Objective: To explore the current evidence and identify knowledge gaps, we conducted a scoping review about the hypoxia exposure effects on people with Parkinson’s disease (PwPD).

Background: A hypoxia exposure may activate the hypoxia-inducible factor-1 (HIF-1α), which improves neuronal survival and increases the transport/uptake of glucose, erythropoiesis, and angiogenesis. Also, HIF-1α activation increases dopamine’s metabolism, improving neuron function. Considering the disturbances in the dopamine metabolism observed in PwPD and the HIF-1α neuronal responses, it is plausible to infer that hypoxia exposure is an attractive therapeutic approach for this population. However, these molecular responses were only observed using animal models, limiting direct extrapolation for humans and demonstrating that the real effects of hypoxia should be better understood in PwPD.

Method: Following the Preferred Reporting Items for Scope Reviews statement and using PCC mnemonic (Population, Concept, and Context), PubMed/NCBI, Web of Science and Scopus were used (descriptors: Parkinson, hypoxia, mountain, and altitude) for papers searching. The included articles were published in English and peer-reviewed journals until February 18, 2021 (eight articles among 1357).

Results: The hypoxia exposure was applied through periods in mountains (hypobaric hypoxia; 3 studies) or using different rebreathing methods (normobaric hypoxia; 5 studies). These studies were consistent to demonstrate that one-week on the mountain – associated with daily walking – induced significant improvements in motor performance, quality of life, and illness patient’s perceptions, which remains after 3 months. Also, PwPD presented a lower sensibility to the drop in oxygen availability (e.g., abnormal ventilator responses), but this non-motor symptom may be attenuated after an intermittent hypoxia training (daily stimuli over 14-days). These results were observed through transversal designs or non-randomized parallel groups.

Conclusion: Although our results indicate the potential use of hypoxia exposure in alleviating Parkinson’s disease symptoms, further well-designed randomized controlled trials are necessary to implement this approach in clinical practice, representing a relatively new and valuable research field for PwPD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/is-the-hypoxia-exposure-beneficial-for-people-with-parkinsons-disease-a-scope-review/