Parkinson's disease (PD) is a chronic, progressive, and neurodegenerative disease, characterized as one of the most common neurological conditions and which shows signs of resting tremor and cognitive decline that impact on quality of life and the performance of daily activities. Furthermore, active stationary cycling (ASC) treatment has been shown to reduce tremor and improve upper limb (ULL) performance in people who have PD. In recent years, virtual reality has been introduced as a therapeutic tool in neurorehabilitation. Additionally, non-immersive VR exergames have been verified as safe and effective therapies for improving motor skills. On the other hand, the effects of using Immersive Virtual Reality (IVR) through the QUEST 2 device in the treatment of people with PD were not evaluated, especially on tremor and cognition.

This study aims to evaluate the effectiveness of immersive virtual reality training, through exergames from Quest 2 device, compared to ASC training on resting tremor, UL performance and cognition of people with PD.

This is a randomized, blinded, controlled clinical trial, with a protocol based on the checklist CONSORT. Will be recruited a sample of 36 people with a diagnosis of PD, on stable treatment with Levodopa, classified in stages I to III of the Hoehn & Yahr classification, aged between 50 and 85 years, with classic Parkinsonian tremor type 1, according to the Movement Disorders Society consensus statement, with normal or corrected visual and hearing acuities and with a minimum of 4 years of formal study. Participants will be randomized to IVR (n=18) and ASC (n=18) groups. The protocol of interventions will last 8 consecutive weeks, divided into two weekly sessions, lasting 60 minutes. The primary outcome will be assessed with the Unified Parkinson's Disease Rating Scale (UPDRS) parts II and III and with the application “Study my tremor”. Secondary outcomes will be evaluated with the Nine-hole peg test, Box and block test, Trail Making Tests, REY list and Parkinson's Disease Questionnaire-39 (PDQ-39). The evaluations will be carried out prior to the interventions, at the end of the interventions and 30 days after the end of the interventions.

Considering that, currently, the options for the treatment of tremor in PD are based on the use of medication and invasive surgical procedures, it is expected that the spontaneous information in the study can elucidate the benefits of conventional training, inspired to maximize the possible therapeutic approaches of that population.

The effects of IVR training compared to ASC on the outcomes have not yet been evaluated in patients with PD. This study will help physiotherapists in the decision-making process, regarding the most effective resource for this population, as it will provide the background for weighing the clinical viability between these two resources.