Letter to the Editor
Exercise prescription for Parkinson's disease patients: Dealing with cardiovascular autonomic dysfunction
Prescrição de exercício para pacientes com doença de Parkinson: lidando com a disfunção autonómica
Hélcio Kanegusukua,
, Marilia Almeida Correiab, Gabriel Grizzo Cucatoc, Raphael Mendes Ritti-Diasd
Autor para correspondência
a Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
b Graduate Program in Medicine, Universidade Nove de Julho, São Paulo, SP, Brazil
c Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom
d Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, SP, Brazil
Lido
3091
Vezesque se leu este artigo
1142
Total PDF
1949
Total HTML
Compartilhar estatísticas
array:23 [ "pii" => "S0870255121004662" "issn" => "08702551" "doi" => "10.1016/j.repc.2021.07.011" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "1867" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2022;41:359-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:19 [ "pii" => "S0870255121004650" "issn" => "08702551" "doi" => "10.1016/j.repc.2021.07.010" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "1866" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2022;41:355-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Heart rate at presentation of COVID-19: Can SARS-CoV-2 be a cause of dysautonomia?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "355" "paginaFinal" => "357" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Frequência cardíaca na apresentação clínica de COVID-19: pode a SARS-CoV-2 ser uma causa de disautonomia?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 730 "Ancho" => 2508 "Tamanyo" => 154326 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Panel A: Kaplan Meier survival analysis stratified according to the heart rate quartile at hospital admission. Panel B: Scatter plot showing no correlation between SatO2 and heart rate at admission. Panel C: Scatter plot showing a weak correlation between temperature and heart rate at admission.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andrea Severo Sánchez, Juan R. Rey, Ángel Manuel Iniesta, Jose L. Merino, Sergio Castrejón-Castrejón, Esteban López-de-Sá, Juan Caro-Codón" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Andrea" "apellidos" => "Severo Sánchez" ] 1 => array:2 [ "nombre" => "Juan R." "apellidos" => "Rey" ] 2 => array:2 [ "nombre" => "Ángel Manuel" "apellidos" => "Iniesta" ] 3 => array:2 [ "nombre" => "Jose L." "apellidos" => "Merino" ] 4 => array:2 [ "nombre" => "Sergio" "apellidos" => "Castrejón-Castrejón" ] 5 => array:2 [ "nombre" => "Esteban" "apellidos" => "López-de-Sá" ] 6 => array:2 [ "nombre" => "Juan" "apellidos" => "Caro-Codón" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121004650?idApp=UINPBA00004E" "url" => "/08702551/0000004100000004/v1_202204130547/S0870255121004650/v1_202204130547/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Exercise prescription for Parkinson's disease patients: Dealing with cardiovascular autonomic dysfunction" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "359" "paginaFinal" => "360" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Hélcio Kanegusuku, Marilia Almeida Correia, Gabriel Grizzo Cucato, Raphael Mendes Ritti-Dias" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Hélcio" "apellidos" => "Kanegusuku" "email" => array:1 [ 0 => "helciokng@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marilia Almeida" "apellidos" => "Correia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Gabriel Grizzo" "apellidos" => "Cucato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Raphael Mendes" "apellidos" => "Ritti-Dias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Hospital Israelita Albert Einstein, São Paulo, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Graduate Program in Medicine, Universidade Nove de Julho, São Paulo, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, SP, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Prescrição de exercício para pacientes com doença de Parkinson: lidando com a disfunção autonómica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Parkinson's disease (PD) is a progressive neurodegenerative disease widely recognized by motor symptoms, such as bradykinesia, rigidity, tremor, and postural instability.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Neurodegeneration may also occur in autonomic cardiovascular control centers and in the projection structures for the target organs, producing autonomic cardiovascular dysfunction (i.e. deleterious alterations of sympathetic and/or parasympathetic autonomic activities).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> It is important to note that these alterations in cardiovascular control may also be observed even in the early stages of the disease or in patients without cardiovascular diseases.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,4</span></a> Moreover, comorbidities and cardiovascular disease risk factors are also frequent in these patients.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Exercise training has been recommended for management of PD. However, because of the cardiovascular dysfunction observed in some patients, some cardiovascular responses at rest (e.g., supine hypertension) and during exercise (blunted cardiovascular submaximal and maximal response to a maximal cardiopulmonary exercise test) are different compared to healthy subjects.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,4</span></a> Therefore, cardiovascular dysfunction as a target of exercise prescriptions should be crucial for PD patients. Despite this, recommendations have been vague or simplistic.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Aerobic exercise is recommended three to seven days per week, for 20-60 minutes daily at an intensity of 60-85% of heart rate peak or 30-89% of heart rate reserve or 9-17 on 6-20 rate of perceived exertion (RPE) scale, according to each patient's motor severity. In addition, resistance exercise has also been recommended two to three days per week, of 1-4 sets of 8-15 repetions of <30-80% of one repetition maximum, and with interval of 2-4 minutes duration between sets, according to the patient's motor severity. In this context, the use of the target percentage of the heart rate reserve should be employed with caution, since exercise intensity prescribed could be overestimated if a maximal exercise test is not performed. Besides, the cardiovascular dysfunction inherent in PD, the cardiovascular comorbities and use of medications that affect the cardiovascular system (e.g., beta blockers, among others) may also blunt heart rate response to maximal exercise test. For PD patients with heart diseases (e.g. coronary artery disease, arrhythmias, among others) maximal exercise test may also provide important information, such as the exercise intensity below the ischemia or arrhythmias threshold.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Similarly, exercise prescription based on RPE also requires caution in some situations. A previous study<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> observed a disconnection between RPE and heart rate parameters during aerobic exercise in PD patients with mild to moderate motor severity, who reported a level of effort between “fairly mild” to “somewhat hard” while they exercised at moderate to vigorous intensity (60-80% of heart rate peak) on the cycle ergometer. Future studies are required to understand the relationship between physiological and perceptual parameters during exercise in PD.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Aerobic exercise with self-selected intensity performed on a cycle ergometer may be one option for PD patients with mild to moderate motor severity and without cardiac diseases who do not have access to more precise exercise prescription via maximal exercise testing. We previously observed that PD patients performed exercise with self-selected intensity within the recommended intensity (60-80% of heart rate peak obtained during a maximal exercise test).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> However, this strategy should also be tested in other situations, such as while walking, in PD patients with other characteristics, among others situations.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cardiovascular dysfunction may also negatively impact on resistance exercise in PD. We previously demonstrated that PD patients exhibit blunted cardiovascular response during resistance exercise as well as during the interval between sets.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> In this context, the monitoring of cardiovascular parameters during these periods (e.g., blood pressure and heart rate) should be to considered for determining the individualized prescription. Furthermore, PD patients may also present orthostatic hypotension and/or supine hypertension, meaning sudden changes of positions should be taken into attention when exercise is performed, and patients should also avoid remaining in a supine position for a long time. Finally, resistance exercise prescription should also consider the use of medications that affect the cardiovascular system and the presence of cardiovascular comorbidities. It is important to check the recommended exercise prescription for each specific comorbidity.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In light of the above, PD patients should also be screened for autonomic cardiovascular conditions before exercise prescription. Maximal exercise testing should be performed for a cardiovascular evaluation and higher accuracy for the exercise prescription. Strategies for exercise prescription should be envisaged for when patients do not have access to more precise exercise prescription based on maximal exercise testing.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Sources of Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">RR received a research productivity fellowship granted by <span class="elsevierStyleGrantSponsor" id="gs1">National Council for Scientific and Technological Development</span>.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Sources of Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuropathology of Parkinson disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.W. Dickson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.parkreldis.2017.07.033" "Revista" => array:6 [ "tituloSerie" => "Parkinsonism Relat Disord" "fecha" => "2018" "volumen" => "46" "paginaInicial" => "S30" "paginaFinal" => "S33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28780180" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Altered cardiorespiratory regulation during exercise in patients with Parkinson's disease: a challenging non-motor feature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Sabino-Carvalho" 1 => "L.C. Vianna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "SAGE Open Med" "fecha" => "2020" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac sympathetic denervation correlates with clinical and pathologic stages of Parkinson's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Fujishiro" 1 => "R. Frigerio" 2 => "M. Burnett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/mds.21989" "Revista" => array:6 [ "tituloSerie" => "Mov Disord" "fecha" => "2008" "volumen" => "23" "paginaInicial" => "1085" "paginaFinal" => "1092" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18442129" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blunted maximal and submaximal responses to cardiopulmonary exercise tests in patients with Parkinson disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Kanegusuku" 1 => "C. Silva-Batista" 2 => "T. Peçanha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.apmr.2015.12.020" "Revista" => array:6 [ "tituloSerie" => "Arch Phys Med Rehabil" "fecha" => "2016" "volumen" => "97" "paginaInicial" => "720" "paginaFinal" => "725" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26780469" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of disease duration and cardiovascular dysautonomia on hypertension in Parkinson's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.L. Vetrano" 1 => "M.S. Pisciotta" 2 => "V. Brandi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Hypertens" "fecha" => "2017" "volumen" => "19" "paginaInicial" => "418" "paginaFinal" => "423" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ACSM's guidelines for exercise testing and prescription" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "American College of Sports Medicine" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "10th ed." "fecha" => "2017" "editorial" => "Lippincott Williams & Wilkins" "editorialLocalizacion" => "Baltimore (MD)" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular, perceived exertion and affective responses during aerobic exercise performed with imposed and a self-selected intensity in patients with Parkinson's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Kanegusuku" 1 => "M. de Almeida Correia" 2 => "P. Longano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3233/NRE-201569" "Revista" => array:6 [ "tituloSerie" => "NeuroRehabilitation" "fecha" => "2021" "volumen" => "48" "paginaInicial" => "267" "paginaFinal" => "272" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33523029" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular responses during resistance exercise in patients with Parkinson disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.S. Miyasato" 1 => "C. Silva-Batista" 2 => "T. Peçanha" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "PMR" "fecha" => "2018" "volumen" => "10" "paginaInicial" => "1145" "paginaFinal" => "1152" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004100000004/v1_202204130547/S0870255121004662/v1_202204130547/en/main.assets" "Apartado" => array:4 [ "identificador" => "93369" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004100000004/v1_202204130547/S0870255121004662/v1_202204130547/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121004662?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 12 | 7 | 19 |
| 2024 Outubro | 66 | 38 | 104 |
| 2024 Setembro | 69 | 26 | 95 |
| 2024 Agosto | 87 | 31 | 118 |
| 2024 Julho | 75 | 47 | 122 |
| 2024 Junho | 57 | 36 | 93 |
| 2024 Maio | 66 | 16 | 82 |
| 2024 Abril | 58 | 32 | 90 |
| 2024 Maro | 62 | 20 | 82 |
| 2024 Fevereiro | 46 | 21 | 67 |
| 2024 Janeiro | 39 | 24 | 63 |
| 2023 Dezembro | 31 | 33 | 64 |
| 2023 Novembro | 39 | 24 | 63 |
| 2023 Outubro | 45 | 24 | 69 |
| 2023 Setembro | 30 | 20 | 50 |
| 2023 Agosto | 29 | 21 | 50 |
| 2023 Julho | 29 | 6 | 35 |
| 2023 Junho | 42 | 16 | 58 |
| 2023 Maio | 52 | 32 | 84 |
| 2023 Abril | 30 | 5 | 35 |
| 2023 Maro | 76 | 24 | 100 |
| 2023 Fevereiro | 45 | 21 | 66 |
| 2023 Janeiro | 44 | 18 | 62 |
| 2022 Dezembro | 65 | 29 | 94 |
| 2022 Novembro | 77 | 31 | 108 |
| 2022 Outubro | 68 | 36 | 104 |
| 2022 Setembro | 51 | 61 | 112 |
| 2022 Agosto | 51 | 75 | 126 |
| 2022 Julho | 58 | 50 | 108 |
| 2022 Junho | 54 | 33 | 87 |
| 2022 Maio | 74 | 43 | 117 |
| 2022 Abril | 125 | 85 | 210 |
| 2022 Maro | 83 | 64 | 147 |
| 2022 Fevereiro | 37 | 35 | 72 |
| 2022 Janeiro | 40 | 30 | 70 |
| 2021 Dezembro | 37 | 28 | 65 |
Mostrar tudo
