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.
Highlights
Parkinson’s disease (PD) is currently the second most common neurodegenerative disorder (Alves et al, 2008; Rossi et al, 2018) and the worldwide prevalence is growing as age and life expectancy increases (Rossi et al, 2018)
The parasympathetic preganglionic neurons are situated in the nucleus ambiguous (NA) and dorsal motor nucleus of the vagus nerve (DMV)
Heart rate variability (HRV) derived estimates of cardiac parasympathetic activity have been observed to be reduced in patients with PD (Kallio et al, 2000; Buob et al, 2010; Sabino-Carvalho et al, 2018; Li et al, 2020) independent of the measurement duration/experimental circumstance
Summary
Parkinson’s disease (PD) is currently the second most common neurodegenerative disorder (Alves et al, 2008; Rossi et al, 2018) and the worldwide prevalence is growing as age and life expectancy increases (Rossi et al, 2018). The disease is well-characterized by a dysfunction of dopamine-producing neurons in the substantia nigra pars compacta and was first described more than 200 years ago (Parkinson, 2002). This dopamine deficiency leads the classical motor dysfunctions (bradykinesia, rigidity, and resting tremor) featuring the disease (Braak and Braak, 2000). PD may include several non-motor impairments, including autonomic and cardiovascular dysfunction (Gallagher et al, 2010; Goldstein, 2014; Merola et al, 2018; SabinoCarvalho et al, 2021). The present minireview will critically evaluate the evidence for parasympathetic and sympathetic dysfunction in PD both at rest and during exercise, explore how such autonomic dysfunction may affect exercise capacity, and explore the therapeutic potential of exercise training
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