Inspira Parkinson: efeitos da caminhada nórdica progredida ao sprint sobre a função respiratória e a capacidade de marcha em pessoas com Parkinson subclassificadas em hipercinéticas e rígidos-acinética

Abstract

Introduction: Parkinson's Disease (PD) is a chronic, neurodegenerative, progressive, and multifactorial condition that affects the substantia nigra in the midbrain. It is considered the primary disease affecting the motor system and the second most common among the elderly. Motor symptoms can be classified as akinetic rigid (AR) or hyperkinetic (HK), each with distinct clinical manifestations. AR individuals, for example, experience greater impairment due to rigidity, bradykinesia, postural instability, and gait disturbances. Respiratory alterations, also present in the natural history of PD, can worsen with hypomobility, becoming a leading cause of death in this population. It is proposed that locomotor training, including walking to sprint, may benefit these respiratory dysfunctions. Objective: To assess the respiratory profile and gait capacity of people with Parkinson's disease (PwPD) and their subtypes; to analyze the relationship and prediction between respiratory function and gait capacity; and to examine the influence of a progressive locomotor training protocol from walking to sprint over a period of 14 weeks in HC and AR subtypes in PwPD. Experimental Design: This is a Randomized Clinical Trial (RCT). The primary outcome (Study 1) will be respiratory activity, defined by Pulmonary Function assessed by spirometry, and respiratory muscle strength assessed by manovacuometry. Secondary outcome (Study 2): will include specific characteristics of gait capacity. The methods involved selecting PwPD over 40 years of age and evaluating before and after the rehabilitation protocol, including medical history, MMSE, PAR-Q, UPDRS MDS, and HY, as well as evaluation of pulmonary function and strength. Statistical Analysis: Student's t-test was used for pre and post comparison, and Generalized Estimating Equations (GEE) for group factors and group*time interaction. For data variation, IC95% and calculation of Hedge's G effect size were adopted. Pearson's test was used for correlations, linear regression for prediction of respiratory variables by locomotor variables, and Bonferroni post-hoc. A significance level of p≤0.05 was adopted for statistical inferences. Results: Thirty-six elderly individuals were approached, 17 were selected. 52.9% of the sample presented respiratory impairment, with restrictive profile being the most common. There was a moderate relationship between respiratory variables and gait capacity. The locomotor training protocol improved respiratory and gait conditions over time, considering better gait performance post-training compared to pre-training in both groups (p<0.05). When observing the group*time factor, the HC group showed improvement in VAS compared to AR (p<0.009), while improvement in respiratory muscle strength of AR over HC was observed after the walking protocol (Pimax, p=0.012).Conclusion: Respiratory muscle weakness in PwPD can be predicted by gait capacity. Locomotor training positively influenced the pulmonary function and gait capacity of both subtypes, as well as the gait capacity of HC.