{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:18:21Z","timestamp":1791389901142,"version":"4.3.3"},"reference-count":143,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,10,31]],"date-time":"2020-10-31T00:00:00Z","timestamp":1604102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Parkinson\u2019s disease (PD) is the second most common neurodegenerative condition after Alzheimer\u2019s disease, affecting an estimated 160 per 100,000 people 65 years of age or older. Fatigue is a debilitating non-motor symptom frequently reported in PD, often manifesting prior to disease diagnosis, persisting over time, and negatively affecting quality of life. Fatigability, on the other hand, is distinct from fatigue and describes the magnitude or rate of change over time in the performance of activity (i.e., performance fatigability) and sensations regulating the integrity of the performer (i.e., perceived fatigability). While fatigability has been relatively understudied in PD as compared to fatigue, it has been hypothesized that the presence of elevated levels of fatigability in PD results from the interactions of homeostatic, psychological, and central factors. Evidence from exercise studies supports the premise that greater disturbances in metabolic homeostasis may underly elevated levels of fatigability in people with PD when engaging in physical activity. Cardiorespiratory impairments constraining oxygen delivery and utilization may contribute to the metabolic alterations and excessive fatigability experienced in individuals with PD. Cardiorespiratory fitness is often reduced in people with PD, likely due to the combined effects of biological aging and impairments specific to the disease. Decreases in oxygen delivery (e.g., reduced cardiac output and impaired blood pressure responses) and oxygen utilization (e.g., reduced skeletal muscle oxidative capacity) compromise skeletal muscle respiration, forcing increased reliance on anaerobic metabolism. Thus, the assessment of fatigability in people with PD may provide valuable information regarding the functional status of people with PD not obtained with measures of fatigue. Moreover, interventions that target cardiorespiratory fitness may improve fatigability, movement performance, and health outcomes in this patient population.<\/jats:p>","DOI":"10.3390\/jfmk5040078","type":"journal-article","created":{"date-parts":[[2020,10,31]],"date-time":"2020-10-31T21:39:56Z","timestamp":1604180396000},"page":"78","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Fatigability and Cardiorespiratory Impairments in Parkinson\u2019s Disease: Potential Non-Motor Barriers to Activity Performance"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9148-2428","authenticated-orcid":false,"given":"Andrew E.","family":"Pechstein","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Science, George Mason University, Fairfax, VA 22030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1066-7389","authenticated-orcid":false,"given":"Jared M.","family":"Gollie","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Science, George Mason University, Fairfax, VA 22030, USA"},{"name":"Research Services, Veterans Affairs Medical Center, Washington, DC 20422, USA"},{"name":"Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, DC 20006, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew A.","family":"Guccione","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Science, George Mason University, Fairfax, VA 22030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/S1474-4422(16)30230-7","article-title":"The epidemiology of Parkinson\u2019s disease: Risk factors and prevention","volume":"15","author":"Ascherio","year":"2016","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1002\/mds.25292","article-title":"The current and projected economic burden of Parkinson\u2019s disease in the United States: Economic Burden of PD in the US","volume":"28","author":"Kowal","year":"2013","journal-title":"Mov. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/S0140-6736(14)61393-3","article-title":"Parkinson\u2019s disease","volume":"386","author":"Kalia","year":"2015","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/S1474-4422(09)70068-7","article-title":"Non-motor symptoms of Parkinson\u2019s disease: Dopaminergic pathophysiology and treatment","volume":"8","author":"Chaudhuri","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_5","first-page":"1","article-title":"Fatigue in Parkinson\u2019s disease: Report from a mutidisciplinary symposium","volume":"2","author":"Friedman","year":"2016","journal-title":"NPJ Parkinson\u2019s Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1002\/mds.26511","article-title":"Parkinson\u2019s disease-related fatigue: A case definition and recommendations for clinical research","volume":"31","author":"Kluger","year":"2016","journal-title":"Mov. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2214","DOI":"10.1007\/s00415-011-6097-7","article-title":"Physical inactivity in Parkinson\u2019s disease","volume":"258","author":"Nimwegen","year":"2011","journal-title":"J. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.pmrj.2010.03.022","article-title":"Fatigue and fatigability in older adults","volume":"2","author":"Eldadah","year":"2010","journal-title":"PM&R"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1002\/mds.21240","article-title":"Fatigue in Parkinson\u2019s disease: A review","volume":"22","author":"Friedman","year":"2007","journal-title":"Mov. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S1474-4422(14)70287-X","article-title":"Prediagnostic presentations of Parkinson\u2019s disease in primary care: A case-control study","volume":"14","author":"Schrag","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1212\/01.WNL.0000144277.06917.CC","article-title":"Is fatigue an independent and persistent symptom in patients with Parkinson disease?","volume":"63","author":"Alves","year":"2004","journal-title":"Neurology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1007\/s10072-015-2340-9","article-title":"Independent effect of fatigue on health-related quality of life in patients with idiopathic Parkinson\u2019s disease","volume":"36","author":"Dogan","year":"2015","journal-title":"Neurol. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1002\/mds.23394","article-title":"What are the most important nonmotor symptoms in patients with Parkinson\u2019s disease and are we missing them?","volume":"25","author":"Gallagher","year":"2010","journal-title":"Mov. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1177\/082585971503100402","article-title":"Validity, reliability, and insights from applying the McGill Quality of Life Questionnaire to People Living with Parkinson\u2019s Disease (MQoL-PD)","volume":"31","author":"Gofton","year":"2015","journal-title":"J. Palliat. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1111\/ene.12950","article-title":"The impact of non-motor symptoms on the quality of life of Parkinson\u2019s disease patients: A longitudinal study","volume":"23","author":"Prakash","year":"2016","journal-title":"Eur. J. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/bs.irn.2017.05.007","article-title":"Chapter twenty-four\u2013fatigue in Parkinson\u2019s disease","volume":"Volume 133","author":"Chaudhuri","year":"2017","journal-title":"International Review of Neurobiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"575","DOI":"10.3233\/JPD-191579","article-title":"Fatigue in parkinson\u2019s disease associates with lower ambulatory diastolic blood pressure","volume":"9","author":"Kotagal","year":"2019","journal-title":"J. Parkinsons. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/mds.26077","article-title":"The onset of nonmotor symptoms in Parkinson\u2019s disease (the ONSET PD study)","volume":"30","author":"Hotter","year":"2015","journal-title":"Mov. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.brainres.2013.10.004","article-title":"Physical activity and the brain: A review of this dynamic, bi-directional relationship","volume":"1539","author":"Loprinzi","year":"2013","journal-title":"Brain Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.mayocp.2017.12.015","article-title":"Aerobic exercise: Evidence for a direct brain effect to slow parkinson disease progression","volume":"93","author":"Ahlskog","year":"2018","journal-title":"Mayo Clin. Proc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1212\/WNL.0b013e318225ab66","article-title":"Does vigorous exercise have a neuroprotective effect in Parkinson disease?","volume":"77","author":"Ahlskog","year":"2011","journal-title":"Neurology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/S1474-4422(13)70123-6","article-title":"Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson\u2019s disease","volume":"12","author":"Petzinger","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1212\/01.WNL.0000055868.06222.AB","article-title":"Effects of fatigue on physical activity and function in patients with Parkinson\u2019s disease","volume":"60","author":"Garber","year":"2003","journal-title":"Neurology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/mds.1042","article-title":"Exacerbated physical fatigue and mental fatigue in Parkinson\u2019s disease","volume":"16","author":"Lou","year":"2001","journal-title":"Mov. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2228","DOI":"10.1249\/MSS.0000000000000929","article-title":"Translating fatigue to human performance","volume":"48","author":"Enoka","year":"2016","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1093\/gerona\/glv202","article-title":"Physical resilience in older adults: Systematic review and development of an emerging construct","volume":"71","author":"Whitson","year":"2016","journal-title":"J. Gerontol. Series A Biol. Sci. Med Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1093\/gerona\/glaa185","article-title":"Fatigability: A Prognostic indicator of phenotypic aging","volume":"75","author":"Schrack","year":"2020","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1212\/WNL.0b013e31827f07be","article-title":"Fatigue and fatigability in neurologic illnesses","volume":"80","author":"Kluger","year":"2013","journal-title":"Neurology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1093\/ptj\/76.1.34","article-title":"Cardiovascular and metabolic responses to upper- and lower-extremity exercise in men with idiopathic Parkinson\u2019s disease","volume":"76","author":"Protas","year":"1996","journal-title":"Phys. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1097\/00005768-199906000-00001","article-title":"Exercise performance in those having Parkinson\u2019s disease and healthy normals","volume":"31","author":"Stanley","year":"1999","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/BF02281625","article-title":"Exercise test in Parkinson\u2019s disease","volume":"9","author":"Reuter","year":"1999","journal-title":"Clin. Auton. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.apmr.2005.11.021","article-title":"Walking capacity in mild to moderate Parkinson\u2019s disease","volume":"87","author":"Canning","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/01.NPT.0000282570.78544.00","article-title":"Cardiovascular response to treadmill testing in parkinson disease","volume":"30","author":"Werner","year":"2006","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1002\/mds.22621","article-title":"Walking economy in people with Parkinson\u2019s disease","volume":"24","author":"Christiansen","year":"2009","journal-title":"Mov. Disord."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1002\/mds.22612","article-title":"Norepinephrine and cardiovascular responses to maximal exercise in Parkinson\u2019s disease on and off medication","volume":"24","author":"Elokda","year":"2009","journal-title":"Mov. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s10072-011-0827-6","article-title":"Energy cost of spontaneous walking in Parkinson\u2019s disease patients","volume":"33","author":"Maggioni","year":"2012","journal-title":"Neurol. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3233\/JPD-2012-012111","article-title":"Cardiovascular responses during a submaximal exercise test in patients with Parkinson\u2019s disease","volume":"2","author":"Speelman","year":"2012","journal-title":"J. Parkinsons. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.jns.2016.09.036","article-title":"Cardiovascular dysfunction in untreated Parkinson\u2019s disease: A multi-modality assessment","volume":"370","author":"Strano","year":"2016","journal-title":"J. Neurol. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.apmr.2015.12.020","article-title":"Blunted maximal and submaximal responses to cardiopulmonary exercise tests in patients with parkinson disease","volume":"97","author":"Kanegusuku","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1139\/apnm-2018-0638","article-title":"Hemodynamic responses to an exercise stress test in Parkinson\u2019s disease patients without orthostatic hypotension","volume":"44","author":"Roberson","year":"2019","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1002\/mds.23127","article-title":"Lowered cardiac sympathetic nerve performance in response to exercise in Parkinson\u2019s disease","volume":"25","author":"Nakamura","year":"2010","journal-title":"Mov. Disord."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"M453","DOI":"10.1093\/gerona\/58.5.M453","article-title":"Old adults perform activities of daily living near their maximal capabilities","volume":"58","author":"Mizelle","year":"2003","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1093\/gerona\/glu134","article-title":"Skeletal muscle mitochondrial function and fatigability in older adults","volume":"70","author":"Santanasto","year":"2015","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1093\/gerona\/gls196","article-title":"Skeletal muscle mitochondrial energetics are associated with maximal aerobic capacity and walking speed in older adults","volume":"68","author":"Coen","year":"2013","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1113\/jphysiol.2007.141879","article-title":"Endurance exercise performance in Masters athletes: Age-associated changes and underlying physiological mechanisms","volume":"586","author":"Tanaka","year":"2008","journal-title":"J. Physiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.rmed.2015.01.021","article-title":"Changes in fatigability following intense aerobic exercise training in patients with interstitial lung disease","volume":"109","author":"Keyser","year":"2015","journal-title":"Respir. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2949","DOI":"10.1080\/09638288.2018.1483432","article-title":"Oxygen uptake on-kinetics before and after aerobic exercise training in individuals with traumatic brain injury","volume":"41","author":"Chin","year":"2019","journal-title":"Disabil. Rehabil."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1007\/s00421-017-3685-y","article-title":"Fatigability, oxygen uptake kinetics and muscle deoxygenation in incomplete spinal cord injury during treadmill walking","volume":"117","author":"Gollie","year":"2017","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"613","DOI":"10.3389\/fphys.2016.00613","article-title":"Master athletes are extending the limits of human endurance","volume":"7","author":"Lepers","year":"2016","journal-title":"Front. Physiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1016\/S0003-9993(03)00376-9","article-title":"Cardiorespiratory fitness and walking ability in subacute stroke patients","volume":"84","author":"Kelly","year":"2003","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/HCR.0000000000000083","article-title":"Cardiorespiratory function before and after aerobic exercise training in patients with interstitial lung disease","volume":"35","author":"Keyser","year":"2015","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/00005768-200001000-00012","article-title":"Limiting factors for maximum oxygen uptake and determinants of endurance performance","volume":"32","author":"Bassett","year":"2000","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/jes.0b013e318156e4ac","article-title":"The final frontier: Oxygen flux into muscle at exercise onset","volume":"35","author":"Poole","year":"2007","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Souron, R., Voirin, A., Kennouche, D., Espeit, L., Millet, G.Y., Rupp, T., and Lapole, T. (2020). Task failure during sustained low-intensity contraction is not associated with a critical amount of central fatigue. Scand J. Med. Sci. Sports.","DOI":"10.1111\/sms.13815"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.cophys.2019.05.004","article-title":"Bioenergetic basis of skeletal muscle fatigue","volume":"10","author":"Sundberg","year":"2019","journal-title":"Curr. Opin. Physiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.pmrj.2010.04.009","article-title":"Peripheral Fatigue: High-Energy Phosphates and Hydrogen Ions","volume":"2","author":"Keyser","year":"2010","journal-title":"PM&R"},{"key":"ref_57","unstructured":"Terjung, R. (2011). Cellular, molecular, and metabolic basis of muscle fatigue. Comprehensive Physiology, John Wiley & Sons, Inc."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1152\/physrev.00015.2007","article-title":"Skeletal muscle fatigue: Cellular mechanisms","volume":"88","author":"Allen","year":"2008","journal-title":"Physiol. Rev."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1152\/physrev.2001.81.4.1725","article-title":"Spinal and supraspinal factors in human muscle fatigue","volume":"81","author":"Gandevia","year":"2001","journal-title":"Physiol. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1249\/MSS.0000000000000923","article-title":"Neural contributions to muscle fatigue: From the brain to the muscle and back again","volume":"48","author":"Taylor","year":"2016","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/j.1440-1681.2012.05681.x","article-title":"Significance of group III and IV muscle afferents for the endurance exercising human","volume":"39","author":"Amann","year":"2012","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e017194","DOI":"10.1136\/bmjopen-2017-017194","article-title":"Exercise response in Parkinson\u2019s disease: Insights from a cross-sectional comparison with sedentary controls and a per-protocol analysis of a randomised controlled trial","volume":"7","author":"Mavrommati","year":"2017","journal-title":"BMJ Open"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1212\/01.wnl.0000341769.50075.bb","article-title":"Incidence and remaining lifetime risk of Parkinson disease in advanced age","volume":"72","author":"Driver","year":"2009","journal-title":"Neurology"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1093\/aje\/kwg068","article-title":"Incidence of Parkinson\u2019s Disease: Variation by Age, Gender, and Race\/Ethnicity","volume":"157","author":"Tanner","year":"2003","journal-title":"Am. J. Epidemiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1016\/j.mayocp.2015.07.026","article-title":"Reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing: Data from the fitness registry and the importance of exercise national database","volume":"90","author":"Kaminsky","year":"2015","journal-title":"Mayo Clin. Proc."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1139\/H07-174","article-title":"Determinants of VO2 max decline with aging: An integrated perspective","volume":"33","author":"Betik","year":"2008","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Katzel, L.I., Ivey, F.M., Sorkin, J.D., Macko, R.F., Smith, B., and Shulman, L.M. (2019, June 12). Impaired Economy of Gait and Decreased Six-Minute Walk Distance in Parkinson\u2019s Disease. Available online: https:\/\/www.hindawi.com\/journals\/pd\/2012\/241754\/.","DOI":"10.1155\/2012\/241754"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1152\/japplphysiol.01237.2009","article-title":"Mechanistic insights into how advanced age moves the site of (.)VO2 kinetics limitation upstream","volume":"108","author":"Poole","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1152\/japplphysiol.00970.2009","article-title":"Aging blunts the dynamics of vasodilation in isolated skeletal muscle resistance vessels","volume":"108","author":"Behnke","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.resp.2004.12.009","article-title":"Effects of aging on microvascular oxygen pressures in rat skeletal muscle","volume":"146","author":"Behnke","year":"2005","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1152\/japplphysiol.00729.2003","article-title":"Altered regional blood flow responses to submaximal exercise in older rats","volume":"96","author":"Musch","year":"2004","journal-title":"J. Appl. Physiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1249\/MSS.0000000000000178","article-title":"Dynamic heterogeneity of exercising muscle blood flow and O2 utilization","volume":"46","author":"Koga","year":"2014","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1242\/jeb.126623","article-title":"Mitochondria to motion: Optimizing oxidative phosphorylation to improve exercise performance","volume":"219","author":"Conley","year":"2016","journal-title":"J. Exp. Biol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1113\/expphysiol.2006.034330","article-title":"Mitochondrial function, fibre types and ageing: New insights from human muscle in vivo","volume":"92","author":"Conley","year":"2007","journal-title":"Exp. Physiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1249\/00003677-199700250-00017","article-title":"Perception of physical exertion: Methods, mediators, and applications","volume":"25","author":"Robertson","year":"1997","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_76","unstructured":"Brooks, G.A., Fahey, T.D., and Baldwin, K.M. (2006). Exercise Physiology: Human Bioenergetics and Its Applications, McGraw-Hill. [4th ed.]."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1212\/WNL.57.6.1140","article-title":"Different histopathology accounting for a decrease in myocardial MIBG uptake in PD and MSA","volume":"57","author":"Orimo","year":"2001","journal-title":"Neurology"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1136\/jnnp.73.6.776","article-title":"Sympathetic cardiac denervation in Parkinson\u2019s disease and pure autonomic failure but not in multiple system atrophy","volume":"73","author":"Orimo","year":"2002","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"338","DOI":"10.7326\/0003-4819-133-5-200009050-00009","article-title":"Cardiac sympathetic denervation in Parkinson disease","volume":"133","author":"Goldstein","year":"2000","journal-title":"Ann. Intern. Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1056\/NEJM199703063361004","article-title":"Sympathetic cardioneuropathy in dysautonomias","volume":"336","author":"Goldstein","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1212\/WNL.58.8.1247","article-title":"Orthostatic hypotension from sympathetic denervation in Parkinson\u2019s disease","volume":"58","author":"Goldstein","year":"2002","journal-title":"Neurology"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1002\/ana.10236","article-title":"Progressive loss of cardiac sympathetic innervation in Parkinson\u2019s disease","volume":"52","author":"Li","year":"2002","journal-title":"Ann. Neurol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/00006231-200303000-00006","article-title":"Cardiac innervation and clinical correlates in idiopathic Parkinson\u2019s disease","volume":"24","author":"Akincioglu","year":"2003","journal-title":"Nucl. Med. Commun."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1007\/s002590050544","article-title":"Peripheral sympathetic dysfunction in patients with Parkinson\u2019s disease without autonomic failure is heart selective and disease specific","volume":"27","author":"Taki","year":"2000","journal-title":"Eur. J. Nucl. Med."},{"key":"ref_85","first-page":"476","article-title":"Iodine 123-labeled meta-iodobenzylguanidine myocardial scintigraphy in the cases of idiopathic Parkinson\u2019s disease, multiple system atrophy, and progressive supranuclear palsy","volume":"37","author":"Yoshita","year":"1997","journal-title":"Rinsho Shinkeigaku"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1136\/jnnp.67.2.189","article-title":"123I-metaiodobenzylguanidine myocardial scintigraphy in Parkinson\u2019s disease","volume":"67","author":"Orimo","year":"1999","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_87","first-page":"71","article-title":"Cardiac sympathetic denervation from the early stage of Parkinson\u2019s disease: Clinical and experimental studies with radiolabeled MIBG","volume":"41","author":"Takatsu","year":"2000","journal-title":"J. Nucl. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"495","DOI":"10.2165\/00002512-200118070-00003","article-title":"Orthostatic hypotension in patients with Parkinson\u2019s disease: Pathophysiology and management","volume":"18","author":"Senard","year":"2001","journal-title":"Drugs Aging"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j.1600-0404.1998.tb05958.x","article-title":"Impaired cardiac uptake of meta-[123I]iodobenzylguanidine in Parkinson\u2019s disease with autonomic failure","volume":"97","author":"Braune","year":"1998","journal-title":"Acta Neurol. Scand."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1212\/WNL.53.5.1020","article-title":"Cardiac uptake of [123I]MIBG separates Parkinson\u2019s disease from multiple system atrophy","volume":"53","author":"Braune","year":"1999","journal-title":"Neurology"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/s002590050548","article-title":"Scintigraphic differentiation between two forms of primary dysautonomia early after onset of autonomic dysfunction: Value of cardiac and pulmonary iodine-123 MIBG uptake","volume":"27","author":"Reinhardt","year":"2000","journal-title":"Eur. J. Nucl. Med."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1097\/00003072-199710000-00008","article-title":"Improved cardiac iodine-123 metaiodobenzylguanidine accumulation after drug therapy in a patient with Parkinson\u2019s disease","volume":"22","author":"Kanzaki","year":"1997","journal-title":"Clin. Nucl. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/00006231-199802000-00007","article-title":"Decreased myocardial accumulation of 123I-meta-iodobenzyl guanidine in Parkinson\u2019s disease","volume":"19","author":"Yoshita","year":"1998","journal-title":"Nucl. Med. Commun."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0022-510X(00)00279-3","article-title":"Differentiation of Parkinson\u2019s disease and multiple system atrophy in early disease stages by means of I-123-MIBG-SPECT","volume":"175","author":"Druschky","year":"2000","journal-title":"J. Neurol. Sci."},{"key":"ref_95","first-page":"371","article-title":"Loss of 123I-MIBG uptake by the heart in Parkinson\u2019s disease: Assessment of cardiac sympathetic denervation and diagnostic value","volume":"40","author":"Satoh","year":"1999","journal-title":"J. Nucl. Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"S101","DOI":"10.1016\/S1071-3581(97)91514-2","article-title":"Total Defect of Metaiodobenzylguanidine (MIBG) Imaging on Heart in Parkinson\u2019s Disease (PD)","volume":"1","author":"Serita","year":"1997","journal-title":"J. Nuclear Cardiol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/j.1750-3639.2006.00032.x","article-title":"Degeneration of cardiac sympathetic nerve begins in the early disease process of Parkinson\u2019s disease","volume":"17","author":"Orimo","year":"2007","journal-title":"Brain Pathol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s10286-006-0317-8","article-title":"Orthostatic hypotension as an early finding in Parkinson\u2019s disease","volume":"16","author":"Goldstein","year":"2006","journal-title":"Clin. Auton. Res."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s10286-007-0396-1","article-title":"Cardiac sympathetic denervation preceding motor signs in Parkinson disease","volume":"17","author":"Goldstein","year":"2007","journal-title":"Clin. Auton. Res."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.nbd.2011.10.025","article-title":"Cardiovascular dysautonomia in Parkinson disease: From pathophysiology to pathogenesis","volume":"46","author":"Jain","year":"2012","journal-title":"Neurobiol. Dis."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1007\/s40520-015-0498-x","article-title":"Treadmill exercise tests in persons with Parkinson\u2019s disease: Responses and disease severity","volume":"28","author":"Bryant","year":"2016","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1002\/ana.410330405","article-title":"Loss of C1 and C3 epinephrine-synthesizing neurons in the medulla oblongata in Parkinson\u2019s disease","volume":"33","author":"Gai","year":"1993","journal-title":"Ann. Neurol."},{"key":"ref_103","first-page":"195","article-title":"Depigmentation in the nerve cells of the substantia nigra and locus ceruleus in Parkinsonism","volume":"5","author":"Forno","year":"1974","journal-title":"Adv. Neurol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1001\/archneur.1984.04210080020007","article-title":"Cerebellar norepinephrine in patients with Parkinson\u2019s disease and control subjects","volume":"41","author":"Kish","year":"1984","journal-title":"Arch. Neurol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1212\/WNL.43.5.986","article-title":"The locus ceruleus and dementia in Parkinson\u2019s disease","volume":"43","author":"Zweig","year":"1993","journal-title":"Neurology"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/BF03159935","article-title":"Pathology of Parkinson\u2019s disease. Changes other than the nigrostriatal pathway","volume":"14","author":"Jellinger","year":"1991","journal-title":"Mol. Chem. Neuropathol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/S0022-510X(99)00101-X","article-title":"Restricted occurrence of Lewy bodies in the dorsal vagal nucleus in a patient with late-onset parkinsonism","volume":"165","author":"Wakabayashi","year":"1999","journal-title":"J. Neurol. Sci."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1002\/ana.410270405","article-title":"Neuropathology of immunohistochemically identified brainstem neurons in Parkinson\u2019s disease","volume":"27","author":"Halliday","year":"1990","journal-title":"Ann. Neurol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1002\/cphy.c130026","article-title":"Dysautonomia in Parkinson\u2019s disease: Neurocardiological abnormalities","volume":"4","author":"Goldstein","year":"2014","journal-title":"Compr. Physiol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1159\/000113469","article-title":"Neuropathology of autonomic nervous system in Parkinson\u2019s disease","volume":"38","author":"Wakabayashi","year":"1997","journal-title":"Eur. Neurol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.parkreldis.2014.02.006","article-title":"Exercise hemodynamics in Parkinson\u2019s disease and autonomic dysfunction","volume":"20","author":"Low","year":"2014","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1152\/jn.00308.2018","article-title":"Blunted cardiovascular responses to exercise in Parkinson\u2019s disease patients: Role of the muscle metaboreflex","volume":"120","author":"Teixeira","year":"2018","journal-title":"J. Neurophysiol."},{"key":"ref_113","first-page":"2050312120921603","article-title":"Altered cardiorespiratory regulation during exercise in patients with Parkinson\u2019s disease: A challenging non-motor feature","volume":"8","author":"Vianna","year":"2020","journal-title":"SAGE Open Med."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/BF00314190","article-title":"Autonomic disturbances and cardiovascular reflexes in idiopathic Parkinson\u2019s disease","volume":"235","author":"Ludin","year":"1987","journal-title":"J. Neurol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e01463","DOI":"10.1002\/brb3.1463","article-title":"Reduced central sympathetic activity in Parkinson\u2019s disease","volume":"9","author":"Doppler","year":"2019","journal-title":"Brain Behav."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1136\/jnnp.74.10.1407","article-title":"Age and duration related changes in muscle sympathetic nerve activity in Parkinson\u2019s disease","volume":"74","author":"Shindo","year":"2003","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1002\/mds.22226","article-title":"Generalized and neurotransmitter-selective noradrenergic denervation in Parkinson\u2019s disease with orthostatic hypotension","volume":"23","author":"Sharabi","year":"2008","journal-title":"Mov. Disord."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/00002826-199302000-00008","article-title":"Effects of yohimbine on plasma catecholamine levels in orthostatic hypotension related to parkinson disease or multiple system atrophy","volume":"16","author":"Senard","year":"1993","journal-title":"Clin. Neuropharmacol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1152\/physrev.00035.2013","article-title":"Regulation of increased blood flow (hyperemia) to muscles during exercise: A hierarchy of competing physiological needs","volume":"95","author":"Joyner","year":"2015","journal-title":"Physiol. Rev."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1152\/japplphysiol.00076.2004","article-title":"Neural control of muscle blood flow during exercise","volume":"97","author":"Thomas","year":"2004","journal-title":"J. Appl. Physiol."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1152\/japplphysiol.00388.2005","article-title":"Effects of arterial hypotension on microvascular oxygen exchange in contracting skeletal muscle","volume":"100","author":"Behnke","year":"2006","journal-title":"J. Appl. Physiol."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1152\/jappl.1999.86.3.845","article-title":"Effects of muscle perfusion pressure on fatigue and systemic arterial pressure in human subjects","volume":"86","author":"Wright","year":"1999","journal-title":"J. Appl. Physiol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1152\/jappl.2000.88.4.1390","article-title":"Effects of systemic arterial blood pressure on the contractile force of a human hand muscle","volume":"88","author":"Wright","year":"2000","journal-title":"J. Appl. Physiol."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1113\/jphysiol.1996.sp021640","article-title":"Effects of arterial perfusion pressure on force production in working human hand muscles","volume":"495","author":"Fitzpatrick","year":"1996","journal-title":"J. Physiol."},{"key":"ref_125","first-page":"673","article-title":"Ultrastructure of skeletal muscle in patients with Parkinson\u2019s disease and upper motor lesions","volume":"32","author":"Ahlqvist","year":"1975","journal-title":"Lab. Invest."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/0022-510X(91)90311-T","article-title":"Respiratory chain abnormalities in skeletal muscle from patients with Parkinson\u2019s disease","volume":"104","author":"Bindoff","year":"1991","journal-title":"J. Neurol. Sci."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1002\/ana.410300304","article-title":"Mitochondrial oxidative phosphorylation defects in parkinson\u2019s disease","volume":"30","author":"Shoffner","year":"1991","journal-title":"Ann. Neurol."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/0022-510X(92)90205-Y","article-title":"Is Parkinson\u2019s disease a mitochondrial disorder?","volume":"107","author":"Yoshino","year":"1992","journal-title":"J. Neurol. Sci."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.1212\/WNL.43.11.2258","article-title":"Mitochondrial respiratory chain activity in skeletal muscle from patients with Parkinson\u2019s disease","volume":"43","author":"Cardellach","year":"1993","journal-title":"Neurology"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/0022-510X(94)90248-8","article-title":"Mitochondrial respiratory failure in skeletal muscle from patients with Parkinson\u2019s disease and multiple system atrophy","volume":"125","author":"Blin","year":"1994","journal-title":"J. Neurol. Sci."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1111\/j.1749-6632.1999.tb07870.x","article-title":"Detection of respiratory chain defects in cultivated skin fibroblasts and skeletal muscle of patients with Parkinson\u2019s disease","volume":"893","author":"Wiedemann","year":"1999","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1136\/jnnp.56.5.477","article-title":"No evidence for altered muscle mitochondrial function in Parkinson\u2019s disease","volume":"56","author":"Anderson","year":"1993","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1212\/WNL.43.11.2262","article-title":"Respiratory chain and mitochondrial DNA in muscle and brain in Parkinson\u2019s disease patients","volume":"43","author":"DiDonato","year":"1993","journal-title":"Neurology"},{"key":"ref_134","first-page":"263","article-title":"Unaltered respiratory chain enzyme activity and mitochondrial dna in skeletal muscle from patients with idiopathic parkinson\u2019s syndrome","volume":"34","author":"Reichmann","year":"1994","journal-title":"ENE"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/0022-510X(94)90245-3","article-title":"A 31P magnetic resonance spectroscopy study of mitochondrial function in skeletal muscle of patients with Parkinson\u2019s disease","volume":"125","author":"Taylor","year":"1994","journal-title":"J. Neurol. Sci."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1093\/brain\/115.2.333","article-title":"Brain, skeletal muscle and platelet homogenate mitochondrial function in Parkinson\u2019s disease","volume":"115","author":"Mann","year":"1992","journal-title":"Brain"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1007\/s00702-004-0195-y","article-title":"Re-evaluation of the dysfunction of mitochondrial respiratory chain in skeletal muscle of patients with Parkinson\u2019s disease","volume":"112","author":"Kirches","year":"2005","journal-title":"J. Neural. Transm."},{"key":"ref_138","first-page":"97","article-title":"Mitochondrial Respiratory Chain Enzyme Activities, mtDNA Variants and Gene Expression Levels in Idiopathic Parkinson\u2019s Disease","volume":"34","author":"Ercan","year":"2009","journal-title":"Turk. J. Biochem."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.parkreldis.2009.06.003","article-title":"Histopathological analysis of skeletal muscle in patients with Parkinson\u2019s disease and \u201cdropped head\u2019\/\u2019bent spine\u201d syndrome","volume":"15","author":"Gdynia","year":"2009","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"703","DOI":"10.3233\/JPD-171173","article-title":"Motivators and barriers to exercise in Parkinson\u2019s disease","volume":"7","author":"Afshari","year":"2017","journal-title":"J. Parkinson\u2019s Dis."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.neulet.2017.08.076","article-title":"Endurance exercise improves function in individuals with Parkinson\u2019s disease: A meta-analysis","volume":"659","author":"Flach","year":"2017","journal-title":"Neurosci. Lett."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1001\/jama.2019.22360","article-title":"Diagnosis and treatment of Parkinson disease: A Review","volume":"323","author":"Armstrong","year":"2020","journal-title":"JAMA"},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1002\/mdc3.13011","article-title":"Cardiopulmonary Function and Aerobic Exercise in Parkinson\u2019s: A systematic review of the literature","volume":"7","author":"Aburub","year":"2020","journal-title":"Mov. Disord. Clin. Pract."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/5\/4\/78\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:27:35Z","timestamp":1760178455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/5\/4\/78"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,31]]},"references-count":143,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["jfmk5040078"],"URL":"https:\/\/doi.org\/10.3390\/jfmk5040078","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,31]]}}}