there is a high risk of cognitive decline. For this reason, individuals with iRBD are a particularly suitable target group for investigating the effects of lifestyle modifications that could slow the progression of the disease at an early stage.

Increasing physical activity could offer a promising way to slow the progression of neurodegenerative processes in the early stages of α-synucleinopathies. Since motor impairments are a central feature of PD and DLB, many affected individuals-even in the early stages of the disease-do not achieve the recommended level of physical activity. Studies on increasing physical activity have shown that physical training has positive effects on cerebrovascular function and cognitive performance, both in healthy aging and in various neurodegenerative diseases. For α-synucleinopathies in particular, there is evidence from animal models, observational studies, and clinical trials with up to six months of follow-up that physical activity may have disease-modifying effects. A recent meta-analysis in PD found that various interventions to increase physical activity have moderate effects on global cognition and even strong effects on executive functions. Therefore, promoting a more active lifestyle could be a promising strategy to positively influence the early course of α-synucleinopathies. Motivational mobile apps offer a novel way to increase physical activity, as they can be used completely independently, allowing for a high degree of scalability of the intervention.

Derivation of research questions

The following key questions will be addressed in the research project:

* Can the progression of motor and cognitive changes in individuals with iRBD be influenced by increasing physical activity?
* Does this intervention also affect biological and imaging markers of pathological brain aging?
* Does this intervention also have an effect on healthy older people?

Conditions

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Parkinson Disease Prodromal Stage Neurodegenerative Diseases Basal Ganglia Diseases Central Nervous System Diseases Synucleinopathies Nervous System Diseases Cerebral Disorder Brain Diseases Parkinsonian Disorders

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Doubling of baseline step count

Large increase in step count and moderate to vigorous physical activity relative to baseline level (+100%).

Group Type EXPERIMENTAL

Increase of physical activity volume and intensity with the use of a motivational smartphone application

Intervention Type BEHAVIORAL

A motivational smartphone application will be available for all participants using their own smartphone: the Alpha-Fit app, comparable to the SLOW-SPEED app (https://clinicaltrials.gov/study/NCT06993142). The Alpha-Fit app will motivate participants to increase the volume and intensity of their physical activity in daily life over a long period of time (12 months) based on their own baseline levels. Different treatment arms will receive different physical activity goals. The app offers participants feedback and support, that will stimulate them to reach their individual physical activity goal (i.e. incremental relative increase of step count and minutes exerting ≥ 64% of maximum heart rate reflecting moderate-to-vigorous physical activity (MVPA) relative to baseline level).

Small increase of baseline step count

Small increase in step count and moderate to vigorous physical activity relative to baseline level (+10%).

Group Type ACTIVE_COMPARATOR

Increase of physical activity volume and intensity with the use of a motivational smartphone application

Intervention Type BEHAVIORAL

A motivational smartphone application will be available for all participants using their own smartphone: the Alpha-Fit app, comparable to the SLOW-SPEED app (https://clinicaltrials.gov/study/NCT06993142). The Alpha-Fit app will motivate participants to increase the volume and intensity of their physical activity in daily life over a long period of time (12 months) based on their own baseline levels. Different treatment arms will receive different physical activity goals. The app offers participants feedback and support, that will stimulate them to reach their individual physical activity goal (i.e. incremental relative increase of step count and minutes exerting ≥ 64% of maximum heart rate reflecting moderate-to-vigorous physical activity (MVPA) relative to baseline level).

Interventions

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Increase of physical activity volume and intensity with the use of a motivational smartphone application

A motivational smartphone application will be available for all participants using their own smartphone: the Alpha-Fit app, comparable to the SLOW-SPEED app (https://clinicaltrials.gov/study/NCT06993142). The Alpha-Fit app will motivate participants to increase the volume and intensity of their physical activity in daily life over a long period of time (12 months) based on their own baseline levels. Different treatment arms will receive different physical activity goals. The app offers participants feedback and support, that will stimulate them to reach their individual physical activity goal (i.e. incremental relative increase of step count and minutes exerting ≥ 64% of maximum heart rate reflecting moderate-to-vigorous physical activity (MVPA) relative to baseline level).

Intervention Type BEHAVIORAL

Other Intervention Names

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Motivational movement intervention

Eligibility Criteria

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Inclusion Criteria

iRBD:

* Age: 50-80 years
* Polysomnographically confirmed diagnosis of iRBD
* Maximum of 120 minutes of sports/outdoor activities per day
* Less than an average of 10,000 steps per day during the 4-week eligibility and baseline phase
* Basic smartphone skills
* Sufficient knowledge of German (native language, C1 or C2)
* Ownership of a suitable smartphone (minimum screen size 4.6 inches, Android version 9 or iOS version 15 or newer)
* Consent to be informed of any additional findings

Healthy controls:

* Age: 50-80 years
* Maximum of 120 minutes of sports/outdoor activities per day
* Less than an average of 10,000 steps per day during the 4-week eligibility and baseline phase
* Basic smartphone skills
* Sufficient knowledge of German (native language, C1 or C2)
* Ownership of a suitable smartphone (minimum screen size 4.6 inches, Android version 9 or iOS version 15 or newer)
* Consent to be informed of any additional findings

Exclusion Criteria

iRBD:

* Relevant cardiovascular diseases
* Problems with dexterity or cognitive impairments that make it difficult to use a smartphone
* Cognitive impairments that limit the ability to make informed decisions and consent to participate in the study
* Ownership of one of the following devices: Huawei P8 Lite, Huawei P9 Lite, Xiaomi Mi 6, Huawei P20 Lite (FitBit is not compatible)

Healthy controls:

* Relevant cardiovascular diseases
* Problems with dexterity or cognitive impairments that make it difficult to use a smartphone
* Cognitive impairments that limit the ability to make informed decisions and consent to participate in the study
* Ownership of one of the following devices: Huawei P8 Lite, Huawei P9 Lite, Xiaomi Mi 6, Huawei P20 Lite (FitBit is not compatible)
* clinically diagnosed iRBD
Minimum Eligible Age

50 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Radboud University Medical Center

OTHER

Sponsor Role collaborator

Medical University Innsbruck

OTHER

Sponsor Role collaborator

IJsfontein B.V., Netherlands

UNKNOWN

Sponsor Role collaborator

Synaptikon GmbH

UNKNOWN

Sponsor Role collaborator

Parkinson Stiftung

UNKNOWN

Sponsor Role collaborator

University Hospital, Bonn

OTHER

Sponsor Role lead

Responsible Party

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Dr. Michael Sommerauer

Senior Consultant Physician, Head of the Sleep Laboratory

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Michael B Sommerauer, Dr.

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Bonn

Locations

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University Hospital of Bonn

Bonn, North Rhine West-Falia, Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Martin M Rodemann

Role: CONTACT

+49 0228 287 - 19436

Emily L Fitzgibbon, M.Sc.

Role: CONTACT

Facility Contacts

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Michael B Sommerauer, Dr.

Role: primary

+49 0228 287 - 19436

References

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Jia RX, Liang JH, Xu Y, Wang YQ. Effects of physical activity and exercise on the cognitive function of patients with Alzheimer disease: a meta-analysis. BMC Geriatr. 2019 Jul 2;19(1):181. doi: 10.1186/s12877-019-1175-2.

Reference Type BACKGROUND
PMID: 31266451 (View on PubMed)

Jellinger KA, Korczyn AD. Are dementia with Lewy bodies and Parkinson's disease dementia the same disease? BMC Med. 2018 Mar 6;16(1):34. doi: 10.1186/s12916-018-1016-8.

Reference Type BACKGROUND
PMID: 29510692 (View on PubMed)

Janssen Daalen JM, Schootemeijer S, Richard E, Darweesh SKL, Bloem BR. Lifestyle Interventions for the Prevention of Parkinson Disease: A Recipe for Action. Neurology. 2022 Aug 16;99(7 Suppl 1):42-51. doi: 10.1212/WNL.0000000000200787.

Reference Type BACKGROUND
PMID: 35970584 (View on PubMed)

Höglinger, G. U. et al. Towards a Biological Definition of Parkinson's Disease. Preprint at https://doi.org/10.20944/preprints202304.0108.v1 (2023).

Reference Type BACKGROUND

Fang X, Han D, Cheng Q, Zhang P, Zhao C, Min J, Wang F. Association of Levels of Physical Activity With Risk of Parkinson Disease: A Systematic Review and Meta-analysis. JAMA Netw Open. 2018 Sep 7;1(5):e182421. doi: 10.1001/jamanetworkopen.2018.2421.

Reference Type BACKGROUND
PMID: 30646166 (View on PubMed)

Dorsey ER, Sherer T, Okun MS, Bloem BR. The Emerging Evidence of the Parkinson Pandemic. J Parkinsons Dis. 2018;8(s1):S3-S8. doi: 10.3233/JPD-181474.

Reference Type BACKGROUND
PMID: 30584159 (View on PubMed)

Litvan I, Goldman JG, Troster AI, Schmand BA, Weintraub D, Petersen RC, Mollenhauer B, Adler CH, Marder K, Williams-Gray CH, Aarsland D, Kulisevsky J, Rodriguez-Oroz MC, Burn DJ, Barker RA, Emre M. Diagnostic criteria for mild cognitive impairment in Parkinson's disease: Movement Disorder Society Task Force guidelines. Mov Disord. 2012 Mar;27(3):349-56. doi: 10.1002/mds.24893. Epub 2012 Jan 24.

Reference Type BACKGROUND
PMID: 22275317 (View on PubMed)

Kim R, Lee TL, Lee H, Ko DK, Lee JH, Shin H, Lim D, Jun JS, Byun K, Park K, Jeon B, Kang N. Effects of physical exercise interventions on cognitive function in Parkinson's disease: An updated systematic review and meta-analysis of randomized controlled trials. Parkinsonism Relat Disord. 2023 Dec;117:105908. doi: 10.1016/j.parkreldis.2023.105908. Epub 2023 Oct 26.

Reference Type BACKGROUND
PMID: 37922635 (View on PubMed)

de Vries NM, Darweesh SKL, Bloem BR. Citius, Fortius, Altius-Understanding Which Components Drive Exercise Benefits in Parkinson Disease. JAMA Neurol. 2021 Dec 1;78(12):1443-1445. doi: 10.1001/jamaneurol.2021.3744. No abstract available.

Reference Type BACKGROUND
PMID: 34724528 (View on PubMed)

Dauvilliers Y, Schenck CH, Postuma RB, Iranzo A, Luppi PH, Plazzi G, Montplaisir J, Boeve B. REM sleep behaviour disorder. Nat Rev Dis Primers. 2018 Aug 30;4(1):19. doi: 10.1038/s41572-018-0016-5.

Reference Type BACKGROUND
PMID: 30166532 (View on PubMed)

Cesari M, Heidbreder A, St Louis EK, Sixel-Doring F, Bliwise DL, Baldelli L, Bes F, Fantini ML, Iranzo A, Knudsen-Heier S, Mayer G, McCarter S, Nepozitek J, Pavlova M, Provini F, Santamaria J, Sunwoo JS, Videnovic A, Hogl B, Jennum P, Christensen JAE, Stefani A. Video-polysomnography procedures for diagnosis of rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages: guidelines from the International RBD Study Group. Sleep. 2022 Mar 14;45(3):zsab257. doi: 10.1093/sleep/zsab257.

Reference Type BACKGROUND
PMID: 34694408 (View on PubMed)

Bliss ES, Wong RH, Howe PR, Mills DE. Benefits of exercise training on cerebrovascular and cognitive function in ageing. J Cereb Blood Flow Metab. 2021 Mar;41(3):447-470. doi: 10.1177/0271678X20957807. Epub 2020 Sep 20.

Reference Type BACKGROUND
PMID: 32954902 (View on PubMed)

Berg D, Borghammer P, Fereshtehnejad SM, Heinzel S, Horsager J, Schaeffer E, Postuma RB. Prodromal Parkinson disease subtypes - key to understanding heterogeneity. Nat Rev Neurol. 2021 Jun;17(6):349-361. doi: 10.1038/s41582-021-00486-9. Epub 2021 Apr 20.

Reference Type BACKGROUND
PMID: 33879872 (View on PubMed)

Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, Bottacchi E, Cannas A, Ceravolo G, Ceravolo R, Cicarelli G, Gaglio RM, Giglia RM, Iemolo F, Manfredi M, Meco G, Nicoletti A, Pederzoli M, Petrone A, Pisani A, Pontieri FE, Quatrale R, Ramat S, Scala R, Volpe G, Zappulla S, Bentivoglio AR, Stocchi F, Trianni G, Dotto PD; PRIAMO study group. The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. Mov Disord. 2009 Aug 15;24(11):1641-9. doi: 10.1002/mds.22643.

Reference Type BACKGROUND
PMID: 19514014 (View on PubMed)

Aarsland D, Batzu L, Halliday GM, Geurtsen GJ, Ballard C, Ray Chaudhuri K, Weintraub D. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers. 2021 Jul 1;7(1):47. doi: 10.1038/s41572-021-00280-3.

Reference Type BACKGROUND
PMID: 34210995 (View on PubMed)

Other Identifiers

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01EA2501

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

101095426

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2025-289-BO

Identifier Type: -

Identifier Source: org_study_id

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