Cardiovascular Effects Of Exercise And Use Of Abdominal Binder In Patients Of Parkinson’s Disease With Orthostatic Hypotension
Abstract
Orthostatic hypotension (OH) is a common manifestation of autonomic dysfunction in Parkinson’s Disease. It can adversely affect a patient’s functional capacity, exercise tolerance and quality of life, while increasing the risk of falls, cerebrovascular disease and overall mortality. Use of an abdominal binder (AB) can help counter OH; however, this has not been sufficiently studied in patients with Parkinson’s Disease (PwPD). Moreover, the hemodynamic effects of upper and lower extremity exercise are unclear in PwPD with OH. Although OH can impair the cerebral circulation, the consequences on the cerebral hemodynamics of wearing an AB or performing exercise are unknown in PwPD with OH.
This thesis aimed to generate practical evidence that is useable by the clinicians as well as the patients during the rehabilitation process of PwPD with OH. The three research studies that constitute this thesis investigated the effects of the interventions on systemic hemodynamics, cerebral hemodynamics and symptoms of orthostasis in PwPD with and without OH. The first study investigated the effects of wearing an abdominal binder (AB) and its subsequent removal in the standing position. The results showed that AB was effective in countering OH and its removal negatively affected the hemodynamics. The second study investigated the effects of performing upright self-regulated aerobic cycling exercise (SRACE). The responses to SRACE were found to be largely similar in all PwPD, regardless of OH. However, PwPD with relatively severe OH developed exercise-induced hypotension (EIH) without symptomatic deterioration. The third study investigated if performing resisted upper limb exercise (RULE) can be used to counter OH in PwPD. The results showed that RULE can be a useful adjunct for a brief quick resolution of OH.
The findings of this thesis suggest that AB and RULE can be used successfully for countering OH, that AB should not be removed while standing, and that BP should be monitored in PwPD with severe OH in order to detect EIH during exercise. These conclusions are expected to expand the knowledge base and provide greater options for the management of OH during the rehabilitation of PwPD, thereby helping in the control of OH and the prevention of potential complications of OH while providing a more tailored rehabilitation.