Objective: To describe the rationale and design of Move-Brain-PD, a randomized multicenter study evaluating whether remotely monitored home-based aerobic exercise improves cognition and motor symptoms in Parkinson’s disease (PD) with mild cognitive impairment (PD-MCI).

Background: PD-MCI is common, negatively affects quality of life, and is the major predictor for conversion to PD dementia¹. Although aerobic exercise shows beneficial effects on motor and non-motor symptoms and may exert disease-modifying effects^2–5, its impact on cognition in PD-MCI, particularly in real-world home-based settings, remains insufficiently explored⁶.

Method: Move-Brain-PD enrolls 150 patients aged 30-80 years with clinically established PD, Hoehn and Yahr stage 1-3, and PD-MCI defined by MDS Level II criteria⁷. Participants are randomized 1:1 to exercise or usual activity control. The intervention consists of at least 75 min/week of vigorous aerobic exercise (60-85% HRmax) or 150 min/week of moderate aerobic exercise (40-60% HRmax), in at least 2 weekly sessions for 12 months, and remotely monitored using a wearable device. Assessments at baseline and month 12 include MDS-UPDRS, NMSS, MoCA, and a multidomain neuropsychological battery. Blood markers include serum and extracellular vesicle measures of total-a-synuclein (a-syn), neurofilament light chain, pro- and anti-inflammatory cytokines, and BDNF, and post-translational modifications of blood derived a-syn. Our study is being conducted within the ERA4Health partnership (ERA4HEALTHNUTRIBRAIN-008 – NCT07299279).

Results: Primary and secondary outcomes include changes in global cognition, specific cognitive domains, and motor and non-motor features, together with blood markers of α-syn species and molecules related to neuroinflammation, neurodegeneration, and synaptic plasticity. Adherence to the physical activity prescription represents a key feasibility outcome.

Conclusion: Move-Brain-PD provides a clinically relevant framework for a remotely monitored non-pharmacological intervention in PD-MCI, evaluating both feasibility and clinical effects, with potential implications for routine exercise prescription and for understanding the mechanistic effects of physical activity in PD.

References: 1. Pedersen, K. F., Larsen, J. P., Tysnes, O. B. & Alves, G. Natural course of mild cognitive impairment in Parkinson disease: A 5-year population-based study. Neurology 88, 767–774 (2017).
2. Marino, G. et al. Intensive exercise ameliorates motor and cognitive symptoms in experimental Parkinson’s disease restoring striatal synaptic plasticity. Sci. Adv. 9, (2023).
3. Ernst, M. et al. Physical exercise for people with Parkinson’s disease: a systematic review and network meta-analysis. Cochrane Database Syst. Rev. 4, (2024).
4. Mak, M. K., Wong-Yu, I. S., Shen, X. & Chung, C. L. Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat. Rev. Neurol. 13, 689–703 (2017).
5. Langeskov-Christensen, M., Franzén, E., Hvid, L. G. & Dalgas, U. Exercise as medicine in Parkinson’s disease. J. Neurol. Neurosurg. Psychiatry 95, 1077–1088 (2024).
6. Murray, D. K., Sacheli, M. A., Eng, J. J. & Stoessl, A. J. The effects of exercise on cognition in Parkinson’s disease: a systematic review. Transl. Neurodegener. 3, (2014).
7. Litvan, I. et al. Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: Movement Disorder Society Task Force guidelines. Mov. Disord. 27, 349–356 (2012).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/move-brain-pd-a-randomized-multicenter-protocol-of-remotely-monitored-home-based-aerobic-exercise-for-parkinsons-disease-patients-with-mild-cognitive-impairment/