Square Stepping Exercise training programme for people with Parkinson's disease

The Square Stepping Exercise (SSE) is a training programme that requires physical exertion and cognitive function, namely concentration of attention, memory and executive functions. The intervention will take place at the Parkinson's Association of Cáceres, will be supervised by an SSE expert and to monitor adherence to the intervention, session attendance checklists will be made. The experimental group will receive SSE training, 3 times a week for 8 weeks with a duration of 50 minutes in each session. They will receive the training guidelines in a booklet with the rules to follow and the movement patterns. Between 2 and 6 patients will perform the exercise simultaneously in the same space. The SSE will be performed on a thin carpet measuring 250 x 100cm, this carpet will be divided into 40 smaller squares of 25cm2. At the end of each face-to-face session, difficulties encountered, incidents or injuries will be followed up and recorded, pointing out the possible cause of the problem. If a participant is unable to execute the intervention, the reason will be recorded. In the SSE there are 200 different movement patterns that vary in difficulty and are classified into three levels: beginner, intermediate and advanced. The beginner level has two levels, while the intermediate and advanced levels have three levels each. The proposed intervention will follow a progression of levels. It will start with movement patterns similar to those of walking and gradually become more complex patterns requiring not only forward, but also lateral, diagonal and backward movements. People should be prevented from stepping on the dividing lines of the squares. The number of stepping patterns and difficulty will increase weekly until the maximum level is reached, which will be maintained until the end of the intervention. In all sessions, the ESS expert will call the pair or group of participants to be trained and indicate the training to be performed. Participants will be given a booklet prepared specifically for the intervention, detailing the 200 movement patterns, which they can consult while the SSE expert shows them the sequence to follow in that day's class. The first activity to do before the session begins is to review the last movement pattern performed in the previous class. Once the patients have memorised the pattern, which is expected to be achieved after 4-5 repetitions, they will continue with the session autonomously. At the end of each session, the ESS expert will ask them about the development of the session and give them 2 scales on the level of perceived exertion. The control group will continue with the treatment carried out within the public health system ("usual care"). Although there is no standard treatment for Parkinson's disease, the usual treatment, depending on the clinical condition of each patient, consists of the prescription of medication, mainly levodopa, and the recommendation of physiotherapy.