Evaluating Heart Rate Variability as a Biomarker for Autonomic Function in Parkinson’s Disease Rehabilitation: A Clustering-Based Analysis of Exercise-Induced Changes
Abstract
1. Introduction
- Total power represents overall autonomic modulation.
- Low-frequency (LF) activity (<0.15 Hz) is primarily linked to baroreflex-mediated autonomic regulation, incorporating both sympathetic and parasympathetic influences.
- High-frequency (HF) activity, on the other hand, is strongly associated with parasympathetic (vagal) activity, reflecting respiratory-related heart rate fluctuations.
- The LF/HF ratio is often interpreted as an index of autonomic balance, though this measure remains debated due to factors such as differences in temporal dynamics between sympathetic and parasympathetic responses and variations in cardiac pacemaker sensitivity.
- Degeneration of brainstem autonomic centers (e.g., dorsal motor nucleus of the vagus, locus coeruleus, and medullary cardiovascular centers), leading to impaired parasympathetic regulation.
- Dysfunction of basal ganglia and limbic circuits, which play a role in autonomic modulation and stress regulation.
- Reduced baroreflex sensitivity and vagal tone, contributing to blood pressure variability, orthostatic hypotension, and cardiovascular instability.
2. Materials and Methods
2.1. Participants
2.1.1. Inclusion Criteria
- Aged between 45 and 75 years;
- Had a diagnosis of Parkinson’s disease, classified as Hoehn and Yahr stages 2–3, indicating moderate disease severity;
- Were stable on PD medications for at least three months prior to the study;
- Could walk independently or with minimal assistance (Unified Parkinson’s Disease Rating Scale—Motor Examination, score ≤ 3 on gait and posture items);
- Had not participated in any structured exercise program or physical activity regimen (e.g., more than three sessions per week, 30–40 min per session) in the past six months or longer;
- Were able to understand and follow instructions in either Arabic or English.
2.1.2. Exclusion Criteria
- Had contraindications to magnetic resonance imaging (MRI), such as metallic implants, claustrophobia, or pacemakers;
- Had significant medical, neurological, or psychiatric conditions unrelated to Parkinson’s disease (e.g., recent strokes, uncontrolled diabetes, or major depressive disorder);
- Displayed severe cognitive impairments (Montreal Cognitive Assessment (MoCA) score < 21), which could hinder their ability to follow instructions;
- Experienced advanced motor complications (Hoehn and Yahr stage > 3) that could compromise their safe participation;
- Were classified as obese (BMI ≥ 30.0 kg/m2), as excessive weight may impact autonomic function, HRV measurements, and exercise tolerance.
2.2. Data Collection
2.3. Statistcal Analysis
3. Results
3.1. Heart Rate Variblity Changes Pre- and Post-Exercise
3.2. Frequency-Domain Analysis
3.3. HRV-Based Evidence of Autonomic Adaptation
4. Discussion
4.1. Impact of Exercise on Autonomic Function
4.2. Heterogeneous HRV Responses: Patient Subgroup Differences
4.3. Clinical and Physiological Implications
4.4. Limitations and Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographics | |||||
---|---|---|---|---|---|
Age (years) | 60.2 ± 4.5 | ||||
Sex | 55 Female + 55 Male | ||||
BMI (kg/m2) | 28.5 ± 2.8 | ||||
HRV Metric | Time | ECG (Mean ± SD) | t-test p-value | PCA Loadings (Feature Importance) | |
PC1 | PC2 | ||||
SD of RR (ms) | Pre-Intervention | 3.4 ± 1.17 | <0.05 | −0.45 | 0.35 |
Post-Intervention | 4.02 ± 1.56 | 0.20 | 0.59 | ||
Mean of RR (ms) | Pre-Intervention | 882 ± 13 | 0.5 | - | - |
Post-Intervention | 890 ± 15 | - | - | ||
SDRR Coeff. of Variation % | Pre-Intervention | 46 ± 17 | <0.05 | −0.36 | 0.32 |
Post-Intervention | 41 ± 21 | 0.18 | 0.58 | ||
VLF (ms2) | Pre-Intervention | 0.56 ± 0.62 | <0.05 | −0.02 | −0.06 |
Post-Intervention | 0.38 ± 1.44 | 0.08 | 0.13 | ||
LF (ms2) | Pre-Intervention | 0.45 ± 0.68 | 0.40 | −0.15 | −0.05 |
Post-Intervention | 0.37 ± 0.61 | 0.14 | 0.22 | ||
HF (ms2) | Pre-Intervention | 0.16 ± 0.09 | 0.33 | −0.12 | −0.09 |
Post-Intervention | 0.20 ± 0.26 | −0.04 | 0.09 | ||
LF/HF | Pre-Intervention | 2.81 ± 2.30 | <0.05 | 0.58 | −0.01 |
Post-Intervention | 1.85 ± 8.78 | 0.44 | 0.00 |
Cluster | Subgroup Name | Number of Patients (%) |
---|---|---|
Cluster 3 | Mixed/Irregular Responders | 66 (60%) |
Cluster 1 | Moderate HRV Responders | 30 (27%) |
Cluster 2 | Strong HRV Responders | 7 (6%) |
Cluster 0 | Low HRV Responders | 7 (6%) |
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Basri, A.M.; Turki, A.F. Evaluating Heart Rate Variability as a Biomarker for Autonomic Function in Parkinson’s Disease Rehabilitation: A Clustering-Based Analysis of Exercise-Induced Changes. Medicina 2025, 61, 527. https://doi.org/10.3390/medicina61030527
Basri AM, Turki AF. Evaluating Heart Rate Variability as a Biomarker for Autonomic Function in Parkinson’s Disease Rehabilitation: A Clustering-Based Analysis of Exercise-Induced Changes. Medicina. 2025; 61(3):527. https://doi.org/10.3390/medicina61030527
Chicago/Turabian StyleBasri, Ahmed M., and Ahmad F. Turki. 2025. "Evaluating Heart Rate Variability as a Biomarker for Autonomic Function in Parkinson’s Disease Rehabilitation: A Clustering-Based Analysis of Exercise-Induced Changes" Medicina 61, no. 3: 527. https://doi.org/10.3390/medicina61030527
APA StyleBasri, A. M., & Turki, A. F. (2025). Evaluating Heart Rate Variability as a Biomarker for Autonomic Function in Parkinson’s Disease Rehabilitation: A Clustering-Based Analysis of Exercise-Induced Changes. Medicina, 61(3), 527. https://doi.org/10.3390/medicina61030527