Parkinson's disease (PD) is a chronic progressive neurological disorder that involves motor and non-motor symptoms that commonly include bradykinesia, rigidity, tremor and postural instability and culminates in functional decline and disability. Postural instability is due to postural changes that are commonly found in these individuals. Muscular disorders characterized by the inability to generate adequate synergy patterns may be responsible for postural instability, leading to postural changes in the sagittal plane, usually with the installation of hyperkyphosis. Exercise is increasingly being recognized as an effective and highly promising non-pharmacological intervention for improving muscle strength in PD. Typical physiotherapy treatment on the ground includes strength training, gait and balance training and has numerous benefits in reducing the motor symptoms of PD. Interventions such as aquatic physical therapy have a growing body of evidence to support the effectiveness of exercise in the PD population. Aquatic exercise has the intrinsic advantage of helping individuals shed their body weight, leading to greater effectiveness of the exercise itself. Knowing that muscle strength is associated with functional capacity and disease severity, physiotherapy becomes an important treatment resource with exercises to improve muscle strength and consequently reduce subsequent functional difficulties. However, due to the scattered evidence of physiotherapy in PD, there is not enough evidence to prescribe a defined rehabilitation program for strengthening trunk extensor musculature, although there is increasing evidence of the effectiveness of therapies on land or aquatic therapy, the evidence is insufficient to support or refute the effectiveness of one physiotherapeutic intervention over another. Therefore, the objective of this study is to investigate the effect of physiotherapy on land and physiotherapy in shallow water in relation to the composition and strength of the trunk extensor and flexor musculature of individuals with Parkinson's disease. A Randomized Clinical Trial will be conducted, in which individuals with a diagnosis of Parkinson's Disease, of the akinetic rigid type, with postural instability, classified from 1 to 3 by the Hoehn and Yahr Scale, aged between 60 and 75 years, and who sign the Free and Informed Consent Form.~Individuals will be randomized into three treatment groups: physical therapy on land, aquatic physical therapy and power training. Evaluation will be carried out in two stages: pre-intervention and post-intervention. The evaluation will consist of an analysis of:~Cognitive function of individuals with Parkinson's disease by the Mini Mental State Examination;~Muscle strength of trunk flexors and extensors and knee extensors and flexors in individuals with Parkinson's disease using an isokinetic dynamometer (Cybex);~Echogenicity and thickness of the quadriceps muscles in individuals with Parkinson's disease through ultrasonography;~Body composition by DEXA;~Balance and functional capacity of individuals with Parkinson's Disease through the Timed Up and Go Test - TUG;~Motor function by the Unified PD Scale (UPDRS III);~Assessment of strength and balance through the sit and stand test;~Static and dynamic balance through the Berg Scale and Test of Romberg;~Quality of life of individuals with Parkinson's Disease through the Parkinson Disease Questionnaire - PDQ39;~Postural and gait analysis, by VICON;~Flexibility of the posterior musculature of the lower limbs through the Bank of Wells; Treatment sessions will take place twice a week for 12 weeks and will last 60 minutes each, totaling 24 sessions.~Functional capacity through the Vertical Jump - Jump with counter movement (CMJ).
Parkinson's disease patients have characteristic postural changes in upper limbs, lower limbs and trunk. The presence of kyphosis is observed as the most common postural deformity. The aim of this study is to verify the effect of dry soil therapy and shallow water therapy on muscle function in individuals with Parkinson's disease? Regarding the benefits, is there a difference between the therapies?