telerehabilitation for dysautonomia in parkinson's disease

Conditions: Parkinson Disease

Summary: people diagnosed with parkinson's disease (pd) exhibit a combination of motor and non-motor symptoms, with the latter posing challenges in terms of identification and management. these non-motor symptoms tend to manifest before the motor symptoms and progressively worsen over time, significantly impacting the symptoms and everyday life activities of those affected. however, there remains a noticeable lack of scientific literature addressing the assessment and rehabilitation of cardiovascular dysautonomia in pd patients. thus, our research aims to address this gap by pursuing the following objectives: 1) assess the feasibility, acceptability, and potential effectiveness of a hybrid telerehabilitation program designed to target cardiovascular health in individuals with parkinson's disease; and 2) characterize cardiovascular dysautonomia using non-invasive measurements of cardiovascular and autonomic nervous system (ans) function and self-reported symptom assessments.

this pilot clinical trial employs mixed methods and aims to recruit 16 participants meeting the criteria of stage 1 to 3 parkinson's disease according to the hoehn and yahr scale, aged 50 or above, under optimized drug therapy, having home internet access, and without exercise contraindications, but exhibiting cardiovascular dysautonomia based on positive clinical results from active orthostatic hypotension maneuver, with or without reported symptoms and/or scopa-aut questionnaire score ≥ 2/3 items. the 12-week telerehabilitation program comprises three weekly sessions, encompassing different exercise modalities to improve walk capacity (aerobic, strength, balance, coordination, flexibility) and education on symptom management. a progressive increase in autonomy is implemented, starting with synchronous/asynchronous sessions of 3/0 in week 1 to 0/3 in week 12. feasibility (recruitment, adherence, retention), acceptability (questionnaire, semi-structured interviews), and potential effectiveness on motor (walking, mobility, balance) and non-motor aspects (pain and cardiovascular dysautonomia) will be measured before and after the intervention.

Eligibility criteria:
inclusion criteria: * patients with pd (1 to 3 on hoeh\&yahr) * patients under treatment with optimized drug therapy. medication is stable for at least 1 month * patients with access to the internet * speaking french or english * 50 years or older * patients having cardiovascular dysautonomia according to the clinical criteria: supine hypertension (sh) (≥140/90 mmhg) and/or orthostatic hypotension (oh) (a drop of systolic blood pressure ≥ 20 mmhg and/or diastolic blood pressure ≥ 10 mmhg during the active orthostatic hypotension test). exclusion criteria: * major cognitive impairment (montreal cognitive assessment, score ≤ 24) * neurological disorders other than pd * musculoskeletal or cardiopulmonary disorders preventing physical activity, contraindication to physical activity, or presence of a cardiac pacemaker.

Keywords: virtual rehabilitation exercise parkinsonism cardiovascular autonomic nervous system cardiorespiratory physical therapy physiotherapy physical activity