Rehabilitation Strategies for Sleep and Autonomic Symptoms in Parkinson's Disease

To evaluate the effectiveness of rehabilitation therapies for managing symptoms of sleep and autonomic dysfunction (cardiovascular, gastrointestinal, urinary and sexual) in Parkinson's disease (PD). The narrative review focuses on recent data drawn from clinical trials, particularly randomized controlled trials, to assess these therapies and the overall quality of the evidence.

Resistance training and aerobic exercises can improve sleep quality in PD. Resistance and aerobic exercises, along with abdominal binders, may help alleviate orthostatic hypotension, though the quality of evidence is not high. Interventions such as expiratory muscle strength training, sensorimotor training, and video-assisted swallowing therapy are beneficial for dysphagia. Pelvic floor muscle training combined with behavioral therapy can potentially mitigate urgency and urge incontinence. Many rehab-based strategies though promising lack sufficient evidence for implementation into clinical practice. The current evidence supports their role in addressing sleep disturbances, orthostatic hypotension and dysphagia. However, the evidence for their effectiveness in treating gastroparesis, constipation, and urinary and sexual dysfunction remains limited.