Clinical Autonomic Research

, Volume 24, Issue 3, pp 111–118

Treadmill gait training improves baroreflex sensitivity in Parkinson’s disease

  • Mohan Ganesan
  • Pramod Kumar Pal
  • Anupam Gupta
  • Talakad N. Sathyaprabha
Research Article



Partial weight supported treadmill gait training (PWSTT) is widely used in rehabilitation of gait in patient with Parkinson’s Diseases (PD). However, its effect on blood pressure variability (BPV) and baroreflex sensitivity (BRS) in PD has not been studied.


To evaluate the effect of conventional and treadmill gait training on BPV components and BRS.


Sixty patients with idiopathic PD were randomized into three groups. Twenty patients in control group were on only stable medication, 20 patients in conventional gait training (CGT) group (Stable medication with CGT) and 20 patients in PWSTT group (Stable medication with 20 % PWSTT). The CGT and PWSTT sessions were given for 30 min per day, 4 days per week, for 4 weeks (16 sessions). Groups were evaluated in their best ‘ON’ states. The beat-to-beat finger blood pressure (BP) was recorded for 10 min using a Finometer instrument (Finapres Medical Systems, The Netherlands). BPV and BRS results were derived from artifact-free 5-min segments using Nevrocard software.


BRS showed a significant group with time interaction (F = 6.930; p = 0.003). Post-hoc analysis revealed that PWSTT group showed significant improvement in BRS (p < 0.001) after 4 weeks of training. No significant differences found in BPV parameters; systolic BP, diastolic BP, co-variance of systolic BP and low frequency component of systolic BP.


Four weeks of PWSTT significantly improves BRS in patients with PD. It can be considered as a non-invasive method of influencing BRS for prevention of orthostatic BP fall in patients with PD.


Parkinson’s disease Blood pressure variability Baroreflex sensitivity Treadmill training Gait training 


  1. 1.
    Mehrholz J, Friis R, Kugler J, Twork S, Storch A, Pohl M (2010) Treadmill training for patients with Parkinson’s disease. Cochrane Database Syst Rev 20(1):CD007830Google Scholar
  2. 2.
    Michalowska M, Fiszer U, Krygowska-Wajs A, Owczarek K (2005) Falls in Parkinson’s disease. Causes and impact on patients’ quality of life. Funct Neurol 20(4):163–168PubMedGoogle Scholar
  3. 3.
    Bloem BR, Beckley DJ, van Dijk JG, Zwinderman AH, Remler MP, Roos RA (1996) Influence of dopaminergic medication on automatic postural responses and balance impairment in Parkinson’s disease. Mov Disord 11(5):509–521PubMedCrossRefGoogle Scholar
  4. 4.
    Perez-Lloret S, Rey MV, Fabre N, Ory F, Spampinato U, Montastruc JL et al (2012) Do Parkinson’s disease patients disclose their adverse events spontaneously? Eur J Clin Pharmacol 68(5):857–865PubMedCrossRefGoogle Scholar
  5. 5.
    Ganesan M, Pal PK, Gupta A, Sathyaprabha TN (2010) Dynamic posturography in evaluation of balance in patients of Parkinson’s disease with normal pull test: concept of a diagonal pull test. Parkinsonism Relat Disord 16(9):595–599PubMedCrossRefGoogle Scholar
  6. 6.
    Ganesan M, Sathyaprabha TN, Gupta A, Pal PK (2014) Effect of partial weight-supported treadmill gait training on balance in patients with Parkinson disease. PMR 6(1):22–33CrossRefGoogle Scholar
  7. 7.
    Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J et al (2012) Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med 366(6):511–519PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Shen X, Mak MK (2014) Balance and gait training with augmented feedback improves balance confidence in people with Parkinson’s disease: a randomized controlled trial. Neurorehabil Neural Repair Jan 9: doi:10.1177/1545968313517752
  9. 9.
    Sanchez-Ferro A, Benito-Leon J, Gomez-Esteban JC (2013) The management of orthostatic hypotension in Parkinson’s disease. Front Neurol 4:64PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Braune S, Elam M, Baron R, Low PA (1999) Assessment of blood pressure regulation. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol 52:287–291Google Scholar
  11. 11.
    Goldstein DS (1983) Arterial baroreflex sensitivity, plasma catecholamines, and pressor responsiveness in essential hypertension. Circulation 68(2):234–240PubMedCrossRefGoogle Scholar
  12. 12.
    Kardos A, Watterich G, de Menezes R, Csanady M, Casadei B, Rudas L (2001) Determinants of spontaneous baroreflex sensitivity in a healthy working population. Hypertension 37(3):911–916PubMedCrossRefGoogle Scholar
  13. 13.
    Szili-Torok T, Kalman J, Paprika D, Dibo G, Rozsa Z, Rudas L (2001) Depressed baroreflex sensitivity in patients with Alzheimer’s and Parkinson’s disease. Neurobiol Aging 22(3):435–438PubMedCrossRefGoogle Scholar
  14. 14.
    Iellamo F, Legramante JM, Massaro M, Raimondi G, Galante A (2000) Effects of a residential exercise training on baroreflex sensitivity and heart rate variability in patients with coronary artery disease: a randomized, controlled study. Circulation 102:2588–2592PubMedCrossRefGoogle Scholar
  15. 15.
    La Rovere MT, Bersano C, Gnemmi M, Specchia G, Schwartz PJ (2002) Exercise-induced increase in baroreflex sensitivity predicts improved prognosis after myocardial infarction. Circulation 106:945–949PubMedCrossRefGoogle Scholar
  16. 16.
    Ditor DS, Kamath MV, MacDonald MJ, Bugaresti J, McCartney N, Hicks AL (2005) Effects of body weight-supported treadmill training on heart rate variability and blood pressure variability in individuals with spinal cord injury. J Appl Physiol 98(4):1519–1525PubMedCrossRefGoogle Scholar
  17. 17.
    Bogert LW, van Lieshout JJ (2005) Non-invasive pulsatile arterial pressure and stroke volume changes from the human finger. Exp Physiol 90(4):437–446PubMedCrossRefGoogle Scholar
  18. 18.
    Imholz BP, Wieling W, van Montfrans GA, Wesseling KH (1998) Fifteen years experience with finger arterial pressure monitoring: assessment of the technology. Cardiovasc Res 38(3):605–616PubMedCrossRefGoogle Scholar
  19. 19.
    Parlow J, Viale JP, Annat G, Hughson R, Quintin L (1995) Spontaneous cardiac baroreflex in humans. Comparison with drug-induced responses. Hypertension 25(5):1058–1068PubMedCrossRefGoogle Scholar
  20. 20.
    Parati G, Di Rienzo M, Omboni S, Ulian L, Mancia G (1995) Blood pressure variability over 24 hours: its different components and its relationship to the arterial baroreflex. J Sleep Res 4:21–29PubMedCrossRefGoogle Scholar
  21. 21.
    Tank J, Baevski RM, Fender A, Baevski AR, Graves KF, Ploewka K et al (2000) Reference values of indices of spontaneous baroreceptor reflex sensitivity. Am J Hypertens 13(3):268–275PubMedCrossRefGoogle Scholar
  22. 22.
    Barbic F, Perego F, Canesi M, Gianni M, Biagiotti S, Costantino G et al (2007) Early abnormalities of vascular and cardiac autonomic control in Parkinson’s disease without orthostatic hypotension. Hypertension 49(1):120–126PubMedCrossRefGoogle Scholar
  23. 23.
    Dolan E, O’Brien E (2010) Blood pressure variability: clarity for clinical practice. Hypertension 56(2):179–181PubMedCrossRefGoogle Scholar
  24. 24.
    Laude D, Elghozi JL, Girard A, Bellard E, Bouhaddi M et al (2004) Comparison of various techniques used to estimate spontaneous baroreflex sensitivity (the EuroBaVar study). Am J Physiol Regul Integr Comp Physiol 286(1):226–231CrossRefGoogle Scholar
  25. 25.
    Milic M, Sun P, Liu F, Fainman C, Dimsdale J, Mills PJ et al (2009) A comparison of pharmacologic and spontaneous baroreflex methods in aging and hypertension. J Hypertens 27(6):1243–1251PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Lanfranchi PA, Somers VK (2002) Arterial baroreflex function and cardiovascular variability: interactions and implications. Am J Physiol Regul Integr Comp Physiol 283(4):815–826Google Scholar
  27. 27.
    Watkins LL, Blumenthal JA, Carney RM (2002) Association of anxiety with reduced baroreflex cardiac control in patients after acute myocardial infarction. Am Heart J 143(3):460–466PubMedCrossRefGoogle Scholar
  28. 28.
    Eckberg DL, Convertino VA, Fritsch JM, Doerr DF (1992) Reproducibility of human vagal carotid baroreceptor–cardiac reflex responses. Am J Physiol 263(2):215–220Google Scholar
  29. 29.
    Loimaala A, Huikuri HV, Koobi T, Rinne M, Nenonen A, Vuori I (2003) Exercise training improves baroreflex sensitivity in type 2 diabetes. Diabetes 52(7):1837–1842PubMedCrossRefGoogle Scholar
  30. 30.
    Iellamo F, Manzi V, Caminiti G, Sposato B, Massaro M, Cerrito A et al (2013) Dose-response relationship of baroreflex sensitivity and heart rate variability to individually-tailored exercise training in patients with heart failure. Int J Cardiol 166(2):334–339PubMedCrossRefGoogle Scholar
  31. 31.
    Martinez DG, Nicolau JC, Lage RL, Toschi-Dias E, de Matos LD, Alves MJ et al (2011) Effects of long-term exercise training on autonomic control in myocardial infarction patients. Hypertension 58(6):1049–1056PubMedCrossRefGoogle Scholar
  32. 32.
    Kaufmann H, Goldstein DS (2013) Autonomic dysfunction in Parkinson disease. Handb Clin Neurol 117:259–278PubMedCrossRefGoogle Scholar
  33. 33.
    Linden D, Diehl RR, Berlit P (1997) Sympathetic cardiovascular dysfunction in long-standing idiopathic Parkinson’s disease. Clin Auton Res 7(6):311–314PubMedCrossRefGoogle Scholar
  34. 34.
    Palma J-A, Urrestarazu E, Alegre M, Pastor MA, Valencia M, Artieda J et al (2013) Cardiac autonomic impairment during sleep is linked with disease severity in Parkinson’s disease. Clin Neurophysiol 124(6):1163–1168PubMedCrossRefGoogle Scholar
  35. 35.
    Palma JA, Carmona-Abellan MM, Barriobero N, Trevino-Peinado C, Garcia-Lopez M, Fernandez-Jarne E et al (2013) Is cardiac function impaired in premotor Parkinson’s disease? A retrospective cohort study. Mov Disord 28(5):591–596PubMedCrossRefGoogle Scholar
  36. 36.
    Werner WG, DiFrancisco-Donoghue J, Lamberg EM (2006) Cardiovascular response to treadmill testing in Parkinson disease. J Neurol Phys Ther 30:68–73PubMedCrossRefGoogle Scholar
  37. 37.
    Goldstein DS (2003) Dysautonomia in Parkinson’s disease: neurocardiological abnormalities. Lancet Neurol 2(11):669–676PubMedCrossRefGoogle Scholar
  38. 38.
    Goldstein DS, Holmes CS, Dendi R, Bruce SR, Li ST (2002) Orthostatic hypotension from sympathetic denervation in Parkinson’s disease. Neurology 58(8):1247–1255PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Mohan Ganesan
    • 1
    • 2
  • Pramod Kumar Pal
    • 3
  • Anupam Gupta
    • 4
  • Talakad N. Sathyaprabha
    • 1
  1. 1.Department of Neurophysiology, Laboratory for Autonomic FunctionsNational Institute of Mental Health and NeurosciencesBangaloreIndia
  2. 2.Department of Physical TherapyCollege of Applied Health Sciences, University of IllinoisChicagoUSA
  3. 3.Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreIndia
  4. 4.Department of Neurological RehabilitationNational Institute of Mental Health and NeurosciencesBangaloreIndia

Personalised recommendations