Autonomic Function in Patients With Parkinson’s Disease: From Rest to Exercise

Abstract

Parkinson’s disease (PD) is a common neurodegenerative disorder classically characterized by symptoms of motor impairment (e.g., tremor and rigidity), but also presenting with important non-motor impairments. There is evidence for the reduced activity of both the parasympathetic and sympathetic limbs of the autonomic nervous system at rest in PD. Moreover, inappropriate autonomic adjustments accompany exercise, which can lead to inadequate hemodynamic responses, the failure to match the metabolic demands of working skeletal muscle and exercise intolerance. The underlying mechanisms remain unclear, but relevant alterations in several discrete central regions (e.g., dorsal motor nucleus of the vagus nerve, intermediolateral cell column) have been identified. Herein, we critically evaluate the clinically significant and complex associations between the autonomic dysfunction, fatigue and exercise capacity in PD.

Predictive Value of Exercise Blood Pressure Changes for Orthostatic Hypotension in Patients With Parkinson’s Disease

“… 24 The presence of DOH suggests mild impairment or early sympathetic failure, and over time about half of patients with PD develop OH, and these patients with DOH may have an even worse prognosis. 25 DOH might therefore be more suitable to use as a diagnostic criterion for evaluating BP changes in patients with PD in the standing position within 5 min, 24 thus reducing the rate of missed diagnoses. At baseline, there were 17 cases (21.3%) with OH, most of which were standard and DOH.…”

“…In patients with PD, OH often reflects sympathetic denervation, which is associated with the loss of cardiac and extracardiac noradrenergic innervation and with arterial baroreceptor reflex dysfunction that especially manifest during standing and exercise. 25 26 27 OH incidence increases with age due to the degradation of BP regulation mechanisms and impaired sensitivity to external changes. 28 In the present study, the ages of the patients differed significantly between the groups at baseline.…”

“…There have been a few investigations of the combination of these methods as preliminary evaluations, which provide ideas for combining early autonomic nerve examination with other methods to improve detection accuracy. 25 29 …”

Physiological and clinical responses to cycling 7850 km over 85 days in a physically active middle‐aged man with idiopathic Parkinson's disease

“…Post‐trip VO 2 max was 151% of predicted values, demonstrating the capacity to maintain high cardiorespiratory fitness while living with PD for ~8 years. PD is associated with sympathetic nervous system dysregulation (Sabino‐Carvalho et al, 2021) and blunted BP responses to static handgrip exercise (Sabino‐Carvalho et al, 2018). In support, BP responses to static handgrip exercise were near‐absent pre‐trip but more closely aligned with data from healthy participants (Lee et al, 2021) at post‐testing.…”

Community Exercise: A New Tool for Personalized Parkinson’s Care or Just an Addition to Formal Care?

“…For example, being aware that cardiorespiratory regulation during exercise can be altered in people with PD when compared to age-matched controls (Sabino-Carvalho et al, 2018 ; Sabino-Carvalho and Vianna, 2020 ). The autonomic dysfunction can lead to inadequate hemodynamic responses, the failure to match the metabolic demands of working skeletal muscle, and exercise intolerance (Sabino-Carvalho et al, 2021 ). Better knowledge and understanding of these responses during exercise in this population is critical to guarantee safety during exercise.…”