---
title: "Basic versus Dual-task Training in Parkinson’s Disease: Results from the PARKEX Trial"
id: "plos-one-15-effects-of-basic-and-dual-task-training-programs-on-physical-function-in"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-15-effects-of-basic-and-dual-task-training-programs-on-physical-function-in"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358534"
published_at: "2026-09-18T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Basic versus Dual-task Training in Parkinson’s Disease: Results from the PARKEX Trial
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-15-effects-of-basic-and-dual-task-training-programs-on-physical-function-in
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358534)
- **Published At:** 2026-09-18T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The PARKEX randomized controlled trial compared **Basic Physical Training (BPT)**, BPT combined with **Functional Exercises (BPT + FE)** (dual-task), and a no-intervention control in people with idiopathic Parkinson’s disease. - Twenty-four participants were randomized and received interventions over 12 weeks with three 60-minute sessions per week; a control group received no intervention. - Primary mechanistic goal of the trial was to assess mitochondrial function; clinical and functional measures were prospectively collected as additional endpoints. - Physical performance improved with both active programs versus control: 1-minute Sit-to-Stand (STS) increased for BPT vs. control (Mean Difference [MD] = 31.00; p = 0.0026) and for BPT + FE vs. control (MD = 19.00; p = 0.0026). - Functional mobility measured by Timed Up and Go (TUG) improved for BPT vs. control (MD = −2.07 s; p = 0.0039) and for BPT + FE vs. control (MD = −2.43 s; p = 0.0028). - Patient-reported outcomes (PDQ-39 quality of life and BDI depressive symptoms) did not show statistically significant between-group differences, though several subscales demonstrated medium effect sizes suggesting possible psychosocial benefits: emotional well-being, bodily discomfort, and activities of daily living. - The authors conclude both exercise programs produced meaningful physical performance gains in early-stage PD; psychosocial effects require confirmation in larger trials. - Trial registration: ClinicalTrials.gov NCT05963425. Data supporting the study are available in a Zenodo repository at the DOI provided in the source. - The published report did not provide full protocol details in the provided excerpt (e.g., complete exercise content, participant demographics, randomization procedures, adherence, or adverse events), which were not reported in the available source text.
## Clinical Analysis & Structured Key Points
Effects of basic and dual-task training programs on physical function in Parkinson’s disease: The PARKEX study | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Exercise is a promising non-pharmacological intervention for motor and non-motor symptoms in Parkinson’s disease (PD). However, direct comparisons between basic physical training (BPT) and dual-task training remain limited. The objective of the current clinical trial is to evaluate clinical and functional effects of BPT and a BPT combined with dual-task functional exercises (BPT + FE) in individuals with PD. In this randomized controlled trial, 24 participants with idiopathic PD were allocated to BPT, BPT + FE, or a no-intervention control group (Con). Interventions lasted 12 weeks (three 60-minute sessions/week). Outcomes included quality of life (PDQ-39), depressive symptoms (BDI), lower-limb strength (1-minute Sit-to-Stand Test, STS), and functional mobility (Timed Up and Go, TUG). Group effects were analyzed using permutation-based ANOVA with Bonferroni correction. Both interventions significantly improved physical performance vs. controls. STS gains were observed for BPT vs. Con (Mean Difference, MD = 31.00; p = .0026) and BPT + FE vs. Con (MD = 19.00; p = .0026). TUG times improved for BPT vs. Con (MD = –2.07s; p = .0039) and BPT + FE vs. Con (MD = –2.43s; p = .0028). Although BDI and PDQ-39 did not show statistically significant changes between group differences (r_rb = –0.429 and –0.339, respectively), several subscales demonstrated medium effect sizes suggesting potentially meaningful trends: emotional well-being (BPT: r_rb = –0.428; BPT + FE: r_rb = –0.446), bodily discomfort (BPT: r_rb = –0.524), and activities of daily living (BPT + FE: r_rb = –0.429). In conclusion, both programs improved physical performance in PD. Patient-reported outcomes did not reach statistical significance, but effect-size patterns suggest possible psychosocial benefits that warrant confirmation in larger trials. Trial registration ClinicalTrials.gov, NCT05963425 . Citation: Magaña JC, Enríquez-Calzada S, Prat R, Deus CM, Pereira SP, Avellanet M, et al. (2026) Effects of basic and dual-task training programs on physical function in Parkinson’s disease: The PARKEX study. PLoS One 21(9): e0358534. https://doi.org/10.1371/journal.pone.0358534 Editor: Meiling Qi, Shandong University, CHINA Received: November 25, 2025; Accepted: August 27, 2026; Published: September 18, 2026 Copyright: © 2026 Magaña et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The data supporting the findings of this study are publicly available in the Zenodo repository at https://doi.org/10.5281/zenodo.18788226 . The dataset is fully anonymized and shared under the Creative Commons Attribution 4.0 International (CC BY 4.0) license. Funding: This work was supported by research funds provided to JM by the Ajuts a l’Activitat de Recerca del Personal Docent i Investigador de la Universitat Ramon Llull (2021-URL-Proj-004). JCM was supported by the Funding program PGRiD 2019–2021 of the School of Psychology, Education, and Sport Sciences Blanquerna (APR-FPCEE2122/04). Funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Introduction Parkinson’s disease (PD) is one of the most prevalent and disabling neurodegenerative disorders globally, and represents a substantial and growing burden on public health systems [ 1 ]. As of 2021, approximately 11.8 million individuals worldwide were living with PD, a number projected to exceed 12 million by 2040 and to reach 25.2 million by 2050, due to population aging and increased life expectancy [ 2 ]. The burden of PD is increasing faster than that of almost any other neurological disorder, placing increasing pressure on global health systems [ 3 ]. This rising burden underscores the urgent need for effective interventions targeting not only symptom relief but also disease-modifying mechanisms [ 4 ]. In addition to its well-known motor symptoms, PD also imposes a significant burden through non-motor symptoms such as depression, cognitive impairment, or compromised quality of life, which often remain under-recognized and undertreated. Currently, there are no pharmacological treatments capable of modifying the course of the disease or controlling its neurodegenerative progressions, and available therapies are primarily symptomatic. In this context, physical activity (PA) has emerged as a promising non-pharmacological therapeutic approach capable of producing clinically meaningful improvements in PD and it is increasingly recognized as an effective strategy for delaying disease progression [ 5 , 6 ]. At the same time, there is growing interest in tailoring exercise interventions to individual patient profiles, optimizing their intensity, duration, and cognitive demands to maximize both adherence and therapeutic benefit. Recent research suggests that regular PA may not only alleviate motor symptoms but also confer potential neuroprotective effects by enhancing neuroplasticity, upregulating neurotrophic factors, and reducing neuroinflammation [ 7 ]. Moreover, PA can improve non-motor symptoms including mood disturbances, sleep disorders, and cognitive decline, thereby contributing to overall quality of life [ 8 ]. Given its multifaceted benefits and low risk profile, integrating structured exercise programs into standard care should be a crucial strategy for PD management; however, high-quality randomized controlled trials in PD populations remain limited, especially those comparing different types of exercise programs and their impact on standard clinical outcomes such as functional mobility, depressive symptoms, and quality of life. Previous studies have shown that dual-task functional training, which simultaneously challenges motor and cognitive functions, can provide greater improvements in gait, balance, and executive functioning compared to single-task approaches in people with PD [ 9 ]. Given the close interaction between motor and cognitive systems, targeting both domains together offers advantages beyond those achieved with motor training alone. Randomized controlled trials have implemented dual-task interventions combining locomotor activities with concurrent cognitive tasks (e.g., mental arithmetic, verbal fluency) or coordinated motor demands (e.g., obstacle negotiation, manipulative tasks), reporting improvements in mobility, balance, and selected executive domains such as divided attention, inhibitory control, working memory, and set-shifting [ 10 – 15 ]. The present study evaluated the clinical and functional outcomes of the PARKEX randomized controlled trial (NCT05963425) [ 16 ], which compared Basic Physical Training (BPT) and BPT combined with Functional Exercises (BPT + FE) against a no-intervention control group in patients with early-stage PD. The PARKEX trial was originally designed to evaluate changes in mitochondrial function as its primary biological endpoint. In addition to these mechanistic outcomes, clinical, motor, non-motor, and quality-of-life measures were prospectively collected to explore the potential functional impact of the intervention. We hypothesized that both interventions would lead to significant improvements in health-related quality of life, depressive symptoms, and functional mobility, with additional benefits expected from dual-task functional training components. This study aims to contribute to the growing body of evidence supporting structured PA as a key element in early PD management. It further explores the added value of dual-task functional training in enhancing physical and mental health outcomes, while providing practical guidance for the development of personalized and scalable exercise interventions for this population. Methods Study design This randomized study employed a between-subjects experimental design to assess the effects of different interventions on quality of life, depressive symptoms, and functional performance. Participants were categorized into three groups based on the intervention received: (1) Basic Physical Training (BPT) focused on strength and resistance, (2) BPT combined with Functional Exercises (BPT + FE), corresponding to a dual-task training condition in which motor exercises were performed simultaneously with structured cognitive tasks, and (3) a no-intervention control group (Con). The 60-minute sessions were conducted 3 times a week for 3 months with 8 participants per group. Attendance was recorded at each session by the supervising trainer. Outcome assessments were conducted by evaluators who were not involved in the intervention delivery. Participant recruitment started in September 2023, and concluded in October 2023. The intervention phase and assessments for outcome measures concluded in May 2024. All study participants provided written informed consent prior to enrollment. The trial was registered at ClinicalTrials.gov (NCT05963425) and the full clinical study protocol was previously published [ 16 ]. Participants A total of 24 individuals diagnosed with idiopathic PD were recruited by the Neurodegenerative Diseases Group of the Vall d’Hebron Research Institute (VHIR), Barcelona, Spain. The sample size (N = 24) was calculated based on the primary mitochondrial endpoint of the trial, as detailed in the published protocol. Clinical and functional outcomes analyzed in the present manuscript were secondary endpoints and the study was not specifically powered to detect changes in these measures. The inclusion criteria comprised patients diagnosed with idiopathic PD in early stages (H&Y stages I-III) during the ‘on’ phase, with good cognitive function (Montreal Cognitive Assessment (MoCA) score ≥26), aged between 45 and 75 years, on a stable medication regimen for at least four weeks prior to enrollment, and capable to participate in exercise programs. Exclusion criteria included comorbidities contraindicating exercise, cognitive impairment (with a MoCA score <26), and participation in other clinical trials. Participants were randomly assigned by an independent investigator to the 3 groups (BPT, BPT + FE, or Con) using a computer-generated block randomization sequence (performed with the program Research Randomizer), and stratified by age and sex after checking the eligibility criteria. Sample size was calculated as described in the study protocol [ 16 ]. A CONSORT flow diagram illustrating participant recruitment, allocation, follow-up, and analysis is provided in Fig 1 . Download: PNG larger image TIFF original image Fig 1. CONSORT flow diagram showing participant flow through the three study arms: BPT, BPT + FE, and control. https://doi.org/10.1371/journal.pone.0358534.g001 Patient and public involvement Patients and the public were not involved in the design or conduct of the study. However, patients contributed to the dissemination of the research findings by participating in conference presentations and related outreach activities. The study protocol was developed by clinicians and physical activity researchers. Overview of the Programs In both intervention programs (BPT and BPT + FE), the core strength–endurance component (BPT) was delivered using eccentric resistance training with a flywheel device ( kBox4 , Exxentric AB, Stockholm, Sweden). The kBox4 inertial discs available were: XS 0.005, S 0.010, M 0.025, and L 0.050 kg·m2, selected by movement pattern and postural demand. The interventions were delivered 3 times per week for 12 weeks. While the overall session structure remained consistent, task complexity and training load were progressively increased based on participant performance. The program was divided into four mesocycles of variable duration (ranging from 2 to 4 weeks), beginning with a neuromuscular adaptation phase, and progressing toward higher eccentric load and power-oriented stimuli. Training intensity was prescribed using the Borg CR10 scale, initially targeting a moderate level (Borg 3–5) and progressively increasing to high levels (Borg 7–9) [ 17 ]. Perceived effort was monitored every two weeks to ensure alignment with the intended intensity range and to guide individualized progression. Flywheel inertia (XS–L) and concentric movement velocity were adjusted to modulate eccentric overload while maintaining safety in people with PD. Mechanical variables displayed by the kMeter system (Exxentric AB, Stockholm, Sweden) were used as real-time biofeedback during exercise execution, allowing participants to visually associate their performance with perceived effort. Perceived exertion was assessed using the Borg CR-10 scale by asking: How difficult was this combination of strength, speed, and inertia? . These ratings were used to guide training progression across mesocycles. The load prescription strategy was further informed by the Flywheel Workout Zones, which maps training stimulus according to the interaction between inertial load and concentric speed [ 18 , 19 ]. For the PARKEX protocol, this framework was adapted to the specific neuromechanical requirements of PD, integrating Borg CR-10 intensity ranges and mesocycle progression ( Fig 2 ). We linked inertia, intended speed, Borg targets and mesocycles as follows: technique and warm-up sessions used small (S) to medium (M) inertia (0.010–0.025 kg·m 2 ) at low speed and Borg 3–5, typically during M1–M2; strength sessions used M inertia (0.025 kg·m 2 ) at low-to-moderate speed and Borg 5–7, during M2–M3; power sessions used extra small (XS) to S inertia (0.005–0.010 kg·m 2 ) at high speed with strict form, Borg 6–8, and short sets, typically in M2; and eccentric overload sessions used M–large (L) inertia (0.025–0.050 kg·m 2 ) with maximal concentric intent and a prolonged eccentric phase, Borg 7–9, during M3–M4, avoiding the high-inertia × high-speed corner for safety in PD ( Fig 2 ). Download: PNG larger image TIFF original image Fig 2. Flywheel training zones for PD in the PARKEX protocol. Zones were defined according to execution speed categories (low–mid–high) and flywheel inertia, with intensity progression guided by the Borg CR-10 scale throughout mesocycles. https://doi.org/10.1371/journal.pone.0358534.g002 A summary of the 12-week training program can be seen in Table 1 : Download: PNG larger image TIFF original image Table 1. Overview of the flywheel training program for PD. https://doi.org/10.1371/journal.pone.0358534.t001 The BPT + FE group performed the same motor training as the BPT group, with the addition of concurrent executive-function tasks integrated directly into the exercises. Cognitive and motor demands were applied simultaneously to induce cognitive–motor interference. Dual-task elements included verbal fluency or structured verbal tasks during resistance exercises, reading modified or non-meaningful text aloud while performing motor tasks, ball-passing activities combined with lower-limb coordination tasks, and corridor-based gait training performed concurrently with cognitive challenges. A summary of the structure and progression of the dual-task training component can be seen in S1 Table . Functional transfer was a key pillar of the program, integrating multi-joint exercises in functional positions (1-min Sit-to-Stand repetitions; STS), presses, rows, lunges) and complex combinations such as the row-squat, which simultaneously challenged strength, postural control, balance, and cardiovascular adjustment [ 18 ]. A demonstration of the eccentric flywheel exercises used in the program can be seen in S2 File . Sessions were conducted during the ON-medication phase when feasible; used harness/hand support as needed, and participants were instructed not to release the flywheel during the eccentric phase. To illustrate the cognitive-motor integration achieved during training, examples of the dual-task exercises performed by the patients are shown in S3 File and S4 File . Outcome measures Clinical, motor, non-motor, and quality-of-life measures were prospectively collected as secondary outcomes within the PARKEX trial to explore the broader functional impact of the intervention. The primary endpoint of the overall trial was mitochondrial function, as described in the previously published study protocol. In the present analysis functional mobility measured by the Timed Up and Go (TUG) was considered the main clinical outcome. Additional outcomes included lower-limb muscular endurance (STS Test), health-related quality of life (PDQ-39 total and subscales), and depressive symptoms (BDI). Assessments were conducted at baseline and after the 12-week intervention period. To account for potential confounding factors, four covariates were included in the analysis: sex, age, body mass index (BMI), and levodopa equivalent daily dose (LEDD). LEDD was calculated following the updated recommendations by Jost et al. (2023), which provide standardized proposals for dose equivalency in PD [ 20 ]. Motor symptom severity was assessed using the Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) [ 21 ]. Cognitive function was evaluated using the MoCA [ 22 ]. Non-motor symptoms were assessed with the Movement Disorder Society-Non-Motor Symptoms Scale (MDS-NMS) [ 23 ], and sleep disturbances were measured using the Parkinson’s Disease Sleep Scale (PDSS) [ 24 ]. The study examined four key dependent variables. Quality of life was assessed using the Parkinson’s Disease Questionnaire-39 (PDQ-39), a disease-specific instrument that evaluates eight dimensions relevant to PD, including mobility, emotional well-being, stigma, social support, cognition, communication, bodily discomfort, and activities of daily living [ 25 , 26 ]. Depressive symptoms were measured with the Beck Depression Inventory (BDI), a widely used 21-item self-report scale assessing the severity of depressive symptoms [ 27 ]. Overall satisfaction was evaluated using the Client Satisfaction Questionnaire (CSQ-8), an eight-item tool providing a global measure of satisfaction with health and social services [ 28 ]. Functional performance was evaluated through two physical assessments: the STS test, which measured lower-body muscular endurance by recording the maximum number of STS repetitions performed with proper technique [ 29 ], and the Timed Up and Go (TUG) test, which evaluated functional mobility by measuring the time taken to stand up from a chair, walk three meters, turn around, return, and sit down again [ 30 , 31 ]. Statistical analysis Descriptive statistics were computed for demographic and clinical variables across the three treatment groups. For each continuous variable (Age, BMI, Years since diagnosis, Hoehn & Yahr stage, UPDRS Total at T1, MoCA at T1, MDS-UPDRS Total at T1, and PDSS-2 Total at T1), we reported the median and interquartile range (IQR), as the distributions were non-normal. To assess differences between groups, we employed non-parametric Kruskal–Wallis tests for each continuous variable. The categorical variable Sex was analyzed separately using a chi-squared test of independence. Data analysis was performed using the R programming language v.4.3.1 on the RStudio integrated development environment (IDE) v.2023.9.1.494 [ 32 , 33 ]. A permutation-based analysis of variance (permutation ANOVA, aovp) was conducted to examine the effect of study group on the outcome variables (BDI, PDQ-39, STS, and TUG), while controlling f
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