{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T02:17:42Z","timestamp":1793758662831,"version":"4.6.1"},"reference-count":87,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["10930012310020"],"award-info":[{"award-number":["10930012310020"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lifestyle interventions have potential to support people with Parkinson\u2019s disease (PD) in self-managing their disease and improving quality of life. Growing evidence suggests positive effects of singular lifestyle interventions, such as physical activity, stress or nutrition. However, several challenges remain. First, despite potential additive and perhaps even synergistic effects, research on combining lifestyle interventions is limited. Second, lifestyle interventions are not routinely addressed as part of standard medical care. Finally, there are significant challenges related to changing behavior and adherence to lifestyle interventions. This study aims to evaluate the effectiveness and cost-effectiveness of an integrated, personalized and stepped care lifestyle approach for people with PD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We will perform a 12-month single-blind randomized controlled trial. We aim to include 256 people with PD, randomized in a 1:1 ratio into a control and intervention group. Both groups receive a clinical assessment with a lifestyle coach and can partake in usual care. The intervention group receives an additional lifestyle intervention, consisting of guidance and interventions on different lifestyle domains: stress, exercise, nutrition, sleep and self-management (the SENSS approach). This intervention is offered remotely according to a stepped care model to personalize the intervention to the participants\u2019 needs and abilities. The primary endpoint is the between-group difference in quality of life at 12\u202fmonths (Parkinson\u2019s Disease Questionnaire-39). Secondary endpoints include between-group differences in PD symptoms, health-related outcomes, self-management and personal goals. Cost-effectiveness and the experiences of participants and healthcare professionals will also be explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study evaluates the effectiveness of an integrated personalized lifestyle intervention for people with PD on both clinical and socio-economic outcomes. We expect this intervention to improve quality of life and self-management of people with PD, without increasing healthcare costs. We also expect to offer valuable insights into how such an intervention can be integrated into current daily care for people with PD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      , identifier NCT06669455.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1752073","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T05:23:40Z","timestamp":1772515420000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The SENSS (Stress, Exercise, Nutrition, Sleep, Self-management) study: study protocol for a randomized controlled trial to evaluate an integrated, personalized and stepped care lifestyle approach for people with Parkinson\u2019s disease"],"prefix":"10.3389","volume":"17","author":[{"given":"Ties J.","family":"Gaveel","sequence":"first","affiliation":[{"name":"Radboud University Medical Center, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elbrich M.","family":"Postma","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastiaan R.","family":"Bloem","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirwan K. L.","family":"Darweesh","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marten","family":"Munneke","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Overbeek","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Helmich","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Zeevat","sequence":"additional","affiliation":[{"name":"Health-Ecore","place":["Zeist, Netherlands"]},{"name":"Department of Health Sciences, University Medical Center Groningen, University of Groningen","place":["Groningen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meine","family":"Zijlstra","sequence":"additional","affiliation":[{"name":"Health-Ecore","place":["Zeist, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis","family":"Boersma","sequence":"additional","affiliation":[{"name":"Health-Ecore","place":["Zeist, Netherlands"]},{"name":"Department of Health Sciences, University Medical Center Groningen, University of Groningen","place":["Groningen, Netherlands"]},{"name":"Department of Management Sciences, Open University","place":["Heerlen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiaan","family":"Overeem","sequence":"additional","affiliation":[{"name":"Sleep Medicine Center Kempenhaeghe","place":["Heeze, Netherlands"]},{"name":"Biomedical Diagnostics Lab, Department of Electrical Engineering, Eindhoven University of Technology","place":["Eindhoven, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelique","family":"Pijpers","sequence":"additional","affiliation":[{"name":"Sleep Medicine Center Kempenhaeghe","place":["Heeze, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Jakimowicz","sequence":"additional","affiliation":[{"name":"Sleep Medicine Center Kempenhaeghe","place":["Heeze, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merel M.","family":"van Gilst","sequence":"additional","affiliation":[{"name":"Sleep Medicine Center Kempenhaeghe","place":["Heeze, Netherlands"]},{"name":"Biomedical Diagnostics Lab, Department of Electrical Engineering, Eindhoven University of Technology","place":["Eindhoven, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne E. M.","family":"Speckens","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Department of Psychiatry, Center of Expertise for Mindfulness, Donders Institute for Brain, Cognition and Behaviour","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Th\u00e9","sequence":"additional","affiliation":[{"name":"Development and Implementation of Decision Aids, ZorgKeuzeLab","place":["Delft, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert","family":"Manhoudt","sequence":"additional","affiliation":[{"name":"Patient Research Council, Dutch Parkinson Association","place":["Utrecht, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemiek","family":"van der Wel","sequence":"additional","affiliation":[{"name":"Patient Research Council, Dutch Parkinson Association","place":["Utrecht, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelien A.","family":"Duits","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University","place":["Maastricht, Netherlands"]},{"name":"Department of Medical Psychology, Maastricht University Medical Center","place":["Maastricht, Netherlands"]},{"name":"Department of Medical Psychology, Radboud University Medical Center","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nienke M.","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Human Movement Science, University Medical Center Groningen, University of Groningen","place":["Groningen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/S1474-4422(24)00038-3","article-title":"Global, regional, and national burden of disorders affecting the nervous system, 1990\u20132021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"23","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cger.2019.08.002","article-title":"Parkinson disease epidemiology, pathology, genetics, and pathophysiology","volume":"36","author":"Simon","year":"2020","journal-title":"Clin Geriatr Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1111\/cns.13549","article-title":"Quality of life in Parkinson\u2019s disease: a systematic review and meta-analysis of comparative studies","volume":"27","author":"Zhao","year":"2021","journal-title":"CNS Neurosci Ther"},{"key":"ref4","volume-title":"Parkinson\u2019s disease: pathogenesis and clinical aspects","author":"Zahoor","year":"2018"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1001\/jama.2019.22360","article-title":"Diagnosis and treatment of Parkinson disease: a review","volume":"323","author":"Armstrong","year":"2020","journal-title":"JAMA"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/S1474-4422(25)00305-9","article-title":"The role of lifestyle interventions in symptom management and disease modification in Parkinson\u2019s disease","volume":"25","author":"Trinh","year":"2026","journal-title":"Lancet Neurol"},{"key":"ref7","article-title":"6 pillars of lifestyle medicine","year":""},{"key":"ref8","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.brainres.2016.10.029","article-title":"Neuroprotective effects of endurance exercise against neuroinflammation in MPTP-induced Parkinson\u2019s disease mice","volume":"1655","author":"Jang","year":"2017","journal-title":"Brain Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"S141","DOI":"10.1002\/mds.22782","article-title":"Enhancing neuroplasticity in the basal ganglia: the role of exercise in Parkinson\u2019s disease","volume":"25","author":"Petzinger","year":"2010","journal-title":"Mov Disord"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"193","DOI":"10.3233\/JPD-160912","article-title":"Regular exercise, quality of life, and mobility in Parkinson\u2019s disease: a longitudinal analysis of National Parkinson Foundation quality improvement initiative data","volume":"7","author":"Rafferty","year":"2017","journal-title":"J Parkinsons Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"144","DOI":"10.3390\/jpm12020144","article-title":"Gastrointestinal dysfunction in Parkinson\u2019s disease: current and potential therapeutics","volume":"12","author":"Han","year":"2022","journal-title":"J Pers Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1038\/s41531-023-00541-w","article-title":"To restrict or not to restrict? 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