Impact of aquatic versus land exercise on glycated hemoglobin and blood pressure in older adults with multimorbidity: A randomized controlled trial protocol.

INTRODUCTION: Multimorbidity is defined as the prese of two or more chronic conditions in the same individual, being a growing global health concern, particularly among older adults. This condition is associated with decreased quality of life, increased healthcare utilization, and functional decline. Although physical exercise is widely recommended for managing chronic diseases, such as hypertension and type 2 diabetes, evidence remains limited regarding the most effective exercise modality for individuals with multimorbidity. This study protocol outlines a randomized controlled trial designed to compare the effects of water-based and land-based exercise programs on glycated hemoglobin and blood pressure in older adults with multiple chronic conditions. METHODS: This protocol describes a single center, randomized controlled trial with stratified allocation based on comorbidity burden. A minimum of 42 participants aged 60 years or older, diagnosed with hypertension and type 2 diabetes mellitus plus other chronic conditions (i.e. obesity, dyslipidemias, depression/anxiety or osteoarthritic) will be recruited. Participants will be randomly assigned to a water exercise, land exercise, or a control group. The intervention groups will engage in supervised exercise sessions three times per week for 10 weeks, combining aerobic and resistance training. Primary outcomes include glycated hemoglobin and systolic blood pressure, whereas secondary outcomes include heart rate variability, lipid profile, spirometry, physical function, anthropometry, and patient-reported outcomes on quality of life, physical activity, sleep quality, and psychological health. Assessments will be conducted before and after the intervention following standardized procedures. This study is registered at ClinicalTrials.gov (NCT06879639).