Parkinson's disease (PD) is a progressive neurological condition that can affect movement, balance, endurance, and overall quality of life. Exercise is widely recognized as one of the most effective non-pharmacological treatments to help people with PD maintain function and independence. However, not all exercise programs produce the same results, and more research is needed to understand which types of exercise offer the greatest physical and physiological benefits.

This study is designed to examine how different types of structured exercise programs influence motor function, cardiorespiratory fitness, and markers of overall health in individuals with Parkinson's disease. The goal is to better understand how exercise can be used to improve movement, daily activities, and general well-being, as well as how it affects the body at a physiological level.

Participants will be adults diagnosed with idiopathic Parkinson's disease who are medically stable and able to safely participate in exercise. Before beginning the study, participants will complete screening procedures to ensure safety and eligibility. Eligible participants will then be assigned to one of several supervised exercise interventions conducted over a defined period. Each exercise program is designed to improve movement and function but differs in structure or training emphasis (for example, aerobic, functional, or task-specific activity).

Exercise sessions will take place under the supervision of licensed physical therapist. Each session will include warm-up, exercise, and cool-down components. Intensity will be monitored using heart rate and perceived exertion to ensure safety and appropriate challenge. Participants will attend sessions multiple times per week for 8 weeks.

Researchers will collect information about movement abilities, balance, walking, endurance, and daily function using standardized physical therapy assessments such as gait tests, balance measures, and questionnaires related to quality of life at baseline, after 8-weeks of intervention and once more after a 4-week follow-up. In addition, blood samples will be collected to analyze physiological responses to exercise at the same 3 testing intervals. These samples will allow investigators to measure biomarkers related to cardiovascular health, nitric oxide availability, oxidative stress, and inflammation. These biological indicators can help identify how exercise affects underlying health mechanisms that may contribute to improved function in people with Parkinson's disease.

All data will be collected by trained research personnel who are experienced in working with individuals with Parkinson's disease. Participants will be monitored for safety at each session, and any adverse events will be documented and reviewed by the principal investigator and the Institutional Review Board (IRB).

By comparing changes across the different exercise programs, this study aims to determine which interventions have the most meaningful impact on mobility, endurance, and quality of life, as well as which ones produce measurable physiological benefits. Results from this research may help guide physical therapists, rehabilitation professionals, and people with Parkinson's disease in choosing the most effective exercise approaches for maintaining function and promoting overall health.

Ultimately, this project seeks to contribute to the growing evidence that targeted, engaging, and appropriately dosed exercise can play a key role in improving the lives of people living with Parkinson's disease. The findings may also help inform future clinical practice guidelines, community exercise programs, and long-term wellness strategies for individuals with movement disorders.

This study is a randomized, controlled, parallel-group trial designed to evaluate the effects of three distinct exercise interventions in individuals with Parkinson's disease. The study compares guided cycling, non-contact boxing, and traditional physical therapy, each representing different approaches to exercise based on differences in intensity, motor demands, and cardiovascular engagement.

Participants will be randomly assigned to one of the three intervention groups using a computer-generated allocation process. Each participant will complete a structured intervention program consisting of supervised exercise sessions conducted twice weekly over an eight-week period. Interventions will be delivered in outpatient clinical and community-based settings under the supervision of licensed physical therapists, with exercise intensity and progression adjusted according to individual performance and tolerance.

The total duration of participation is approximately 15 weeks and includes baseline assessment, an intervention phase, post-intervention testing, and a follow-up assessment following a four-week washout period without structured exercise. This design allows for evaluation of both immediate responses to training and short-term retention of exercise-related adaptations.

The guided cycling intervention utilizes structured aerobic training performed on stationary ergometers, with workload adjusted based on individualized physiological responses. The non-contact boxing intervention incorporates large-amplitude, rhythmical, and task-specific movements designed to engage motor, cognitive, and cardiovascular systems simultaneously. The traditional physical therapy intervention reflects standard rehabilitation practice and includes a combination of aerobic conditioning, balance training, strengthening, and functional mobility exercises.

All intervention sessions will be supervised by licensed physical therapists with support from trained personnel to ensure consistency of delivery and participant safety. Monitoring procedures will be used across all intervention groups to assess participant response and guide appropriate modification of activity as needed.

This study is conducted within a collaborative clinical and academic framework to support standardized implementation of interventions and data collection. The findings are intended to improve understanding of how different exercise strategies may influence adaptation in individuals with Parkinson's disease and to inform the development of more targeted rehabilitation approaches.

Study Design

This is a single-site, randomized, controlled, interventional trial conducted in El Paso, Texas, with collaboration between the University of Texas at El Paso (UTEP) and MOVE Therapy Services. Participants will be randomized (computer-generated block randomization) into one of three intervention arms:

1. Guided Cycling Group
2. Non-Contact Boxing Group
3. Traditional Physical Therapy (Standard Care) Group

The total duration for each participant is 15 weeks, consisting of:

• Week 1: Baseline testing
• Weeks 2-9: 8-week intervention (two 60-minute sessions per week)
• Week 10: Post-intervention testing
• Weeks 11-14: Four-week rest/washout
• Week 15: Final follow-up testing

All sessions will be led by licensed physical therapists with assistance from trained Doctor of Physical Therapy (DPT) students. Data collection will occur at UTEP's Rehabilitation Sciences Complex for the cycling and physical therapy groups, and at MOVE Therapy Services for the boxing group.

Intervention Descriptions

1. Non-Contact Boxing:

   This intervention emphasizes large-amplitude, rhythmical, and task-specific movements that combine cognitive, motor, and cardiovascular elements. Sessions include warm-up, boxing rounds (heavy bag, speed bag, mitt work), agility and balance circuits, and cool-down routines. Participants wear gloves, engage in multi-directional footwork, and perform high-intensity drills under therapist supervision. HR and BP are continuously monitored for safety.

2. Guided Cycling:

   This program uses stationary cycle ergometers (Lode Corival) with intensity determined by participants' lactate threshold, established through cardiopulmonary exercise testing (CPET). Each session includes a warm-up, 40-minute cycling component with alternating low, moderate, and high-intensity bouts, and a cool-down. HR and RPE are recorded throughout. Lactate micro-sampling from the earlobe is used periodically to confirm workloads within prescribed zones.

3. Traditional Physical Therapy (Standard Care):

This intervention incorporates multimodal training emphasizing aerobic exercise, resistance and balance training, gait practice, and task-specific functional activities. Intensity is set between 60-85% HRmax, adjusted by perceived exertion and HR monitoring. Each session includes warm-up, treadmill or cycling intervals, balance tasks with and without visual cues, strength training, and community-oriented gait exercises. Safety is ensured through therapist supervision, gait belts, and appropriate rest breaks.

Inclusion Criteria:

1. Diagnosis of Parkinson's Disease
2. Independent ambulation
3. Hoehn and Yahr stage of 1-3
4. 50 years of age or older
5. Must speak English or Spanish

Exclusion Criteria:

1. History of stroke
2. History of heart attack
3. Non-ambulatory
4. Hoehn and Yahr of stage 4 or 5
5. Osteoporosis
6. Unmanaged Parkinson's medication

Individual participant data will be available without identifiers upon request.