Case Report: Metabolic adaptations to intensive aerobic training in Parkinson's disease: autonomic and physiopathological response.
6 affiliations
- 1Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, Sustainable Living Concept Laboratory "Marco Marchetti" (Xlab), Campus Folcara, Cassino, Italy.
- 2IRCCS San Raffaele Roma, Cassino, Italy.
- 3Department of Human Science and Promotion of Quality of Life, San Raffaele Rome Open University, Rome, Italy.
- 4European University of Technology, EUt+ (University of Cassino and Southern Lazio), Cassino, Italy.
- 5IRCSS San Raffaele Roma, Rome, Italy.
- 6Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy.
Abstract
Introduction
Aerobic exercise is a key non-pharmacological intervention in Parkinson's disease (PD), yet the physiological mechanisms underlying its therapeutic effects remain incompletely understood. This case report aimed to investigate metabolic and cardiovascular adaptations to an intensive aerobic training programme in a person with PD, with particular focus on metabolic efficiency and insulin-like growth factor 1 (IGF-1) response.Methods
A 72-year-old man with idiopathic PD (Hoehn & Yahr stage II, ON medication) participated in a 4-week intensive treadmill training programme (20 sessions) within the METEX-PD protocol. Exercise was performed at a constant external workload (5.0-5.5 km·h⁻¹; 6.0-8.8 METs). Heart rate (HR) was continuously monitored, oxygen uptake ( V˙ O₂) was assessed using a portable metabolic analyser, post-exercise blood lactate concentration was measured, and serum IGF-1 levels were evaluated. Assessments were conducted at baseline, mid-intervention, and post-training.Results
Progressive reductions in HR, V˙ O₂, measured METs, and energy cost were observed throughout the intervention, indicating improved aerobic efficiency despite the maintenance of a constant external workload. HR responses across training sessions showed a peculiar pattern suggestive of chronotropic incompetence and cardiovascular drift. Non metabolic Hyperventilation occurred during post training testing. Serum IGF-1 levels increased following the training period, whereas no acute exercise-induced changes were detected. Blood lactate responses remained consistent with the prescribed exercise intensity.Discussion
Intensive aerobic training induced favourable metabolic adaptations in this individual with PD, as evidenced by improved aerobic efficiency and increased circulating IGF-1 levels. These adaptations occurred despite potential autonomic dysfunction affecting cardiovascular responses. The findings support the use of direct metabolic measurements to better characterise training adaptations and optimise individualised aerobic exercise prescription in people with PD. Further studies are warranted to confirm these observations in larger cohorts.
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BibTeX
@article{dermo2026case,
title = {{Case Report: Metabolic adaptations to intensive aerobic training in Parkinson's disease: autonomic and physiopathological response.}},
author = {Annalisa D'Ermo and Rossella Rotondo and Tommaso Di Libero and Giada D'Alessandro and Angelo Rodio and Elvira Padua and Fabrizio Stocchi and Michela Goffredo and Michele Guescini and Vilberto Stocchi and Giuseppe Rosano and Maria Francesca De Pandis},
journal = {Frontiers in sports and active living},
year = {2026},
month = oct,
doi = {10.3389/fspor.2026.1920699},
url = {https://europepmc.org/article/MED/42908999},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Metabolic adaptations to intensive aerobic training in Parkinson's disease: autonomic and physiopathological response.
AU - Annalisa D'Ermo
AU - Rossella Rotondo
AU - Tommaso Di Libero
AU - Giada D'Alessandro
AU - Angelo Rodio
AU - Elvira Padua
AU - Fabrizio Stocchi
AU - Michela Goffredo
AU - Michele Guescini
AU - Vilberto Stocchi
AU - Giuseppe Rosano
AU - Maria Francesca De Pandis
PY - 2026
DA - 2026/10/07
JO - Frontiers in sports and active living
DO - 10.3389/fspor.2026.1920699
UR - https://europepmc.org/article/MED/42908999
AB - Introduction Aerobic exercise is a key non-pharmacological intervention in Parkinson's disease (PD), yet the physiological mechanisms underlying its therapeutic effects remain incompletely understood. This case report aimed to investigate metabolic and cardiovascular adaptations to an intensive aerobic training programme in a person with PD, with particular focus on metabolic efficiency and insulin-like growth factor 1 (IGF-1) response.Methods A 72-year-old man with idiopathic PD (Hoehn & Yahr stage II, ON medication) participated in a 4-week intensive treadmill training programme (20 sessions) within the METEX-PD protocol. Exercise was performed at a constant external workload (5.0-5.5 km·h⁻¹; 6.0-8.8 METs). Heart rate (HR) was continuously monitored, oxygen uptake ( V˙ O₂) was assessed using a portable metabolic analyser, post-exercise blood lactate concentration was measured, and serum IGF-1 levels were evaluated. Assessments were conducted at baseline, mid-intervention, and post-training.Results Progressive reductions in HR, V˙ O₂, measured METs, and energy cost were observed throughout the intervention, indicating improved aerobic efficiency despite the maintenance of a constant external workload. HR responses across training sessions showed a peculiar pattern suggestive of chronotropic incompetence and cardiovascular drift. Non metabolic Hyperventilation occurred during post training testing. Serum IGF-1 levels increased following the training period, whereas no acute exercise-induced changes were detected. Blood lactate responses remained consistent with the prescribed exercise intensity.Discussion Intensive aerobic training induced favourable metabolic adaptations in this individual with PD, as evidenced by improved aerobic efficiency and increased circulating IGF-1 levels. These adaptations occurred despite potential autonomic dysfunction affecting cardiovascular responses. The findings support the use of direct metabolic measurements to better characterise training adaptations and optimise individualised aerobic exercise prescription in people with PD. Further studies are warranted to confirm these observations in larger cohorts.
SN - 2624-9367
ER -