Effects of Water Therapy on risk of falls in older people

INTERVENTION: Exercise Therapy Hydrotherapy Other Sixty participants will be selected, divided into two groups (Hydrotherapy and Control) randomly. All randomization processes will be performed by a researcher without any link to the study.The Control Group will not pperform any intervention. The training of the Hydrotherapy Group will last 16 weeks, with two sessions per week of 1 hour each, on non‐consecutive days. Physiotherapy professionals will follow the intervention.The Hydrotherapy Group will perform a multi‐component training, involving: 5 minutes of warm‐up; 20 minutes of resistance exercises and muscular activation of the main muscle groups of the trunk and lower limbs; 15 minutes of balance activities; 15 minutes of aerobic resistance exercises (gait, swimming with speed increase); and 5 minutes of cool down. The warm‐up will be consisted of gait in different directions and with increased speed, associated to some playful activity. The resistance and muscular activation exercises will focus on the abdominal, quadriceps, gluteal, tibialis anterior and triceps muscles. Three sets of 12 repetitions will be performed, with a rest interval of 1 minute between sets. The intensity will be gradually progressed according to the Borg Effort Perception Scale (6 to 20 points). The intensity will be maintained between 14 and 17 points and verified within each session. To increase the overload, we will use aquatubes, planks, shiners, as well as immersion level, surface area, speed of movement, range of motion and turbulence.Balance activities will include semi‐static exercise, static and dynamic weight transfer, gait on line, gait on unstable surfaces, and transposition and diversion of obstacles. The difficulty will be increased when the volunteer can perform the exercises adequately, according to reduction of sensory inputs (vision and tactile), reduction of the support base, increase in the complexity of movements and addition of motor and cognitive tasks.The intensity of aerobic exercise will range from 60 CONDITION: Aged Aged; Sedantary lifestyle; Comprehensive health care ; Aged ; Sedentary Lifestyle ; Comprehensive Health Care Comprehensive Health Care Sedentary Lifestyle SECONDARY OUTCOME: Secondary outcome 1: Presence of falls assessed by falls calendar and phone calls once a month, during 16 weeks of training and 6 weeks of detraining. Secondary outcome 2: Body mass index from the weight calculation divided by the squared height at the initial time, after 16 weeks of training and 6 weeks of detraining. INCLUSION CRITERIA: Ability to walk alone; reported initial availability of attending the training twice a week; not being engaged for five or more times per week in one or more of the activities walking, running, cycling, swimming, aerobic exercise, dancing, gardening or weight lifting. PRIMARY OUTCOME: Primary outcome 1: Lower limbs strength assessed by 5 times sit‐to‐stand test at baseline, after 16 weeks of training and 6 weeks of detraining.; Primary outcome 2: The balance will be evaluated by means of pressure center data (COP) obtained by the Force Platform (EMG System). Three trials of each condition, lasting 30 seconds and a 1 minute interval between them, will be performed at baseline, after 16 weeks of training and 6 weeks of detraining. Primary outcome 3: Mobility will be assessed by the simple Timed Up and Go (TUG) test associated with a cognitive‐motor task (TUG‐DT), at the initial time, after 16 weeks of training and 6 weeks of detraining. Primary outcome 4: Cognition will be evaluated by ACE‐R (consisting of a battery of brief cognitive evaluation, ranging from 0 to 100 points) and by BAF (an instrument specially developed for detecting changes in executive functions associated with the functioning of the frontal cortex), at the initial time, after 16 weeks of training and 6 weeks of detraining. Primary outcome 5: Behavioral symptoms will be assessed using abbreviated GDS, FES‐I and Cardioemotion. The abbreviated GDS is validated for Brazil and has a sensitivity of 86.8% and specificity of 82.4% for depression. The fear of falling will be evaluated by the FES‐I, being an adapted evaluation for the Brazilian elderly population. The Cardioemotion appliance is a cardiovascular biofeedback, which can be used for mental health assessment and training. Performed at baseline, after 16 weeks of training and 6 weeks of detraining.