This clinical trial investigates the effects of block periodization training versus traditional power resistance training on neuromuscular and functional performance in persons with Parkinson's Disease. The study addresses a critical question in exercise prescription for PD: whether systematic periodization—cycling through different training phases—provides superior benefits compared to continuous high-intensity power training[@signorile].
Periodization is a well-established exercise programming approach in sports science that involves systematic variation of training variables (intensity, volume, and exercise selection) over time. While widely used in athletic populations, its application to neurodegenerative conditions like Parkinson's disease remains poorly understood. This trial represents one of the first efforts to translate periodization principles to PD rehabilitation[@hemmelmann].
| Parameter | Value |
|---|---|
| NCT Number | NCT07141849 |
| Title | Periodization and Parkinson's Disease |
| Official Title | Comparison of Changes in Neuromuscular and Functional Performance Due to Block Periodization or Traditional Power Training in Persons With Parkinson's Disease |
| Phase | Not Applicable (Interventional) |
| Status | RECRUITING |
| Sponsor | University of Miami |
| Lead Principal Investigator | Joseph Signorile, PhD |
| Enrollment | 60 participants |
| Study Type | INTERVENTIONAL |
| Allocation | Randomized, Parallel Group |
| Masking | None (Open Label) |
| Start Date | August 29, 2025 |
| Primary Completion | December 30, 2025 |
| Last Updated | September 2, 2025 |
This is a randomized, controlled, parallel-group trial comparing two resistance training paradigms:
| Design Element | Description |
|---|---|
| Allocation | Randomized (1:1 ratio) |
| Intervention Model | Parallel |
| Primary Purpose | Treatment |
| Masking | None (participants and researchers aware of assignment) |
| Enrollment | 60 participants (30 per arm) |
Participants in this arm receive traditional high-speed power resistance training:
The power training approach emphasizes rapid force production through quick muscle contractions, targeting the velocity component of force generation that is particularly affected in Parkinson's disease[@fragkiadaki2023].
Participants in this arm undergo a structured block periodization program:
The periodization protocol follows a three-phase block model:
| Phase | Duration | Focus | Intensity |
|---|---|---|---|
| Hypertrophy | Weeks 1-3 | Muscle growth, metabolic stress | 60-70% 1RM, 12-15 reps |
| Strength | Weeks 4-9 | Force development | 75-85% 1RM, 6-10 reps |
| Power | Weeks 10-12 | Velocity training | 50-70% 1RM, 3-6 reps |
This systematic cycling allows different physiological adaptations to be targeted sequentially, potentially optimizing overall training efficiency[@hemmelmann].
The inclusion of Hoehn & Yahr stages 1-3 ensures participants can safely perform resistance exercises while representing the population most likely to benefit from exercise interventions. The exclusion criteria protect vulnerable individuals from exercise-related adverse events while maintaining external validity[@schoot2022].
Measure: Maximum load that can be lifted in one repetition
Testing Protocol:
Timepoints: Baseline, 12 weeks
Significance: 1RM is the gold standard for measuring muscle strength and provides direct insight into force-generating capacity. Reductions in 1RM are associated with functional decline in PD, while improvements predict better outcomes[@bloem2023].
Measure: Power produced at various loads
Testing Protocol:
Timepoints: Baseline, 12 weeks
Significance: Power (the ability to produce force rapidly) is more strongly associated with functional mobility than strength alone. PD particularly affects power generation, making this a clinically meaningful endpoint[@fragkiadaki2023].
Measure: Gait velocity
Protocol:
Clinical Significance: Gait speed is a powerful predictor of fall risk, institutionalization, and mortality in PD. Improvements of 0.10 m/s are considered clinically meaningful.
Measure: Functional lower body strength
Protocol:
Clinical Significance: This test predicts functional independence and fall risk. It specifically assesses the lower limb strength needed for daily activities like rising from a chair.
Measure: Upper body power
Protocol:
Clinical Significance: Assesses functional upper body power important for reaching and daily activities.
Measure: Dynamic mobility and balance
Protocol:
Clinical Significance: The TUG is a validated, reliable measure of functional mobility in PD. Times >13.5 seconds indicate increased fall risk.
Periodization has been a cornerstone of athletic training for decades, but its application to rehabilitation populations is emerging. The principle of systematic training variation allows:
Block periodization, as used in this trial, organizes training into concentrated phases:
Phase 1: Hypertrophy (Weeks 1-3)
Phase 2: Strength (Weeks 4-9)
Phase 3: Power (Weeks 10-12)
Power training specifically targets the velocity component of movement that is disproportionately affected in PD:
Studies show power training improves:
The mechanism involves both neural adaptations (faster motor unit recruitment) and muscle-specific changes (improved fiber type recruitment)[@ruder2023].
Both training approaches likely benefit PD through multiple pathways:
Exercise increases brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), and insulin-like growth factor (IGF-1). These factors:
Exercise modulates microglial activation and reduces pro-inflammatory cytokines (IL-6, TNF-α). Chronic neuroinflammation drives PD progression, making this an important disease-modifying mechanism.
Exercise enhances functional connectivity in motor networks:
This trial contributes to growing evidence that exercise may modify PD progression beyond symptomatic management:
If block periodization proves superior, it would provide:
For clinicians prescribing exercise in PD:
| Consideration | Power Training | Periodization |
|---|---|---|
| Simplicity | Simple to implement | Requires phase transitions |
| Progression | Gradual load increase | Distinct phase shifts |
| Adaptation | Single pathway | Multiple targeted pathways |
| Monitoring | Load-based | Phase-specific metrics |
Laboratory of Neuromuscular Research and Active Aging
| Role | Name | Contact |
|---|---|---|
| Primary Contact | Caleb P Calaway, BS | cpc79@miami.edu |
| Principal Investigator | Joseph F. Signorile, PhD | jsignorile@miami.edu |
| Phone | — | 305-284-3105 |
Currently Recruiting: The trial is actively enrolling participants meeting eligibility criteria.
Based on the study design and existing evidence, this trial will provide valuable data on:
Primary Hypothesis: Block periodization training will produce greater improvements in power output compared to traditional power training, while producing equivalent improvements in strength.
Secondary Hypotheses: