Effects of ankle exercise combined with deep breathing on blood flow velocity in the femoral vein

3D-Printed Hydrogels with Engineered Nanocrystalline Domains as Functional Vascular Constructs

Three-dimensionally printed (3DP) hydrogel-based vascular constructs have been investigated in response to the impaired function of blood vessels or organs by replicating exactly the 3D structural geometry to approach their function. However, they are still challenged by their intrinsic brittleness, which could not sustain the suture piercing and enable the long-term structural and functional stability during the direct contact with blood. Here, we reported the high-fidelity digital light processing (DLP) 3D printing of hydrogel-based vascular constructs from poly(vinyl alcohol)-based inks, followed by mechanical strengthening through engineering the nanocrystalline domains and subsequent surface modification. The as-prepared high-precision hydrogel vascular constructs were imparted with highly desirable mechanical robustness, suture tolerance, swelling resistance, antithrombosis, and long-term patency. Notably, the hydrogel-based bionic vein grafts, with precise valve structures, exhibited excellent control over the unidirectional flow and successfully fulfilled the biological functionalities and patency during a 4-week implantation within the deep veins of beagles, thus corroborating the promising potential for treating chronic venous insufficiency.

The impact of ankle movements on venous return flow: A comparative study

OBJECTIVE

To compare the haemodynamic effects of different ankle movements combined ankle and toe movements on the femoral vein of the lower extremity.

METHODS

28 healthy volunteers participated in the study. Doppler ultrasound was used to measure peak systolic velocity and time-averaged mean velocity of the common femoral vein during ankle dorsiflexion, ankle dorsiflexion with simultaneous toe extension, ankle plantarflexion, and ankle plantarflexion with simultaneous toe flexion.

RESULTS

In comparison to the resting state, both ankle alone or ankle combined with toe movement showed statistically significant differences (p < .01). However, there were no significant difference in the velocity of the common femoral vein between ankle alone and ankle combined with toe movement (p > .05). It is noteworthy that dorsiflexion of the ankle resulted in the highest peak velocity of blood flow.

CONCLUSION

The impact of ankle movement, with or without toe movement, the velocity of the common femoral vein is not significantly correlated.

Effect of active and passive techniques used in thromboembolic prophylaxis on venous flow velocity in the post-procedure period

Introduction

Studies have shown that using mechanical thromboembolic prophylaxis methods speeds up venous flow and decreases stasis. These studies examine the post-intervention period of 1-10 min. The length of the effect of procedures to raise venous flow velocity cannot be determined by clinical trials. To apply mathematical techniques to estimate how long mechanical thromboembolism prophylaxis procedures will increase venous flow rate.

Methods

In the survey, we examined 25 persons (poststroke patients), with an average age of 57.2 ± 6.3 years. Regarding the proportion of genders, 13 (52%) participants were male and 12 (48%) female. The peak venous blood flow velocity was measured with a HADECO BIDOP ES-100V II type Doppler ultrasound device, using an 8 MHz head, in the femoral vein, at the level of the hip joint. We estimated the change of the venous blood flow velocity from the available sampled data using the method of least squares. For the calculations, we used Microsoft Excel, version Mac Excel 2019.

Results

The decrease in peak venous flow velocity can be approximated by a logarithm function. Mathematical calculations show that after active thromboembolic prophylaxis interventions, resting venous flow velocity is restored at 26.8 min on the intact limb and 85.1 min on the hemiparetic side. Resting flow velocity is restored in 131.9 min after passive mobilization of the hemiparetic side and in 137.7 min after the consensual effect.

Discussion

An elementary mathematical function can be used to estimate the time to recovery of peak venous flow velocity to resting state from measurements taken 15 min after the intervention. Active and passive mechanical thromboembolic prophylaxis after the intervention has a longer-term effect on venous flow velocity.

The relationship between inspiratory muscle strength, venous refilling time, disease severity, and functional capacity in patients with chronic venous insufficiency

BACKGROUND

Our aim is to evaluate the relationship between inspiratory muscle strength and venous refilling time, disease severity, and functional capacity in patients with chronic venous insufficiency (CVI).

METHODS

Sixty-one patients (49 female, aged 20-65 ) were enrolled in the study. The demographic characteristics of the patients were questioned. All patients were assessed with maximum inspiratory and expiratory pressure (MIP/MEP) for inspiratory and expiratory muscle strength, photoplethysmography for venous refilling time (VRT), venous clinical severity score (VCSS) for disease severity, and 6-min walk test (6-MWT) for functional capacity.

RESULTS

The mean age of the patients was 49.48 ± 13.19 years, and the mean duration of disease was 9.18 ± 6.57 years. There was statistically significant positive association between MIP and VRT(r: 0.331, p: 0.009), 6-MWT (r: 0.616, p < 0.001) values, and there was negative association between MIP and VCSS(r: -0.439 p < 0.001) scores.

CONCLUSION

Evaluation of inspiratory muscle strength and elimination of its deficiency, providing interventions to approach normative values have the potential to contribute positively to the treatment of the patient.

Study of EEG alpha wave response on the effects of video-guided deep breathing on pain rehabilitation

BACKGROUND

Athletes with chronic ankle pain (CAP) are more inclined to suffer from physical and psychological pain depending on the severity of the injuries, which might trigger the powerless feeling on future sports participation. Therefore, an efficient and simple method is useful to integrate into conventional physiotherapy (CP) for maintaining mental wellness.

OBJECTIVE

This research aimed to verify the effects and progress of video-guided deep breathing (DB) integrated into CP through study on the changes of alpha waves and pain scale.

METHODS

Alpha waves were recorded using an electroencephalogram (EEG) and a visual analogue scale (VAS) to assess pain intensity before and after the intervention (6 weeks). Thirty CAP participants were recruited and randomly assigned to two groups: group A for video-guided DB integration into their CP and group B for CP. The effects of pre and post intervention were analyzed using a paired t-test with statistical significance set at p< 0.05.

RESULTS

Profound results from the research have shown that the participants who received both the DB+CP revealed a significant increase in alpha wave (p< 0.05) at occipital region.

CONCLUSION

The significant result reveals an increase in alpha waves in the occipital region after 6 weeks and indicates that the video-guided DB with a smartphone application is able to produce a change in CAP participants. This supports the DB integration to the CP for altering the pain perception.

THE EFFECTS OF INSPIRATORY MUSCLE TRAINING VERSUS CALF MUSCLE TRAINING ON QUALITY OF LIFE, PAIN, VENOUS FUNCTION AND ACTIVITY IN PATIENTS WITH CHRONIC VENOUS INSUFFICIENCY

OBJECTIVE

The aim of this study was to evaluate the effect of inspiratory muscle training(IMT) and calf muscle exercise training(ETC) in addition to compression therapy(CT) on quality of life, venous refilling time, disease severity, pain, edema, range of motion, muscle strength and functionality in patients with chronic venous insufficiency (CVI) compared to compression treatment alone.

METHODS

Thirty-two participants diagnosed with CVI were randomly divided into three groups. IMT in addition to compression therapy, Group 1, exercise training for the calf muscle in addition to compression therapy, Group 2, and compression therapy alone, Group 3. All the patients were assessed with the Chronic Venous Insufficiency Quality of Life Questionnaire-20, Nottingham Health Profile, photoplethysmography, venous clinical severity score, visual analog scale, intraoral pressure measurements, dynamometer, digital goniometer, 6-minute walk test and lower extremity functional scale.

RESULTS

After treatment, Group 2 improved more than groups 1 and 3 in terms of quality of life, venous refilling time, pain, edema, range of motion, muscle strength and functionality scores; Group 1 improved more than groups 2 and 3 in terms of disease severity, inspiratory and expiratory muscle strength values(p<0.05). Only physical mobility and right leg venous refilling time increased in group 3(p<0.05).

CONCLUSIONS

IMT and ETC improve venous function in both legs in patients with CVI while CT alone improves venous function only in the right leg of patients with CVI.

Which Frequency of Ankle Pump Exercise Should Be Chosen for the Prophylaxis of Deep Vein Thrombosis?

Introduction

Ankle pump exercise (APE) is an effective method to prevent deep vein thrombosis (DVT) in the lower extremities. However, traditional APE at a frequency of 3 times/min applied in the clinic lacked high compliance, and individuals were found to prefer an APE of 30 times/min. This study aimed to compare the effects of APEs with the above two different frequencies on the venous hemodynamics and fatigue of lower extremities.

Methods

The study applied a randomized cross-over design, and 307 healthy adults were randomly assigned into two groups, whose left feet performed 5 minutes of traditional APE (3 times/min, after 10 minutes of rest) and 5 minutes of selected APE (30 times/min, after 10 minutes of rest) in different orders. The diameters and blood flow velocities of the external iliac vein, femoral vein, and popliteal vein of the left extremities were recorded with the color doppler ultrasound when participants were at rest and after 5 minutes of traditional or selected APE. The fatigue of lower extremities was assessed with the Rating of Perceived Exertion (RPE) after the participants performed 5 minutes of different APEs.

Results

After both traditional APE and selected APE, the diameters and blood flow (peak systolic) velocities of the external iliac vein, femoral vein, and popliteal vein increased significantly in the participants (P<.01), and the effects of the two APEs on venous hemodynamics of the lower extremities had no significant difference (P>.05). However, participants reported that traditional APE caused higher fatigue, and 252 (82.1%) participants preferred APE at 30 times/min.

Conclusion

Both traditional and selected APE could increase venous blood flow in the lower extremity. Despite the equivalent effects, the selected APE of 30 times/min may cause less fatigue than the traditional one of 3 times/min.

Outpatient and Home-Based Treatment: Effective Settings for Hip Fracture Rehabilitation in Elderly Patients

Femoral neck fractures are a major source of disability in the elderly. Rehabilitation is fundamental to recover pre-fracture functionality. We conducted an observational cohort study with the aim of comparing the efficacy of rehabilitation programs in different therapeutic settings. We included elderly patients who had undergone surgical stabilization of a hip fracture. The participants were divided into 3 groups: group 1, outpatient rehabilitation; group 2, inpatient rehabilitation; group 3, home-based rehabilitation. Patients were evaluated at baseline, at three months, and at six months after fracture. Our outcome measures were the Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, and muscle strength in hip flexion, abduction, and knee extension. At six months, all three groups showed an average statistically significant improvement (p < 0.05) in all outcome measures compared to the baseline. Considering the between-group analysis, final BI was significantly higher in outpatient than inpatient-treated patients (p = 0.018), but no statistical difference was found between outpatient and home-based patients. Our findings suggest that rehabilitation leads to significant functional recovery after hip fracture in elderly patients. Both outpatient and home-based rehabilitation seem to be reasonable options for hip fracture rehabilitation.

Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review

PURPOSE OF REVIEW

Chronic venous insufficiency is found to some extent in a large proportion of the world's population, especially in the elderly and obese. Despite its prevalence, little research has been pursued into this pathology when compared to similarly common conditions. Pain is often the presenting symptom of chronic venous insufficiency and has significant deleterious effects on quality of life. This manuscript will describe the development of pain in chronic venous insufficiency, and will also review both traditional methods of pain management and novel advances in both medical and surgical therapy for this disease.

RECENT FINDINGS

Pain in chronic venous insufficiency is a common complication which remains poorly correlated in recent studies with the clinically observable extent of disease. Although lifestyle modification remains the foundation of treatment for pain associated with chronic venous sufficiency, compression devices and various pharmacologic agents have emerged as safe and effective treatments for pain in these patients. In patients for whom these measures are insufficient, recently developed minimally invasive vascular surgical techniques have been shown to reduce postsurgical complications and recovery time, although additional research is necessary to characterize long-term outcomes of these procedures. This review discusses the latest findings concerning the pathophysiology of pain in chronic venous insufficiency, conservative and medical management, and surgical strategies for pain relief, including minimally invasive treatment strategies.

Gravity magnetic resonance imaging measurement of muscle pump change accompanied by aging and posture

AIM

To date no age-comparative study has been reported about effect of exercise on muscle pump action change, while its effect is suggested to differ in ages. This study aims to clarify the changes in muscle pump action with aging by measuring the muscle and vein area, and blood flow in lower legs.

METHODS

Subjects were healthy volunteers and consisted of three groups: young age group (N = 20), middle age group (N = 20) and old age group (N = 16). The lower leg flexor muscle area and popliteal vein area were measured by using T1-weighed magnetic resonance imaging at the condition pre- and post-ankle exercise in three positions. Moreover, popliteal blood flow velocity was also measured using phase contrast magnetic resonance imaging.

RESULTS

The elderly had the highest number of individuals who had exercise habits (p < .001). In a multiple linear regression analysis, sitting posture, leg muscle volume, and rate of change in the soleus muscle were significantly related to blood flow velocity change.

CONCLUSIONS

No difference was found in the changes in muscle pump action with age. The study results suggested that elderly people with exercise habits might be able to maintain the muscle pump action.

Effects of altered blood flow induced by the muscle pump on thrombosis in a microfluidic venous valve model

Deep vein thrombosis (DVT) often occurs in the lower limb veins of bedridden patients and greatly reduces the quality of life. The altered blood flow in venous valves induced by the insufficient efficacy of the muscle pump is commonly considered as a main factor. However, it is still a great challenge to observe the altered blood flow in real time, and its role in the formation of thrombi is poorly understood. Here we make a microfluidic venous valve model with flexible leaflets in a deformable channel that can mimic the motion of valves and the compression of vessels by muscle contraction, and identify the stasis and intermittent reflux in the valve pocket generated by the muscle pump. A thrombus forms in the stasis flow, while the intermittent reflux removes the fibrin and inhibits the growth of the thrombus. A flexible microfluidic device that can mimic the motion of valves and the contraction of vessels would have wide applications in the research on cardiovascular diseases.

The effects of the addition of motor imagery to home exercises on pain, disability and psychosocial parameters in patients undergoing lumbar spinal surgery: A randomized controlled trial

CONTEXT

Patients who have suffered from persistent symptoms often undergo lumbar spinal surgery (LSS). Motor imagery should be added to postoperative home exercises to reduce patient complaints.

OBJECTIVE

The aim of this study was to compare the effects of home exercise plus motor imagery and only home exercise in patients undergoing LSS.

DESIGN

A randomized controlled study.

SETTINGS

This study was designed by researchers at Dokuz Eylul University.

PARTICIPANTS

Thirty-seven patients undergoing LSS were randomized to motor imagery group (n = 19) and control group (n = 18).

MAIN OUTCOME MEASURES

Pain was measured by Visual Analogue Scale, disability related to low back pain by Oswestry Disability Index, pain-related fear by Tampa Scale of Kinesiophobia, depression by Beck Depression Inventory, quality of life by World Health Organization Quality of Life Scale-Short Form (WHOQOL-BREF). All assessments were repeated in the preoperative period, three weeks after and six weeks after the surgery.

INTERVENTIONS

Motor imagery group underwent home exercise plus motor imagery program applied by voice recording. Control group underwent only home exercise program. Exercise program compliance was monitored by exercise diary and telephone calls once every week.

RESULTS

There was a significant improvement in pain at rest and during activity, disability, kinesiophobia, depression, physical health and psychological sub-parameters of WHOQOL-BREF between preoperative period, and the third week and sixth week in both groups (p < 0.05). When comparing groups for gain scores, there was a more significant improvement in pain during activity in motor imagery group (p < 0.05). Motor imagery should be addressed as an effective treatment after LSS.

Effect of resistance of the exercise band on the peak femoral vein velocity during active ankle flexion

Objective

To examine the resistance effect of using an exercise band on the lower extremity venous velocity during active ankle flexion.

Methods

Twenty healthy young adult men performed active ankle flexion every 2 s either with no band or with two exercise bands, marked red and silver in the order of increasing tension. They held the band in its natural length with an elbow in extension and an ankle in maximal dorsiflexion at initiation of each active plantar flexion in each posture. The peak velocity in the right superficial femoral vein was measured in each condition.

Results

Holm’s multiple comparisons revealed significant increases in the mean (individual 95% confidence intervals) peak velocities (cm/s) with no, red, and silver bands (35.8 (28.9–42.7), 46.5 (38.8–54.3), and 56.9 (47.0–66.8), respectively, in the sitting posture, and 50.7 (39.2–62.3), 60.7 (46.8–74.6), and 69.0 (55.3–82.7), respectively, in the supine posture; all p < 0.01).

Conclusion

Resistance with the exercise bands efficiently enhanced the femoral venous velocity during active ankle plantar flexion.

Effect of Active and Passive Mechanical Thromboprophylaxis and Consensual Effect on the Venous Blood Flow Velocity Among Hemiparetic Patients

Our aim was to measure the venous blood flow velocity (VBFV) in case of hemiparetic patients, after passive and active thromboembolic methods, as well as the consensual effect in the hemiparetic limb following the active venous exercises in the healthy limb. We examined 215 patients, with the median age of 58.0 (55.0-63.0) years. The VBFV was measured with a HADECO BIDOP ES-100 V II type Doppler ultrasound device, using an 8 MHz head, on the femoral vein at the level of the hip joint. For statistical analysis, SPSS version 22 was used. After passive movement, on the hemiparetic side, compared to the value in resting state, the VBFV significantly (12.6; 11.6-13.5 cm/s; P < .001) increased. Following active venous exercises performed on the healthy side, the VBFV significantly (18.0; 15.6-19.6 cm/s; P < .001) increased compared to the value in resting state. Following the active venous exercises performed on the healthy side, the VBFV measured on the hemiparetic side (consensual effect) was significantly (15.1 [14.1-16.5] cm/s; P < .001) higher than the value on the hemiparetic side in resting state. Active and passive mechanical thromboprophylaxis methods can be effective. Movements of the healthy limb significantly increase the VBFV in the inactive limb, and patients can perform it themselves several times a day.

Femoral venous flow velocity during passive ankle exercise in patients with chronic spinal cord injury

[Purpose] We examined the effect of passive ankle exercise on femoral venous flow in paralyzed, atrophied lower legs of patients with chronic spinal cord injury. [Participants and Methods] Ten males with complete spinal cord injury at the T6–12 levels and ten able-bodied males participated in this study. B-mode muscle ultrasound was performed on the medial gastrocnemius muscle to evaluate muscle atrophy. Doppler ultrasound was used to measure the time-averaged mean velocity in the femoral vein at rest and during passive motion of the ankle. [Results] Mean muscle thickness was significantly reduced in the spinal cord injury group, showing a mean value of 67.2% compared with able-bodied participants. No significant differences were observed in the time-averaged mean velocity at rest between the groups, although they were slightly lower in the spinal cord injury group than in the able-bodied group. During passive motion, no significant difference was observed in the time-averaged mean velocity between the groups, although the mean value in those with spinal cord injury was 65.9% that of the able-bodied group. Time-averaged mean velocity increased in both groups, compared with baseline. [Conclusion] Passive ankle exercise increased time-averaged mean velocity in spinal cord injury, but venous blood velocity was reduced in spinal cord injury compared to the able-bodied group. We believe that significant muscle atrophy affected our results in chronic spinal cord injury.

Nurse-led patient training improves deep vein thrombosis knowledge and self-care practices

The study focused on assessing the effect of nurse-led deep vein thrombosis prevention training on patients' knowledge and self-care practices. Forty patients participated in this quasi-experimental study. Participants were trained by the guidebook prepared by the researchers before the surgery. Data were collected with Autar Deep Vein Thrombosis Risk Assessment Scale and questionnaires before and after the training. The questionnaires were prepared by the researcher. Data were evaluated with Mann-Whitney U, Wilcoxon, Kruskal-Wallis variance analysis, significance of difference test between two means, and one-way variance analysis tests. The average deep vein thrombosis knowledge score was 0.1 ± 0.5 over 54 before the training, whereas it was 20.2 ± 5.7 after the training, and there was a statistically significant difference in patients' deep vein thrombosis knowledge scores after training period (P = .000). Patients performed an average of 8.8 out of 13 protective self-care practices during the postsurgery period. The majority of the patients were satisfied with the training. The training provided by the nurse contributed to the fact that the patients had knowledge about their own health problems and took responsibility for self-care. We have not been able to increase the awareness we want on some groups such as those older than 52 years. Other studies should be carried out, especially in these groups, with different training methods.

Pilot study evaluating the efficacy of exergaming for the prevention of deep venous thrombosis

OBJECTIVE

Current prophylactic protocols fail to prevent deep venous thrombosis (DVT) in a significant minority of patients, and it remains one of the leading causes of preventable death. We therefore quantified the efficacy of novel game-based exercises (exergaming) to augment femoral venous parameters relative to ankle movement and muscle flexion.

METHODS

Healthy volunteers were recruited to perform a series of ankle and foot exercises using a wireless foot sensor (LEGSys; BioSensics LLC, Watertown, Mass) to navigate a computer cursor sequentially on a screen to the center of 200 circular targets. A single ultrasound technician (W.A.M.) measured each patient's mean flow volume, peak flow velocity, mean flow velocity, and cross-sectional area of the right femoral vein at baseline and obtained immediate postexercise (PEX), 5-minute PEX, and 15-minute PEX measurements. Electromyography (EMG) was performed at baseline and during the exercise. Baseline demographics and medical and surgical comorbidities were also recorded. The primary end point was the difference between baseline and immediate PEX mean flow volume estimates. We secondarily explored the association of baseline characteristics and EMG measurements with femoral vein parameters.

RESULTS

Fifteen healthy subjects (53% male; 28.1 ± 4.6 years) completed the exergaming task within a mean of 4 minutes, 2 ± 21 seconds. Immediately after exercise, the femoral vein mean flow volume, mean velocity, and peak systolic velocity increased by 49%, 53%, and 48%, respectively (P < .02 for each). Mean flow volume and velocity remained significantly elevated 5 minutes after exercise (P < .04 for each). Plantar flexion and dorsiflexion velocities and EMG frequency and intensity were not significantly correlated with PEX mean flow volume estimates (P > .05). Subgroup analysis revealed that women (P < .01) and Hispanics (P < .01) exhibited significantly slower PEX responses. Subjects with the largest improvements in mean flow volume had lower peak plantar flexion velocities (P < .01).

CONCLUSIONS

Exergaming increases mean flow volume, mean flow velocity, and peak systolic velocity within the femoral vein by approximately 50% above baseline. Exergaming represents a novel and potentially attractive method of DVT prevention by augmenting femoral vein mean volume flow and capitalizing on biofeedback. Less forceful but more uniform contractions were found to be most effective at augmenting venous blood flow. Exergaming will require further validation in larger study bases, among patients at higher risk of DVT.

Effects of forced deep breathing on blood flow velocity in the femoral vein: Developing a new physical prophylaxis for deep vein thrombosis in patients with plaster cast immobilization of the lower limb

INTRODUCTION

Patients with plaster cast immobilization of the lower limb have an estimated symptomatic venous thromboembolism rate of 5.5%. However, there is currently no practical physical prophylaxis for deep-vein thrombosis (DVT). The objective of this study was to examine the effects of forced deep breathing on peak blood velocity in the superficial femoral vein (PBVFV), which is a surrogate measure of the efficacy of thromboprophylaxis against DVT, in patients with plaster cast immobilization of the lower limb.

MATERIALS AND METHODS

Nine young males and 18 elderly males were recruited. We immobilized the right lower limb of each subject with a plaster splint and measured PBVFV during forced deep breathing in supine and sitting positions.

RESULTS

In all subjects, PBVFV during forced deep breathing in both positions was significantly higher than at rest. There was no significant difference in the PBVFV change ratio for three breathing rates in the sitting position for the young subjects (15breaths/min: 415%, 5breaths/min: 475%, 3breaths/min: 483%), whereas that for the elderly subjects at 3breaths/min (449%) was significantly higher than that at 15breaths/min (284%).

CONCLUSIONS

Forced deep breathing significantly increased PBVFV in patients with plaster cast immobilization of the lower limb in both supine and sitting positions. Testing the efficacy and adherence in clinical contexts, and following up with the incidence rate of DVT in future studies, is necessary for the development of a new physical prophylaxis for DVT.

Intense Triceps Surae Contraction Increases Lower Extremity Venous Blood Flow

Objective

Venous thromboembolism can be prevented by physical prophylaxis, such as active ankle exercise (AAE), in addition to pharmacological treatment. However, the relationship between the intensity of triceps surae (TS) exercise and venous flow is unclear, and physical thromboprophylaxis has not been established for patients with leg cast immobilization. The goals of the current study were to clarify the degree of intensity of TS isotonic contraction required to increase peak blood velocity (PV) in the superficial femoral vein to higher than that at no resistance and to determine if TS isometric contraction can increase PV.

Methods

A prospective, nonrandomized, controlled trial was performed in 20 healthy young adult men. PVs at rest and during one TS isotonic or isometric contraction were measured using Doppler ultrasonography. Isotonic contraction intensity was defined as no resistance with contraction of maximum effort and 25%, 50%, 75%, and 100% of one repetition maximum (1RM). Isometric contraction intensity was defined as 15-35%, 40-60%, 65-85%, and 90-100% of the maximal voluntary contraction.

Results

Isotonic contraction at 75% 1RM (51.4 cm/s [95% CI, 40.1-62.6]) and 100% 1RM (54.9 cm/s [95% CI, 43.1-66.7]) significantly increased PV compared to that with no resistance (41.0 cm/s [95% CI, 32.2-49.8]) (P=0.005, 0.001, respectively). Isometric contraction increased PV significantly at all intensities (all P≤0.002).

Conclusions

Applying resistance at ≥75% 1RM increases venous flow and enhances the effect of AAE with TS isotonic contraction. TS isometric contraction may serve as thromboprophylaxis for patients undergoing leg cast immobilization.

Passive ankle movement increases cerebral blood oxygenation in the elderly: an experimental study

BACKGROUND

Ankle exercise has been proven to be an effective intervention to increase venous velocity. However, the efficacy of ankle exercise for improving cerebral circulation has not been determined. We hypothesized that ankle exercise in the supine position would be able to increase oxyhemoglobin levels measured at the forehead.

METHODS

Seventeen community-dwelling elderly women participated in this study. We recorded blood pressure, heart rate (HR), and oxyhemoglobin (OxyHb) levels from the participants in the supine position. Participants repeated ankle plantar flexion and dorsiflexion movements for 1 min. Two types of exercise were used: active movement and passive movement. We used two-way analysis of variance to assess the differences in mean arterial blood pressure (MAP), HR, and OxyHb between different exercises (active and passive) and times (before and after exercise).

RESULTS

The HR and MAP increased during active exercise but not during passive exercise. On the other hand, the levels of OxyHb measured at the forehead were elevated during both active and passive exercises. This increase lasted at least 1 min after exercise. There was no significant difference between active and passive exercise with regard to OxyHb; however, a significant difference was observed between before and after exercise (p < 0.05, η(2) G = 0.153).

CONCLUSIONS

The physiological response of OxyHb to ankle exercise was different from that of the other cardiovascular functions. Both active and passive ankle exercises were able to increase cerebral blood oxygenation, whereas the other cardiovascular functions did not respond to passive exercise.

Immediate effects of electrical stimulation, diathermy, and physical exercise on lower limb arterial blood flow in diabetic women with peripheral arterial disease: a randomized crossover trial

OBJECTIVE

The purpose of this study was to assess the effects of high-voltage electrical stimulation (HVES), continuous short wave diathermy, and physical exercise on arterial blood flow in the lower limbs of diabetic women with peripheral arterial disease.

METHODS

A crossover study was carried out involving 15 diabetic women (mean age of 77.87 ± 6.20 years) with a diagnosis of peripheral arterial disease. One session of each therapeutic resource was held, with a 7-day washout period between protocols. Blood flow velocity was evaluated before each session and 0, 20, 40 and 60 minutes after the administration of each protocol. Two-way repeated-measures analysis of variance with Bonferroni post hoc test was used for the intragroup and intergroup comparisons.

RESULTS

In the intragroup analysis, a significant reduction (P < .05) was found in blood flow velocity in the femoral and popliteal arteries over time with HVES and physical exercise and in the posterior tibial artery with the physical exercise protocol. However, no significant differences were found in the intergroup analysis (P > .05).

CONCLUSION

Proximal blood circulation in the lower limb of diabetic women with peripheral arterial disease was increased by a single session of HVES and physical exercise, whereas distal circulation was only increased with physical exercise.

Early mobilization on continuous renal replacement therapy is safe and may improve filter life

Introduction

Despite studies demonstrating benefit, patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization. No researchers have reported filter pressures during mobilization, and it is unknown whether mobilization is safe or affects filter lifespan. Our objective in this study was to test the safety and feasibility of mobilization in this population.

Methods

A total of 33 patients undergoing continuous renal replacement therapy via femoral, subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled. Patients underwent one of three levels of mobilization intervention as appropriate: (1) passive bed exercises, (2) sitting on the bed edge or (3) standing and/or marching. Catheter dislodgement, haematoma and bleeding during and following interventions were evaluated. Filter pressure parameters and lifespan (hours), nursing workload and concern were also measured.

Results

No episodes of filter occlusion or failure occurred during any of the interventions. No adverse events were detected. The intervention filters lasted longer than the nonintervention filters (regression coefficient = 13.8 (robust 95% confidence interval (CI) = 5.0 to 22.6), P = 0.003). In sensitivity analyses, we found that filter life was longer in patients who had more position changes (regression coefficient = 2.0 (robust 95% CI = 0.6 to 3.5), P = 0.007). The nursing workloads between the intervention shift and the following shift were similar.

Conclusions

Mobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life. These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011)

Electronic supplementary material

The online version of this article (doi:10.1186/cc14001) contains supplementary material, which is available to authorized users.

Polypharmacy in elderly patients at discharge from the acute care hospital

OBJECTIVE

To investigate correlates of polypharmacy at discharge from wards of general medicine and geriatrics.

POPULATION

2465 patients enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study.

MAIN OUTCOME MEASURE

Polypharmacy, ie having more than 6 drugs prescribed at discharge.

METHODS

Data on drugs prescribed at home, during hospital stay, and at discharge were collected according to a validated procedure. Logistic regression analysis was used to identify independent correlates of polypharmacy at discharge. The adherence to current therapeutic guidelines was assessed for selected drugs (digitalis, diuretics, antithrombotics, bronchodilators)

RESULTS

The median number of prescribed drugs was 3.0 before admission and 4.0 at discharge (p < 0.001). Polypharmacy prior to admission (Odds Ratio [OR] 4.32, 95% Confidence Interval [CI] 3.13-5.96), cumulative comorbidity (OR 1.81, 95% CI 1.40-2.32) and selected chronicconditions (diabetes, heart failure, chronic obstructive pulmonary disease, renal insufficiency, and depression) were significant correlates of polypharmacy at discharge. Negative correlate of the outcome was the occurrence of adverse drug reactions prior to admission (OR 0.22, 95% CI 0.09-0.51). The rate of appropriate prescription reached 80% only for antithrombotics either at home or in hospital and at discharge.

CONCLUSIONS

Hospitalization increases drug prescription at discharge in elderly patients. Efforts are needed to identify the determinants and to assess the quality of this prescription practice, with the final aim of contrasting polypharmacy.

The impact of intermittent pneumatic compression devices on deep venous flow velocity in patients with congestive heart failure

BACKGROUND

Intermittent pneumatic compression (IPC) has been used to prevent deep venous thrombosis (DVT), but the effects of IPC on the hemodynamics of popliteal and soleal veins, especially in patients with congestive heart failure (CHF) have not been evaluated. The aim of this study was to evaluate the effects of IPC on the flow velocity of deep veins in the lower extremities and to compare the efficacy of two different types of IPC in deep venous flow enhancement in patients with CHF.

METHODS

Flow velocities of popliteal and soleal veins were recorded in 19 patients with CHF and in 19 control subjects using a high-resolution linear probe. Peak and mean flow velocities were measured (1) at rest, (2) with sequential foot and calf IPC (SFC-IPC) which consists of an electrically driven air compressor and four air chambers, and (3) with impulse foot IPC (IF-IPC) which consists of a pneumatic impulse generator operated at an applied pressure of 130 mmHg.

RESULTS

In the resting condition, popliteal venous flow velocity in the CHF group was attenuated (12.8+/-4.7 cm/s vs. 21.1+/-13.5 cm/s; p<0.05). Both SFC-IPC and IF-IPC increased venous velocity, but the increase with IF-IPC in CHF patients was lower than that in control subjects. In the soleal veins, after applying SFC-IPC, the peak and mean velocity in CHF increased to the same extent as in the control group. IF-IPC increased soleal venous velocity in control subjects, but there was no increase in CHF patients.

CONCLUSION

Two-dimensional Doppler scanning revealed a significant increase in the mean and peak velocities in the soleal and popliteal veins with SFC-IPC but not with IF-IPC in patients with CHF. These results indicate that SFC-IPC could have favorable effects in preventing DVT in patients with CHF.

Effects of augmented respiratory muscle pressure production on locomotor limb venous return during calf contraction exercise

We determined effects of augmented inspiratory and expiratory intrathoracic pressure or abdominal pressure (Pab) excursions on within-breath changes in steady-state femoral venous blood flow (Qfv) and net Qfv during tightly controlled (total breath time = 4 s, duty cycle = 0.5) accessory muscle/"rib cage" (DeltaPab <2 cmH2O) or diaphragmatic (DeltaPab >5 cmH2O) breathing. Selectively augmenting inspiratory intrathoracic pressure excursion during rib cage breathing augmented inspiratory facilitation of Qfv from the resting limb (69% and 89% of all flow occurred during nonloaded and loaded inspiration, respectively); however, net Qfv in the steady state was not altered because of slight reductions in femoral venous return during the ensuing expiratory phase of the breath. Selectively augmenting inspiratory esophageal pressure excursion during a predominantly diaphragmatic breath at rest did not alter within-breath changes in Qfv relative to nonloaded conditions (net retrograde flow = -9 +/- 12% and -4 +/- 9% during nonloaded and loaded inspiration, respectively), supporting the notion that the inferior vena cava is completely collapsed by relatively small increases in gastric pressure. Addition of inspiratory + expiratory loading to diaphragmatic breathing at rest resulted in reversal of within-breath changes in Qfv, such that >90% of all anterograde Qfv occurred during inspiration. Inspiratory + expiratory loading also reduced steady-state Qfv during mild- and moderate-intensity calf contractions compared with inspiratory loading alone. We conclude that 1) exaggerated inspiratory pressure excursions may augment within-breath changes in femoral venous return but do not increase net Qfv in the steady state and 2) active expiration during diaphragmatic breathing reduces the steady-state hyperemic response to dynamic exercise by mechanically impeding venous return from the locomotor limb, which may contribute to exercise limitation in health and disease.

Skeletal muscle pump versus respiratory muscle pump: modulation of venous return from the locomotor limb in humans

The vast majority of quantitative data examining the effects of breathing on venous return have been derived from anaesthetized or reduced animal preparations, making an extrapolation to an upright exercising human problematic due to the lack of a hydrostatic column and an absence of muscular contraction. Thus, this study is the first to quantitatively examine the effects of different breathing mechanics on venous return from the locomotor limbs both at rest and during calf contraction exercise in the semirecumbent human. When subjects inspired using predominantly their ribcage/accessory inspiratory muscles at rest (change in gastric pressure (DeltaP(GA)) = <2 cmH(2)O, change in oesophageal pressure (DeltaP(ES)) = approximately -6 cmH(2)O; inspiratory time/total breath time (T(I)/T(TOT)) = 0.5), a slight facilitation of femoral venous return was observed during inspiration (65% of all flow occurred during inspiration), with a slight reduction in femoral venous return during the ensuing expiratory phase of the breath. However, when subjects inspired using a predominantly diaphragmatic breath at rest (DeltaP(GA) = > 5 cmH(2)O, DeltaP(ES) = approximately -6 cmH(2)O; T(I)/T(TOT) = 0.5), femoral venous return was markedly impeded (net retrograde flow of 11%) and significantly lower than that observed during ribcage breathing conditions (P < 0.01). During the ensuing expiratory phase of a diaphragmatic breath, there was a large resurgence of femoral venous blood flow. The pattern of modulation during ribcage and diaphragmatic breathing persisted during both mild (peak calf force = 7 kg) and moderate (peak calf force = 11 kg) levels of calf contraction. Despite the significant within-breath modulation of femoral venous return by breathing, net blood flow in the steady state was not altered by the breathing pattern followed by the subjects. Though popliteal blood flow appeared to be modulated by respiration at rest, this pattern was absent during mild calf contraction where popliteal outflow was phasic with the concentric phase of calf contraction. We conclude that respiratory muscle pressure production is the predominant factor modulating venous return from the locomotor limb both at rest and during calf contraction even when the veins of the lower limb are distended due to the presence of a physiologic hydrostatic column.