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Abstract Background: Patients with Parkinson’s disease (PD) have shown impaired gait rhythmicity and increased prefrontal activation during complex tasks, presumably to compensate for decreased automaticity. Exercise can reduce cortical excitability and enhance automaticity, thereby improving walking function. However, the effectiveness of treadmill training and Baduanjin on prefrontal activity has received little attention when patients with PD walk under different dual-task conditions. This randomized control trial (RCT) will investigate the comparative effects of treadmill training and Baduanjin on prefrontal activation and gait function during both single and dual tasks in PD. Methods: This RCT will be designed as a single-center, three-arm, single-blind study. One hundred and forty-four participants will be allocated into treadmill training, Baduanjin, or waitlist control groups. Participants in both the treadmill training and Baduanjin groups will receive 45 min of specific exercise three times weekly for 12 weeks. Participants in the control groups will maintain routine care and lifestyle. The primary and secondary outcomes will be assessed at baseline, after a 12-week intervention, and at the end of a12-week follow-up. The primary outcomes will be prefrontal activation (oxygenated hemoglobin concentration, HbO2) measured by functional near-infrared spectroscopy (fNIRS), and gait parameters (gait speed, stride length, double-phase time, stride variability, and step width) assessed by an electronic walkway with pressure sensors. The secondary outcomes will be motor function, balance, mobility, and quality of life. Discussion: This study will determine whether treadmill training or Baduanjin is more effective in reducing prefrontal activation and improving gait function. If the findings are consistent with our expectations, they may help clinicians and physical therapists to manage gait impairments in patients with PD and to select targeted interventions for them. Trial registration: https://www.chictr.org.cn/. Trial number: ChiCTR2300075048. Registered on 23 Aug 2023.
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