Ankle plantar-dorsal flexion exercises mitigate orthostatic hypotension in patients with neurodegenerative diseases

Orthostatic hypotension is frequently observed in patients with neurodegenerative diseases such as multiple system atrophy (MSA) and Parkinson's disease (PD). This study aimed to investigate the immediate effects of ankle plantar-dorsal flexion (APDF) exercises on hemodynamics and autonomic nerve function in patients with orthostatic hypotension. Thirteen consecutively admitted patients diagnosed with MSA or PD and orthostatic hypotension were included in this study. This crossover study included two consecutive, randomly assigned intervention sessions: one exercise session and one control session. In both sessions, patients sat relaxed in a chair for 6 min before standing up for 5 min. During the exercise session, they performed APDF exercises at 60 cycles/min during the final minute of sitting. Blood pressure and autonomic nerve function were monitored continuously. Correlations between patient characteristics and changes in SBP after standing (ΔSBP) were also analyzed. After 1 min of standing, SBP was reduced by a median value of 17.5 mmHg during the control session, while it lowered to only 1.0 mmHg during the exercise session. There were no significant changes in heart rate frequencies during both sessions. These results suggest that APDF exercises mitigate the drop in SBP through improved venous return, without affecting autonomic nerve function. We conclude that a short bout of ankle exercises may be an effective and safe intervention to prevent orthostatic hypotension in patients with neurodegenerative diseases.