Department of Neurology, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Parkinsons Dis. 2012;2(3):241-7. doi: 10.3233/JPD-2012-012111.
Patients with Parkinson's disease (PD) are physically less active than controls, and autonomic dysfunction may contribute to this sedentary lifestyle. Specifically, an altered cardiovascular response to physical effort may restrict physical activities.
To assess the cardiovascular responses to a submaximal exercise test in PD patients and controls, 546 sedentary PD patients and 29 sedentary healthy controls performed the Åstrand-Rhyming submaximal cycle exercise test.
Average heart rate was used to estimate maximal oxygen consumption (VO2max). Variables that may affect submaximal activity in PD patients, including disease severity, fatigue, and level of physical activity in daily life, were recorded.
Fewer PD patients (46%) completed the submaximal exercise test successfully than the controls (86%). The estimated VO2max of patients with a successful test was 34% lower than the controls (p < 0.001). Multivariate regression analyses revealed that higher body weight, lower systolic blood pressure, lower resting heart rate, and lower maximal workload were associated with an increased risk of an inadequate heart rate increase during submaximal exercise (R2 = 27%). PD patients with a successful submaximal exercise test had lower estimated VO2max values than controls.
Importantly, half of the PD patients had an inadequate heart rate increase during submaximal exercise, which was likely caused by cardiac sympathetic denervation leading to autonomic dysfunction. PD patients should therefore be screened to identify their limitations in exercise performance. Caution should be applied when prescribing beta blockers, as they might limit physical activities further.
帕金森病（PD）患者的身体活动量低于对照组，自主神经功能障碍可能导致这种久坐的生活方式。具体来说，体力活动时心血管反应的改变可能会限制身体活动。
评估帕金森病患者和对照组在亚极量运动试验中的心血管反应，546 名久坐的帕金森病患者和 29 名久坐的健康对照者进行了 Åstrand-Rhyming 亚极量自行车运动试验。
平均心率用于估计最大摄氧量（VO2max）。记录了可能影响 PD 患者亚极量活动的变量，包括疾病严重程度、疲劳和日常生活中的身体活动水平。
成功完成亚极量运动试验的 PD 患者（46%）少于对照组（86%）。成功测试的患者的估计 VO2max 比对照组低 34%（p < 0.001）。多变量回归分析显示，较高的体重、较低的收缩压、较低的静息心率和较低的最大工作量与亚极量运动中心率增加不足的风险增加相关（R2 = 27%）。成功完成亚极量运动试验的 PD 患者的估计 VO2max 值低于对照组。
重要的是，一半的 PD 患者在亚极量运动中出现心率增加不足，这可能是由于心脏交感神经去神经支配导致自主神经功能障碍所致。因此，应筛查 PD 患者以确定其运动表现的局限性。在开β受体阻滞剂时应谨慎，因为它们可能会进一步限制身体活动。
