Strength and Dual-Task on Sarcopenia in People With Parkinson's Disease

Parkinson´s disease and parkinsonian syndromes are associated with progressive motor and non-motor impairments that may compromise functional independence and quality of life. Sarcopenia, characterized by reduced muscle strength, muscle mass, and physical performance, is highly prevalent in these populations and may contribute to an increased risk of falls, frailty, and disability. This prospective, parallel-group, three-arm randomized controlled trial aims to compare the effects of three levels of physiotherapy intervention on sarcopenia-related parameters and physical function in adults with Parkinson´s disease or parkinsonian syndromes. The Education Group will receive standarized nutritional education and general physical exercise recommendations through structed educational materials, without supervised exercise training. The Progressive Resistance Training (PRT) Group will receive standarized nutritional education and participate in supervised progressive resistance trained combined with cognitive dual-task exercises. The PRT plus Instability Group will receive the same nutritional education, progressive resistance training, and cognitive dual-task training, with additional instability and postural control components. Participants in the two supervised exercise groups will complete two physiotherapy sessions per week for 12 weeks. Assessments will be conducted at baseline (T0), immediately after the 12-week intervention (T1), and four weeks after completion of the intervention (T2). Outcomes will include clinical and functional status, muscle strength, body composition and other sarcopenia-related measures, physical performance, nutritional status, neurocognitive status, number of falls, and Parkinson\'s disease-related clinical characteristics. The study will evaluate the effects of supervised progressive resistance training compared with an educational intervention and will explore whether adding instability and postural control demands to progressive resistance training provides additional effects on physical function, sarcopenia-related outcomes, and fall-related functional risk in people with Parkinson\'s disease and parkinsonian syndromes.