Norepinephrine and cardiovascular responses to maximal exercise in Parkinson's disease on and off medication (original) (raw)
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Applied Physiology, Nutrition, and Metabolism, 2018
The presence of postganglionic sympathetic denervation is well established in Parkinson’s disease (PD). Denervation at cardiac and blood vessel sites may lead to abnormal cardiovascular and hemodynamic responses to exercise. The aim of the present investigation was to examine how heart rate (HR) and hemodynamics are affected by an exercise test in PD patients without orthostatic hypotension. Thirty individuals without orthostatic hypotension, 14 individuals with PD, and 16 age-matched healthy controls performed an exercise test on a cycle ergometer. Heart rate, blood pressure, and other hemodynamic variables were measured in a fasted state during supine rest, active standing, exercise, and supine recovery. Peak HR and percent of age-predicted maximum HR (HRmax) achieved were significantly blunted in PD (p < 0.05, p < 0.01). HR remained significantly elevated in PD during recovery compared with controls (p = 0.03, p < 0.05). Systolic, diastolic, and mean arterial pressures w...
Autonomic Function in Patients With Parkinson’s Disease: From Rest to Exercise
Frontiers in Physiology
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.
SAGE Open Medicine
The incidence of Parkinson’s disease is increasing worldwide. The motor dysfunctions are the hallmark of the disease, but patients also experience non-motor impairments, and over 40% of the patients experience coexistent abnormalities, such as orthostatic hypotension. Exercise training has been suggested as a coping resource to alleviate Parkinson’s disease symptoms and delay disease progression. However, the body of knowledge is showing that the cardiovascular response to exercise in patients with Parkinson’s disease is altered. Adequate cardiovascular and hemodynamic adjustments to exercise are necessary to meet the metabolic demands of working skeletal muscle properly. Therefore, since Parkinson’s disease affects parasympathetic and sympathetic branches of the autonomic nervous system and the latter are crucial in ensuring these adjustments are adequately made, the understanding of these responses during exercise in this population is necessary. Several neural control mechanisms ...
Cardiovascular Responses During Resistance Exercise in Patients With Parkinson Disease
PM & R : the journal of injury, function, and rehabilitation, 2018
Patients with Parkinson disease (PD) present cardiovascular autonomic dysfunction that impairs blood pressure control. However, cardiovascular responses during resistance exercise are unknown in these patients. To investigate cardiovascular responses during resistance exercise performed with different muscle masses in patients with PD. Two groups, repeated-measures design. Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo. Thirteen patients with PD (4 women, 62.7 ± 1.3 years, stages 2-3 of the modified Hoehn and Yahr scale; "on" state of medication) and 13 paired control patients without PD (7 women, 66.2 ± 2.0 years). Both groups performed, in a random order, bilateral and unilateral knee extension exercises (2 sets, 10-12 maximal repetition, 2-minute intervals). Systolic blood pressure (SBP) and heart rate (HR) were assessed before (pre) and during the exercises. Independent of set and exercise type, SBP and HR increases wer...
Does cardiovascular autonomic dysfunction contribute to fatigue in Parkinson's disease?
Movement Disorders, 2011
Patients with Parkinson's disease often complain of fatigue, and although cardiac sympathetic denervation is thought to be associated with fatigue, this link remains unclear. Previously, we detected cardiac sympathetic denervation in patients with Parkinson's disease using dobutamine, a selective beta-1 stimulant. To clarify the involvement of autonomic dysfunction in fatigue in Parkinson's disease, we conducted autonomic function tests on 33 patients with Parkinson's disease (mean age, 66.1 6 5.6 years; 20 men, 13 women) and evaluated their relationships to fatigue. We divided patients into 2 groups, fatigued (n 5 12) and nonfatigued (n 5 21), based on an average score ! 3.3 on the Parkinson fatigue scale. Autonomic function tests included the coefficient of variation of R-R intervals, head-up tilt test, norepinephrine and dobutamine infusion tests, and cardiac 123 I-metaiodobenzylguanidine scintigraphy. The coefficient of variation of R-R intervals and the systolic blood pressure changes accompanying the head-up tilt test did not show significant differences between the 2 groups; however, the pressor responses in the norepinephrine and dobutamine infusion tests were significantly greater in the fatigued group than in the nonfatigued group. The 123 I-metaiodobenzylguanidine heartto-mediastinal uptake ratio was lower in the fatigued group than in the nonfatigued group. Partial correlation analyses, using disease duration and Hoehn and Yahr stage as control variables, also demonstrated significant correlations between the Parkinson fatigue scale score and the results of the autonomic function tests and cardiac 123 I-metaiodobenzylguanidine uptake. Our results suggest that autonomic dysfunction, including cardiac sympathetic denervation, is associated with fatigue in patients with Parkinson's disease. V
Autonomic dysfunction in recent onset and advanced Parkinson's disease
Clinical Neurology and Neurosurgery, 1988
Autonomic nervous dysfuu~tion is a well known complication of Parkinson's disease. Autonomic symptoms occur with increasing frequency during the course of the disease. Cardiovascular reflex tests have been used in order to study the type and the severity of autonomic nervous dysfunction in Parkinson's disease. Many authors have found that the baroreflex function measured by the Valsalva manoeuvre is unaffected in Parkinson's diseaseEe3, but other authors have found a decreased response to the Valsalva pro-cedure4s5. Sachs et a1.6 found that there is no difference in heart rate response (Valsaiva ratio) to Valsalva manoeuvre but Turkka7 found that RR-interval variation during the Valsalva test was clearly decreased. There have been only a few reports regarding the heart rate variation induced by normal or deep breathing. All authors have found that respiratory sinus arrhythmia is decreased in Parkinson's dis-ease6-9.10 It has been claimed that orthostatic hypotension is connected with Parkinson's disease-in some cases3*4t9, but other authors have found no difference in the magnitude of orthostatic hypotension when compared with healthy controls'.2*6. Goetz et ~1.~ found that immediate orthostatic systolic blood pressure drop increased in parkinsonian patients compared with controls, but after prolonged standing there was no remaining difference.
Adapted Physical Activity Quarterly, 2018
The purpose of this study was to compare acute cardiometabolic responses to 3 modes of treadmill exercise in adults diagnosed with Parkinson’s disease (PD). Eight elderly adults with PD (67.9 ± 3.0 yr) completed 1 session each on a land, aquatic, and antigravity treadmill at 50% body weight. Participants walked from 1 to 3 mph in 0.5-mph increments at 0% grade for 5 min at each speed. Heart rate, energy expenditure, blood pressure, and rating of perceived exertion were measured at rest and during exercise. All variables except diastolic blood pressure increased with speed on all treadmills (p
Autonomic dysfunction according to disease progression in Parkinson's disease
Parkinsonism & Related Disorders, 2014
Background: Although autonomic dysfunction is common in patients with Parkinson's disease (PD), few data are available regarding its pattern and quantitative severity with increasing Hoehn and Yahr (H&Y) stage. We conducted autonomic function tests to quantify autonomic dysfunction in PD patients and to elucidate its possible relationship with disease progression. Methods: We performed autonomic function tests including Valsalva ratio, heart rate response to deep breathing, quantitative sudomotor axon reflex test, and head-up tilt test in 66 patients with PD. We compared clinical characteristics and results of autonomic function tests between stages, and correlated the proportion of abnormal patients in each test with their H&Y stage. In addition, logistic regression analyses were conducted to examine the contribution of increasing H&Y stage to impairments of each domain of the autonomic nervous system. Results: We found that PD patients with higher disease stage tended to have impairments in cardiovagal and sudomotor domains of the autonomic nervous system. Cardiovagal function was the domain most influenced by disease progression. Our findings also demonstrated that the pattern of sudomotor impairment in PD was similar to that in patients with peripheral autonomic neuropathy. Conclusions: Our study demonstrates that autonomic dysfunction is not only common in early stage PD but it increases in severity with increasing disease stage. Given that the patterns of sudomotor impairments in PD are similar to those in peripheral neuropathy, our data support a previous hypothesis that pathophysiology of PD involves both the central and peripheral nervous systems.
Parkinson’s Disease and Forced Exercise: A Preliminary Study
Rehabilitation Research and Practice, 2013
Objective. The concept of forced exercise has drawn attention for the treatment of Parkinson’s disease symptoms with anecdotal reports of success. This study sought to ascertain any significant effect of forced exercise using a motorized stationary bicycle when compared to controls on Parkinson’s disease symptoms in a blinded, randomized, and controlled setting.Setting. Parkinson’s disease outpatient clinic, Veterans Administration Medical Center.Method. We assessed 23 patients (13 experimental and 10 controls) on a number of standard Parkinson’s measures at baseline, after participation in eight weeks of twice weekly forced exercise or eight weeks of conventional clinic care, and then after a three-month period had elapsed. Dependent measures were UPDRS-III, Berg Balance Scale, finger taping test, and the PDQ-39.Results. Results did not demonstrate any main effect differences between the exercise and control groups on any measure at any point in time. A within subjects effect was d...