Exercise hemodynamics in Parkinson's disease and autonomic dysfunction

Low, David A.; Vichayanrat, Ekawat; Iodice, Valeria

doi:10.1016/j.parkreldis.2014.02.006

Cited by 26 publications

(14 citation statements)

References 14 publications

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“…Another strategy is to use the BORG scale of perceived effort [78] although the patient needs to be educated in how to use this scale. Another adverse effect to consider is that persons with PD have an increased risk of exercise-induced hypotension [79] and possibly also of post-exercise orthostatic hypotension [80]. A typical and worrisome manifestation is fainting after the patient has reached the top of a staircase, which can lead to injurious syncopal falls.…”

Section: Safetymentioning

confidence: 99%

Current Perspectives on Aerobic Exercise in People with Parkinson's Disease

et al. 2020

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Parkinson’s disease (PD) is a progressive neurological disorder characterized by motor and non-motor symptoms for which only symptomatic treatments exist. Exercise is a widely studied complementary treatment option. Aerobic exercise, defined as continuous movement of the body’s large muscles in a rhythmic manner for a sustained period that increases caloric requirements and aims at maintaining or improving physical fitness, appears promising. We performed both a scoping review and a systematic review on the generic and disease-specific health benefits of aerobic exercise for people with PD. We support this by a meta-analysis on the effects on physical fitness (VO2max), motor symptoms (Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor section), and health-related quality of life (39-item Parkinson’s disease Questionnaire (PDQ-39)). Aerobic exercise has generic health benefits for people with PD, including a reduced incidence of cardiovascular disease, a lower mortality, and an improved bone health. Additionally, there is level 1 evidence that aerobic exercise improves physical fitness (VO2max) and attenuates motor symptoms (MDS-UPDRS motor section) in the off-medication state, although the long-term effects (beyond 6 months) remain unclear. Dosing the exercise matters: improvements appear to be greater after training at higher intensities compared with moderate intensities. We found insufficient evidence for a beneficial effect of aerobic exercise on health-related quality of life (PDQ-39) and conflicting results regarding non-motor symptoms. Compliance to exercise regimes is challenging for PD patients but may be improved by adding exergaming elements to the training program. Aerobic exercise seems a safe intervention for people with PD, although care must be taken to avoid falls in at-risk individuals. Further studies are needed to establish the long term of aerobic exercise, including a focus on non-motor symptoms and health-related quality of life.

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Section: Safetymentioning

confidence: 99%

Current Perspectives on Aerobic Exercise in People with Parkinson's Disease

et al. 2020

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“…However, there was a decrease in blood pressure over the intervention in both groups, as well as a decrease in the symptoms of orthostatic hypotension in the EXCEED group. Orthostatic hypotension is prevalent in PD (15–58%) due to cardiovascular autonomic dysfunction 26 . This can lead to increased incidence of falls 27 and could be a marker for disease progression and cognitive decline in PD 28 .…”

Section: Discussionmentioning

confidence: 99%

Enhanced Exercise Therapy in Parkinson's disease: A comparative effectiveness trial

Ridgel

Walter

Tatsuoka

et al. 2016

Journal of Science and Medicine in Sport

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Objectives Exercise can improve motor function in people with Parkinson’s disease but depression reduces the motivation to participate in regular exercise. The aim of this study was to develop a novel Enhanced Exercise Therapy program that uses manual-driven guided exercise and peer-facilitated psychoeducation for individuals with Parkinson’s disease and depression. Design 24 week randomized controlled design. Methods Thirty individuals were randomized to Enhanced Exercise Therapy or self-guided therapy, and evaluated at baseline, 12-weeks and at 24-weeks. Enhanced Exercise Therapy included group exercise and group psychoeducation for 12 weeks. Between 13–24 weeks, individuals had access to the fitness facility but group sessions were not held. Self-guided therapy included written guidelines for a self-paced exercise program and psychoeducation. Primary outcome measures included the number of exercise sessions and International Physical Activity Questionnaire score. Secondary measures included resting heart rate, supine blood pressure, estimated VO2max and incidence of orthostatic hypotension. Results Twenty four individuals completed the study (80% retention) and both groups attended similar number of exercise sessions. There were no significant changes in cardiovascular fitness measures but there was a significant increase in the amount of physical activity in the Enhanced Exercise Therapy group and a decrease in the self-guided therapy group during the post-intervention period. Conclusions Enhanced exercise therapy appears to promote engagement in an exercise program and more physical activity, even after group sessions were concluded in individuals with Parkinson’s disease and depression.

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“…In turn, physical immobility worsens OH, leading to a “vicious cycle” of deconditioning . Physical exercise is therefore a key component of the therapeutic regimen, but because physical activity in the standing position can worsen hypotension in patients with autonomic failure, exercise should be performed in the recumbent or sitting position using a recumbent stationary bicycle or rowing machine. The exception is exercise in a pool because the hydrostatic pressure of water allows upright exercise without hypotension .…”

Section: Cardiovascular Autonomic Dysfunctionmentioning

confidence: 99%

Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies

2018

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Dysfunction of the autonomic nervous system afflicts most patients with Parkinson disease and other synucleinopathies such as dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure, reducing quality of life and increasing mortality. For example, gastrointestinal dysfunction can lead to impaired drug pharmacodynamics causing a worsening in motor symptoms, and neurogenic orthostatic hypotension can cause syncope, falls, and fractures. When recognized, autonomic problems can be treated, sometimes successfully. Discontinuation of potentially causative/aggravating drugs, patient education, and nonpharmacological approaches are useful and should be tried first. Pathophysiology-based pharmacological treatments that have shown efficacy in controlled trials of patients with synucleinopathies have been approved in many countries and are key to an effective management. Here, we review the treatment of autonomic dysfunction in patients with Parkinson disease and other synucleinopathies, summarize the nonpharmacological and current pharmacological therapeutic strategies including recently approved drugs, and provide practical advice and management algorithms for clinicians, with focus on neurogenic orthostatic hypotension, supine hypertension, dysphagia, sialorrhea, gastroparesis, constipation, neurogenic overactive bladder, underactive bladder, and sexual dysfunction. © 2018 International Parkinson and Movement Disorder Society.

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Exercise hemodynamics in Parkinson's disease and autonomic dysfunction

Cited by 26 publications

References 14 publications

Current Perspectives on Aerobic Exercise in People with Parkinson's Disease

Current Perspectives on Aerobic Exercise in People with Parkinson's Disease

Enhanced Exercise Therapy in Parkinson's disease: A comparative effectiveness trial

Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies

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