O treinamento de caminhada nórdica, progredindo para o sprint, modifica os parâmetros biomecânicos e clínico-funcionais de pessoas com parkinson? um estudo piloto de um ensaio clínico não randomizado e quasi-experimental

Abstract

Introduction: Parkinson's Disease (PD) is an idiopathic neurological disorder characterized by the loss of dopaminergic neurons in the substantia nigra. Individuals with this condition present both motor and non-motor symptoms. Physical exercise (PE) is one of the treatment possibilities. PE, in turn, provides several clinical benefits and improves functional mobility. However, disease progression is associated with decreased strength, power, and speed, which are directly linked to motor symptoms. Objectives: Thus, the aim of this study was to evaluate the effects of 11 weeks of Nordic Walking and sprint training on biomechanical parameters, physical qualities (strength, power, and speed), mechanical efficiency (Force-Velocity Profile, RFPEAK(%), and DRF), and sprint performance, as well as clinical-functional parameters such as gait capacity, handgrip strength, and motor symptoms in people with Parkinson's disease (PwP). Methods: This is a pilot study of a non-randomized, quasi-experimental clinical trial, approved by the Ethics and Research Committee of the Institute of Health Sciences (ICS) (CAAE nº 67654523.7.0000.0018). The target population was people with Parkinson's disease (PwP) in stages 2 to 3 on the Hoehn and Yahr scale. The participants were evaluated over two weeks in the pre-intervention period (T1), during which sociodemographic data were collected, sprints on a 40-meter track were filmed for analysis of physical qualities and mechanical efficiency, along with clinical-functional tests. The intervention (T2) consisted of 11 weeks of progressive interval locomotor training with Nordic walking progressing to sprinting, followed by post-intervention assessment (T3). Results: The sample consisted of 7 PwP with Hoehn and Yahr scale stages ranging from 1.50 to 2.50, and a disease duration of (5.50 ± 3.15) years. The mean age was (68.6 ± 7.87) years, body mass and height were (72.2 ± 15.2 kg and 167 ± 8.42 cm), respectively. Participants showed improvements in physical qualities: Theoretical Maximum Horizontal Force F0(N) (p = 0.038); Theoretical Maximum Speed - V0 (m/s) (p = 0.011); and Maximum Speed - VMAX (p = 0.013). There was maintenance of execution time (p = 0.535) and maximum power - PMAX (W/kg) (p = 0.199). Additionally, improvements in mechanical efficiency were observed: Force-Velocity Profile - FV_Profile (p = 0.019), Peak Force Ratio - RFPEAK (%) (p = 0.045), and Force Decrease Rate - DRF (p = 0.029). Clinical-functional capacities were maintained, including gait speed (p = 0.057), functional mobility (p = 0.024), Locomotor Rehabilitation Index (LRI), motor symptoms (p = 0.198), and handgrip strength for the right hand (p = 1.00) and left hand (p = 0.703). Conclusion: Our intervention led to improvements in physical qualities related to strength and speed, as well as mechanical efficiency concerning the F-V Profile, RFPEAK%, and DRF. However, maximum power, gait parameters, functional mobility, and clinical variables remained stable.