title: Exercise hemodynamics in Parkinson's disease and autonomic dysfunction.
abstract: OBJECTIVE
  To clarify the characteristics of hemodynamic responses to exercise and orthostasis in Parkinson's disease patients, especially those with autonomic failure.
  
  
  METHODS
  Clinical audit of supine cycling exercise test data (with active standing tests pre- and post-exercise) of Parkinson's patients with autonomic dysfunction. 23 patients (71 ± 7 yr, 7 females) with a confirmed diagnosis of Parkinson's were identified.
  
  
  RESULTS
  Group mean systolic blood pressure (SBP) fell during pre-exercise standing (-39 ± 29 mmHg, P < 0.001, 17 patients had orthostatic hypotension (OH)), while heart rate (HR) increased (+13 ± 7 beats min(-1), P < 0.001). SBP (P < 0.001) increased during exercise with a wide variation in responses. SBP increased in 13 patients (INC; +30 ± 14 mmHg) and either did not change or decreased in 10 patients (DEC -12 ± 11 mmHg, P < 0.001 vs INC). The increase in HR was not different between sub-groups (30 ± 12 vs 25 ± 10 beats min(-1), INC vs. DEC, P = 0.29). The size of the pre-exercise stand SBP reduction was greater in DEC vs INC (-64 ± 23 (10 out of 10 had OH) vs -19 ± 16 mmHg (7 out of 13 had OH), respectively, P < 0.001). The HR elevation was not different between sub-groups (13 ± 8 vs 13 ± 4 beats min(-1), DEC vs INC, P = 0.94). Post-exercise SBP/DBP were lower for both sub-groups compared to pre-exercise and the standing SBP reduction post-exercise was not greater relative to pre-exercise in either sub-group.
  
  
  CONCLUSIONS
  Exercise-induced hypotension can occur in Parkinson's disease patients with autonomic failure with the magnitude of the exercise response being related to the severity of autonomic dysfunction. Exercise does not appear to worsen OH in this sample of Parkinson's patients.
authors.affiliation: Research Institute of Sport and Exercise Sciences, Faculty of Science, Liverpool John Moores University, UK; Autonomic and Neurovascular Medicine Unit, Faculty of Medicine, Imperial College London at St Mary's Hospital, London, UK; Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square/Division of Clinical Neurology, Institute of Neurology, University College London, UK. Electronic address: D.A.Low@ljmu.ac.uk.
authors.forename: David A
authors.initials: DA
authors.lastname: Low
authors.affiliation: Autonomic and Neurovascular Medicine Unit, Faculty of Medicine, Imperial College London at St Mary's Hospital, London, UK; Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square/Division of Clinical Neurology, Institute of Neurology, University College London, UK.
authors.forename: Ekawat
authors.initials: E
authors.lastname: Vichayanrat
authors.affiliation: Autonomic and Neurovascular Medicine Unit, Faculty of Medicine, Imperial College London at St Mary's Hospital, London, UK; Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square/Division of Clinical Neurology, Institute of Neurology, University College London, UK.
authors.forename: Valeria
authors.initials: V
authors.lastname: Iodice
authors.affiliation: Autonomic and Neurovascular Medicine Unit, Faculty of Medicine, Imperial College London at St Mary's Hospital, London, UK; Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square/Division of Clinical Neurology, Institute of Neurology, University College London, UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Mathias
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000209:etiology*; D001794:Blood Pressure / Q000502:physiology; D015444:Exercise / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*
keywords: Blood pressure; Exercise; Hypotension; Parkinson's disease; Pressor