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To compare the efficacy of two physiotherapy protocols (water-based vs. non-water-based) on postural deformities of patients with Parkinson’s disease.A single blind, randomized controlled pilot study.Inpatient (Rehabilitative Department).A total of 30 patients with idiopathic Parkinson’s disease.Participants were randomly assigned to one of two eight-week treatment groups: Water-based (n = 15) or non-water-based physiotherapy exercises (n = 15).Changes in the degree of cervical and dorsal flexion and in the angle of lateral inclination of the trunk (evaluated by means of a posturographic system) were used as primary outcomes. Unified Parkinson Disease Rating Scale section III, Time Up and Go Test, Berg Balance Scale, Activities-specific Balance Confidence, Falls Efficacy Scale and the Parkinson’s disease quality of life questionnaire (39 items) were the secondary outcomes. All outcomes were assessed at baseline, at the end of training and eight weeks after treatment. Patients were always tested at the time of their optimal antiparkinsonian medication (‘on’ phase).After the treatment, only Parkinson’s disease subjects randomized to water-based treatment showed a significant improvement of trunk posture with a significant reduction of cervical flexion (water-based group: −65.2°; non-water-based group: +1.7°) and dorsal flexion (water-based group: −22.5°; non-water-based group: −6.5°) and lateral inclination of the trunk (water-based group: −2.3°; non-water-based group: +0.3°). Both groups presented significant improvements in the secondary clinical outcomes without between-group differences.Our results show that water-based physiotherapy was effective for improving postural deformities in patients with Parkinson’s disease.