a Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA.
b Center on Aging, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Appl Physiol Nutr Metab. 2019 Jul;44(7):751-758. doi: 10.1139/apnm-2018-0638. Epub 2018 Dec 6.
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 (HR) achieved were significantly blunted in PD ( < 0.05, < 0.01). HR remained significantly elevated in PD during recovery compared with controls ( = 0.03, < 0.05). Systolic, diastolic, and mean arterial pressures were significantly lower at multiple time-points during active standing in PD compared with controls. Systemic vascular resistance index (SVRI) decreased significantly at the onset of exercise in PD, and remained significantly lower during exercise and the first minute of supine recovery. End diastolic volume index (EDVI) was significantly lower in PD during supine rest and recovery. Our results indicate for the first time that normal hemodynamics are disrupted during orthostatic stress and exercise in PD. Despite significant differences in EDVI at rest and during recovery, and SVRI during exercise, cardiac index was unaffected. Our finding of significantly blunted HR and HR recovery in PD patients has substantial implications for exercise prescription and recovery guidelines.
去交感神经节后神经支配在帕金森病（PD）中已经得到充分证实。心脏和血管部位的去神经支配可能导致运动时心血管和血液动力学的异常反应。本研究的目的是检查在没有直立性低血压的 PD 患者中，运动试验如何影响心率（HR）和血液动力学。30 名无直立性低血压的个体、14 名 PD 患者和 16 名年龄匹配的健康对照者在自行车测力计上进行了运动试验。在空腹状态下，在仰卧休息、主动站立、运动和仰卧恢复期间测量心率、血压和其他血液动力学变量。PD 患者的峰值 HR 和达到的年龄预测最大 HR（HR）的百分比明显降低（<0.05，<0.01）。与对照组相比，PD 患者在恢复期间的 HR 仍然显著升高（=0.03，<0.05）。与对照组相比，PD 患者在主动站立期间的多个时间点收缩压、舒张压和平均动脉压明显较低。PD 患者的全身血管阻力指数（SVRI）在运动开始时显著降低，并且在运动和仰卧恢复的第一分钟期间仍显著降低。在仰卧休息和恢复期间，PD 患者的舒张末期容积指数（EDVI）明显较低。我们的研究结果首次表明，在 PD 中，正常的血液动力学在直立应激和运动期间受到干扰。尽管在休息和恢复期间 EDVI 和运动期间 SVRI 存在显著差异，但心输出量指数不受影响。我们发现 PD 患者的 HR 和 HR 恢复明显降低，这对运动处方和恢复指南具有重要意义。
