Walking with blood flow restriction in Parkinson's disease: vascular, neurotrophic and functional outcomes: a randomized controlled trial (WALK-BFR-PD Trial).

BACKGROUND: Blood flow restriction (BFR) training induces beneficial adaptations at low exercise intensities. However, studies on its effects during walking exercise in individuals with Parkinson's disease (PD) remain limited. METHODS: Twenty-four individuals with PD (Hoehn and Yahr stages 2-3) were randomly assigned to a walking exercise (WALK, n = 8), walking with BFR (WALK-BFR, n = 8), or control group (CON, n = 8). Both exercise groups performed supervised training twice weekly for 8 weeks; the WALK-BFR group was trained with BFR applied at 40-60% of the arterial occlusion pressure. The outcomes included vascular, neurotrophic, functional, and quality-of-life parameters. Exercise-related adverse events were recorded. RESULTS: The WALK group did not show significant improvements in brain-derived neurotrophic factor (BDNF), flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), Five Times Sit-to-Stand Test, Timed Up and Go Test (TUGT), or 10-Meter Walk Test (10MWT) [all p > 0.05]. Although total Unified Parkinson's Disease Rating Scale (UPDRS) scores decreased in the WALK group, a similar reduction was observed in the CON group, with the only distinct improvement observed in UPDRS Part I. In contrast, WALK-BFR demonstrated significant improvements in BDNF and FMD (both p < 0.05), as well as functional performance (TUGT and 10MWT), quality of life (PDQ-8), and total UPDRS scores, with additional reductions in UPDRS Parts II-IV. However, baPWV did not significantly change in any group (p > 0.05). Both interventions were well tolerated, with a similar incidence of mild and transient lower-extremity muscle soreness in WALK and WALK-BFR groups. CONCLUSION: WALK-BFR was associated with concurrent improvements in neurotrophic, vascular, and functional outcomes and quality of life in individuals with PD. Furthermore, the intervention was well tolerated and may represent a feasible rehabilitation strategy.