Genetics and Aerobic Exercise to Slow Parkinson's Disease Trial (GEARS)

Genetics and Aerobic Exercise to Slow Parkinson's Disease (GEARS) Trial

The proposed multi-site, Genetics and Aerobic Exercise to Slow PD (GEARS) Trial will, for the first time, determine the interplay between genetics and exercise in altering PD progression. In sum, 200 PD patients will be recruited from the Cleveland and Salt Lake City metro areas to participate in the Pedaling for Parkinson's (PFP) community-based exercise program. Participants will exercise at community-based sites 3x/week for 12 months. All participants will undergo genotyping using an array that includes the genome backbone and common risk variants associated to increase risk for multiple neurological disorders including PD.

Study Overview

• Status: Not yet recruiting
• Conditions: Parkinson Disease
• Intervention / Treatment: Other: High intensity stationary cycling

Detailed Description

A long-standing unmet need in the treatment of Parkinson's disease (PD) is the identification of a disease-modifying intervention (e.g. pharmaceutical, surgical or behavioral). A growing body of evidence indicates that high-intensity aerobic exercise, when delivered in a highly supervised, well-controlled laboratory setting, improves PD symptomology. Two fundamental gaps remain related to the widespread utilization of exercise to slow PD: 1) are community-based exercise programs effective in altering disease progression and 2) what is the role of genetics in modulating the disease altering effects of high-intensity aerobic exercise? Our underlying hypothesis is that high-intensity, community-based exercise slows disease progression in PD and does so more effectively in individuals with a lower genetic/biological burden. Genetic burden for PD will be determined through the calculation of a PD polygenic risk score (PRS).

Total study duration is ~12.5 months to accommodate data collection sessions and enrollment in PFP class. The study consists of five in-person assessments at the Cleveland Clinic or the University of Utah: informed consent, enrollment (On- and Off-medication separated by at least 24 hrs), 6 months (Off-medication), and 12 months (Off-medication). Asking participants to withhold medication for Off-state examinations imposes a burden, but the Off-state (12 hours off meds) will increase insight into the direct effect of exercise on PD and provides more reliable, less confounded time comparisons. Antiparkinsonian medication will be reconciled at Baseline, 6- and 12-month timepoints. Outcome metrics are provided in Table 1. Notably, all outcome metrics will be collected at each time point after the consent appointment (baseline on, baseline off, 6 month and 12 month) with the exception of the quality of life metrics (Neuro-QoL and MDS-UPDRS I, II, IV) which will be collected at one of the two baseline assessments (instead of both baseline assessments), 6 month, and 12 month; the quality of life questionnaires ask questions about one's quality of life over the previous 7 days and are non-specific to medication state. Genetic data and demographics will be gathered at the first enrollment assessment visit. Following the two enrollment visits, the participant will begin attending PFP classes 3x/wk at the community center most convenient to them. Participants will be recruited and enrolled on a continuous basis.

• Study Type: Interventional
• Enrollment (Estimated): 200
• Phase: Phase 2; Phase 3

Contacts and Locations

• Study Contact: Name: Elizabeth Jansen, MPH; Phone Number: 216-780-9160; Email: jansena@ccf.org
• Study Contact Backup: Name: Anson Rosenfeldt, DPT; Phone Number: 216-644-7617; Email: rosenfa2@ccf.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Adult with a diagnosis of PD by a physician or physician extender
2. Hoehn and Yahr stage I-III
3. Demonstrate the ability to safely mount and dismount a stationary cycle
4. Reliable transportation to the community exercise facility
5. Smartphone device for activity data monitoring
6. On a stable dose of anti-parkinsonian medication

Exclusion Criteria:

1. Participation in disease modifying PD-related clinical trial or study
2. Diagnosis of dementia or any neurocognitive impairment that compromises one's ability to provide informed consent.
3. Implanted deep brain stimulation electrodes or focused ultrasound for PD management
4. Recommendation for medical clearance using the American College of Sports Medicine (ACSM) Preparticipation Health Screen a. If the ACSM screen recommends medical clearance, the participant must obtain medical clearance by their health care provider prior to participation.

b. Those who choose not to obtain physician clearance will not be eligible for participation.

e) A musculoskeletal issue (arthritis, osteoporosis, back problem) that would limit one's ability to engage in a cycling intervention f) Neurological disease other than Parkinson's disease (i.e. multiple sclerosis, stroke) g) Current cardiac arrhythmia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Interventional Arm; All participants will exercise in a community setting 3x/week for 12 months

Other: High intensity stationary cycling; All community based exercise sessions are: 3x/week for 40 min, which includes a 5-min warm up & cool down and a 30-minute main exercise set. Exercise parameters will be set by a neurologically trained physical therapist and will be progressed over time with the ultimate goal of the individual reaching moderate-vigorous exercise. Moderate-vigorous exercise for this project is defined as a cadence of 75+ rpms and a target HR of 60-80% of their age-predicted max

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
MDS-UPDRS III	Rater-observed PD global motor symptoms	Enrollment On and Off Medications, 6 months post-enrollment, and 12 months post-enrollment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nine Hole Peg Test	Upper extremity dexterity	Enrollment On and Off Medications, 6 months post-enrollment, and 12 months post-enrollment
Timed Up & Go	Sit to stand from chair, ambulate 3m, turn, return to chair and sit	Enrollment On and Off Medications, 6 months post-enrollment, and 12 months post-enrollment
Six Minute Walk Test	Cardiovascular Fitness	Enrollment On and Off Medications, 6 months post-enrollment, and 12 months post-enrollment
Processing Speed	Symbol/digit matching; test of information processing speed, implicit learning	Enrollment On and Off Medications, 6 months post-enrollment, and 12 months post-enrollment

Collaborators and Investigators

• Sponsor: Jay Alberts
• Collaborators: National Institutes of Health (NIH)

Study record dates

Study Major Dates

• Study Start (Estimated): June 15, 2024
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: May 29, 2024
• First Submitted That Met QC Criteria: May 29, 2024
• First Posted (Estimated): June 4, 2024

Study Record Updates

• Last Update Posted (Estimated): June 4, 2024
• Last Update Submitted That Met QC Criteria: May 29, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Parkinsonian Disorders; Basal Ganglia Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases; Parkinson Disease
• Other Study ID Numbers: 24-100

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No