Original research| Volume 98, ISSUE 11, P2134-2141, November 2017

Effects of Progressive Resistance Training on Cardiovascular Autonomic Regulation in Patients With Parkinson Disease: A Randomized Controlled Trial



      To evaluate the effects of a progressive resistance training (RT) on cardiac autonomic modulation and on cardiovascular responses to autonomic stress tests in patients with Parkinson disease (PD).


      Randomized clinical trial.


      The Brazil Parkinson Association.


      Patients (N=30) with PD (modified Hoehn & Yahr stages 2–3) were randomly divided into 2 groups: a progressive RT group (PD training [PDT] group) and a control group (PD control [PDC] group). In addition, a group of paired healthy control (HC) subjects without PD was evaluated.


      The PDT group performed 5 resistance exercises, 2 to 4 sets, 12 to 6 repetitions maximum per set. Individuals in the PDC group maintained their usual lifestyle.

      Main Outcome Measures

      The PDT and PDC groups were evaluated before and after 12 weeks. The HC group was evaluated once. Autonomic function was assessed by spectral analysis of heart rate variability and cardiovascular responses to autonomic stress tests (deep breathing, Valsalva maneuver, orthostatic stress).


      Compared with baseline, the normalized low-frequency component of heart rate variability decreased significantly after 12 weeks in the PDT group only (PDT: 61±17 normalized units [nu] vs 47±20nu; PDC: 60±14nu vs 63±10nu; interaction P<.05). A similar result was observed for systolic blood pressure fall during orthostatic stress that also was reduced only in the PDT group (PDT: −14±11mmHg vs −6±10mmHg; PDC: −12±10mmHg vs −11±10mmHg; interaction P<.05). In addition, after 12 weeks, these parameters in the PDT group achieved values similar to those in the HC group.


      In patients with PD, progressive RT improved cardiovascular autonomic dysfunction.


      List of abbreviations:

      HC (healthy control), HFR-R (high-frequency component of R-R interval variability), LFR-R (low-frequency component of R-R interval variability), PD (Parkinson disease), PDC (PD control), PDT (PD training), RM (repetition maximum), RT (resistance training)
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        • Jankovic J.
        Parkinson's disease: clinical features and diagnosis.
        J Neurol Neurosurg Psychiatry. 2008; 79: 368-376
        • Gelpi E.
        • Navarro-Otano J.
        • Tolosa E.
        • et al.
        Multiple organ involvement by alpha-synuclein pathology in Lewy body disorders.
        Mov Disord. 2014; 29: 1010-1018
        • Goldstein D.S.
        • Li S.T.
        • Kopin I.J.
        Sympathetic neurocirculatory failure in Parkinson disease: evidence for an etiologic role of alpha-synuclein.
        Ann Intern Med. 2001; 135: 1010-1011
        • Jellinger K.A.
        Synuclein deposition and non-motor symptoms in Parkinson disease.
        J Neurol Sci. 2011; 310: 107-111
        • Orimo S.
        • Uchihara T.
        • Nakamura A.
        • et al.
        Axonal alpha-synuclein aggregates herald centripetal degeneration of cardiac sympathetic nerve in Parkinson's disease.
        Brain. 2008; 131: 642-650
        • Barbic F.
        • Perego F.
        • Canesi M.
        • et al.
        Early abnormalities of vascular and cardiac autonomic control in Parkinson's disease without orthostatic hypotension.
        Hypertension. 2007; 49: 120-126
        • Buob A.
        • Winter H.
        • Kindermann M.
        • et al.
        Parasympathetic but not sympathetic cardiac dysfunction at early stages of Parkinson's disease.
        Clin Res Cardiol. 2010; 99: 701-706
        • Delgado G.
        • Estanol B.
        • Rodriguez-Violante M.
        • Martinez-Memije R.
        • Infante-Vazquez O.
        • Bertado-Ramirez N.
        Cardiovascular variability in Mexican patients with Parkinson's disease.
        Arq Neuropsiquiatr. 2014; 72: 762-767
        • Matinolli M.
        • Korpelainen J.T.
        • Korpelainen R.
        • Sotaniemi K.A.
        • Myllyla V.V.
        Orthostatic hypotension, balance and falls in Parkinson's disease.
        Mov Disord. 2009; 24: 745-751
        • Coon E.A.
        • Sletten D.M.
        • Suarez M.D.
        • et al.
        Clinical features and autonomic testing predict survival in multiple system atrophy.
        Brain. 2015; 138: 3623-3631
        • Lacigova S.
        • Brozova J.
        • Cechurova D.
        • Tomesova J.
        • Krcma M.
        • Rusavy Z.
        The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients: 10 year follow-up.
        Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016; 160: 111-117
        • Duarte J.
        • García Olmos L.M.
        • Mendoza A.
        • Clavería L.E.
        The natural history of Parkinson's disease in the province of Segovia: mortality in a longitudinal study (20-year follow-up).
        Am Heart J. 2015; 169: 508-514
        • Liang H.W.
        • Huang Y.P.
        • Pan S.L.
        Parkinson disease and risk of acute myocardial infarction: a population-based, propensity score-matched, longitudinal follow-up study.
        Acta Neurol Scand. 2013; 127: 295-300
        • Falvo M.J.
        • Schilling B.K.
        • Earhart G.M.
        Parkinson's disease and resistive exercise: rationale, review, and recommendations.
        Mov Disord. 2008; 23: 1-11
        • Bloomer R.J.
        • Schilling B.K.
        • Karlage R.E.
        • Ledoux M.S.
        • Pfeiffer R.F.
        • Callegari J.
        Effect of resistance training on blood oxidative stress in Parkinson disease.
        Med Sci Sports Exerc. 2008; 40: 1385-1389
        • Corcos D.M.
        • Robichaud J.A.
        • David F.J.
        • et al.
        A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease.
        Mov Disord. 2013; 28: 1230-1240
        • Kelly N.A.
        • Ford M.P.
        • Standaert D.G.
        • et al.
        Novel, high-intensity exercise prescription improves muscle mass, mitochondrial function, and physical capacity in individuals with Parkinson's disease.
        J Appl Physiol (1985). 2014; 116: 582-592
        • Shulman L.M.
        • Katzel L.I.
        • Ivey F.M.
        • et al.
        Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease.
        JAMA Neurol. 2013; 70: 183-190
        • Silva-Batista C.
        • Corcos D.M.
        • Roschel H.
        • et al.
        Resistance training with instability for patients with Parkinson's disease.
        Med Sci Sports Exerc. 2016; 48: 1678-1687
        • Figueroa A.
        • Kingsley J.D.
        • McMillan V.
        • Panton L.B.
        Resistance exercise training improves heart rate variability in women with fibromyalgia.
        Clin Physiol Funct Imaging. 2008; 28: 49-54
        • Selig S.E.
        • Carey M.F.
        • Menzies D.G.
        • et al.
        Moderate-intensity resistance exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability, and forearm blood flow.
        J Card Fail. 2004; 10: 21-30
        • Podsiadlo D.
        • Richardson S.
        The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
        J Am Geriatr Soc. 1991; 39: 142-148
        • Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology
        Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.
        Circulation. 1996; 93: 1043-1065
        • Rahman F.
        • Pechnik S.
        • Gross D.
        • Sewell L.
        • Goldstein D.S.
        Low frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation.
        Clin Auton Res. 2011; 21: 133-141
        • Ewing D.J.
        • Clarke B.F.
        Diagnosis and management of diabetic autonomic neuropathy.
        Br Med J (Clin Res Ed). 1982; 285: 916-918
        • Bennett T.
        • Fentem P.H.
        • Fitton D.
        • Hampton J.R.
        • Hosking D.J.
        • Riggott P.A.
        Assessment of vagal control of the heart in diabetes. Measures of R-R interval variation under different conditions.
        Br Heart J. 1977; 39: 25-28
        • Bonde-Petersen F.
        • Christensen N.J.
        • Henriksen O.
        • et al.
        Aspects of cardiovascular adaptation to gravitational stresses.
        Physiologist. 1980; 23: S7-S10
        • Piha S.J.
        Autonomic responses to the Valsalva manoeuvre in healthy subjects.
        Clin Physiol. 1995; 15: 339-347
        • Brown L.E.
        • Weir J.P.
        ASEP procedures recommendation I: accurate assessment of muscular strength and power.
        J Exerc Physiol Online. 2001; 4: 1-12
        • Allen N.E.
        • Canning C.G.
        • Sherrington C.
        • Fung V.S.
        Bradykinesia, muscle weakness and reduced muscle power in Parkinson's disease.
        Mov Disord. 2009; 24: 1344-1351
        • Gray W.K.
        • Hildreth A.
        • Bilclough J.A.
        • Wood B.H.
        • Baker K.
        • Walker R.W.
        Physical assessment as a predictor of mortality in people with Parkinson's disease: a study over 7 years.
        Mov Disord. 2009; 24: 1934-1940
        • Montano N.
        • Ruscone T.G.
        • Porta A.
        • Lombardi F.
        • Pagani M.
        • Malliani A.
        Power spectrum analysis of heart rate variability to assess the changes in sympathovagal balance during graded orthostatic tilt.
        Circulation. 1994; 90: 1826-1831
        • Forte R.
        • De Vito G.
        • Figura F.
        Effects of dynamic resistance training on heart rate variability in healthy older women.
        Eur J Appl Physiol. 2003; 89: 85-89
        • Gerage A.M.
        • Forjaz C.L.
        • Nascimento M.A.
        • Januario R.S.
        • Polito M.D.
        • Cyrino E.S.
        Cardiovascular adaptations to resistance training in elderly postmenopausal women.
        Int J Sports Med. 2013; 34: 806-813
        • Kanegusuku H.
        • Queiroz A.C.
        • Silva V.J.
        • de Mello M.T.
        • Ugrinowitsch C.
        • Forjaz C.L.
        High-intensity progressive resistance training increases strength with no change in cardiovascular function and autonomic neural regulation in older adults.
        J Aging Phys Act. 2015; 23: 339-345
        • Madden K.M.
        • Levy W.C.
        • Stratton J.K.
        Exercise training and heart rate variability in older adult female subjects.
        Clin Invest Med. 2006; 29: 20-28
        • Ewing D.J.
        • Hume L.
        • Campbell I.W.
        • Murray A.
        • Neilson J.M.
        • Clarke B.F.
        Autonomic mechanisms in the initial heart rate response to standing.
        J Appl Physiol Respir Environ Exerc Physiol. 1980; 49: 809-814
        • Brilla L.R.
        • Stephens A.B.
        • Knutzen K.M.
        • Caine D.
        Effect of strength training on orthostatic hypotension in older adults.
        J Cardiopulm Rehabil. 1998; 18: 295-300
        • Mhyre T.R.
        • Boyd J.T.
        • Hamill R.W.
        • Maguire-Zeiss K.A.
        Parkinson's disease.
        Subcell Biochem. 2012; 65: 389-455
        • Schapira A.H.
        • Jenner P.
        Etiology and pathogenesis of Parkinson's disease.
        Mov Disord. 2011; 26: 1049-1055
        • Tuon T.
        • Valvassori S.S.
        • Dal Pont G.C.
        • et al.
        Physical training prevents depressive symptoms and a decrease in brain-derived neurotrophic factor in Parkinson's disease.
        Brain Res Bull. 2014; 108: 106-112
        • Kleiger R.E.
        • Miller J.P.
        • Bigger Jr., J.T.
        • Moss A.J.
        Decreased heart rate variability and its association with increased mortality after acute myocardial infarction.
        Am J Cardiol. 1987; 59: 256-262