Tackling anxiety- and stress-related freezing of gait in people with Parkinson’s disease (TACKLING-FOG): study protocol for a randomized controlled trial

Tackling anxiety- and stress-related freezing of gait in people with Parkinson’s disease (TACKLING-FOG): study protocol for a randomized controlled trial | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 17 January 2026 V1 Latest version Share on Tackling anxiety- and stress-related freezing of gait in people with Parkinson’s disease (TACKLING-FOG): study protocol for a randomized controlled trial Authors : Gijs Vissers 0009-0008-2440-3492 [email protected] , Anouk Tosserams , Annelien Duits A , Anouk van der Heide , Bastiaan Bloem , Rick C. Helmich , William Young R , and Jorik Nonnekes Authors Info & Affiliations https://doi.org/10.22541/au.176866755.56870836/v1 368 views 84 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Freezing of gait (FOG) is a common and disabling symptom in people with Parkinson’s Disease (PD), characterized by paroxysmal episodes where there is an inability to step effectively, despite attempting to do so. Anxiety and stress exacerbate FOG, particularly in situations where people with FOG anticipate not being in control of their movements. Some people with PD use compensatory strategies that target anxiety and stress to improve FOG. However, tailored strategies to ameliorate anxiety- and stress-related FOG have never been evaluated in a systematic manner. TACKLING-FOG aims to evaluate the effectiveness of a novel 4-week Managing-the-Mental-State-intervention in reducing FOG-related anxiety and stress, in order to improve FOG. We also aim to identify the key determinants influencing the response to the intervention. This study is a randomized controlled trial (RCT) with a waitlist control group. Forty participants with PD who experience anxiety- or stress-related FOG will be included. All participants receive a baseline measurement and are subsequently randomized to the intervention or control group in a 1:1 ratio. The intervention group immediately receives 4 weekly sessions of the Managing-the-Mental-State-intervention, whereas the control group enters a waitlist period. Afterwards, both groups are reassessed. Next, the intervention group enters a 10-week follow-up period, while the control group receives the intervention, is re-assessed, and enters the follow-up period. Both groups receive a final measurement at the end of the follow-up. The primary outcome is the percentage of time frozen during a home-based walking course that includes self-selected FOG ‘hotspots’. Secondary outcomes involve the percentage of time frozen during the same trajectory under elevated-stress conditions and during a standardized FOG-provoking protocol. Additionally, heart rate is collected as a physiological marker of stress and anxiety, and questionnaires are administered to assess domains that may improve in response to the intervention, including anxiety, quality of life, and self-esteem. TACKLING-FOG will be the first RCT to examine the use of tailor-made behavioral strategies to tackle anxiety- and stress-related FOG in people with PD. Supplementary Material File (figure_1.docx) Download 36.18 KB File (table_1.docx) Download 14.50 KB File (table_2.docx) Download 20.90 KB File (tackling-fog_manuscript_protocolpaper_final.docx) Download 148.65 KB Information & Authors Information Version history V1 Version 1 17 January 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords anxiety parkinson disease parkinson's Authors Affiliations Gijs Vissers 0009-0008-2440-3492 [email protected] Radboud universitair medisch centrum View all articles by this author Anouk Tosserams Radboud universitair medisch centrum View all articles by this author Annelien Duits A Radboud universitair medisch centrum View all articles by this author Anouk van der Heide Radboud universitair medisch centrum View all articles by this author Bastiaan Bloem Radboud universitair medisch centrum View all articles by this author Rick C. Helmich Radboud universitair medisch centrum View all articles by this author William Young R University of Exeter Faculty of Health and Life Sciences View all articles by this author Jorik Nonnekes Radboud universitair medisch centrum View all articles by this author Metrics & Citations Metrics Article Usage 368 views 84 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Gijs Vissers, Anouk Tosserams, Annelien Duits A, et al. Tackling anxiety- and stress-related freezing of gait in people with Parkinson’s disease (TACKLING-FOG): study protocol for a randomized controlled trial. Authorea . 17 January 2026. DOI: https://doi.org/10.22541/au.176866755.56870836/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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