The influence of temperature upon venous pressure in the foot

Mechanisms of orthostatic intolerance during heat stress

Heat stress profoundly and unanimously reduces orthostatic tolerance. This review aims to provide an overview of the numerous and multifactorial mechanisms by which this occurs in humans. Potential causal factors include changes in arterial and venous vascular resistance and blood distribution, and the modulation of cardiac output, all of which contribute to the inability to maintain cerebral perfusion during heat and orthostatic stress. A number of countermeasures have been established to improve orthostatic tolerance during heat stress, which alleviate heat stress induced central hypovolemia (e.g., volume expansion) and/or increase peripheral vascular resistance (e.g., skin cooling). Unfortunately, these countermeasures can often be cumbersome to use with populations prone to syncopal episodes. Identifying the mechanisms of inter-individual differences in orthostatic intolerance during heat stress has proven elusive, but could provide greater insights into the development of novel and personalized countermeasures for maintaining or improving orthostatic tolerance during heat stress. This development will be especially impactful in occuational settings and clinical situations that present with orthostatic intolerance and/or central hypovolemia. Such investigations should be considered of vital importance given the impending increased incidence of heat events, and associated cardiovascular challenges that are predicted to occur with the ensuing changes in climate.

Human cardiovascular responses to passive heat stress

Heat stress increases human morbidity and mortality compared to normothermic conditions. Many occupations, disease states, as well as stages of life are especially vulnerable to the stress imposed on the cardiovascular system during exposure to hot ambient conditions. This review focuses on the cardiovascular responses to heat stress that are necessary for heat dissipation. To accomplish this regulatory feat requires complex autonomic nervous system control of the heart and various vascular beds. For example, during heat stress cardiac output increases up to twofold, by increases in heart rate and an active maintenance of stroke volume via increases in inotropy in the presence of decreases in cardiac preload. Baroreflexes retain the ability to regulate blood pressure in many, but not all, heat stress conditions. Central hypovolemia is another cardiovascular challenge brought about by heat stress, which if added to a subsequent central volumetric stress, such as hemorrhage, can be problematic and potentially dangerous, as syncope and cardiovascular collapse may ensue. These combined stresses can compromise blood flow and oxygenation to important tissues such as the brain. It is notable that this compromised condition can occur at cardiac outputs that are adequate during normothermic conditions but are inadequate in heat because of the increased systemic vascular conductance associated with cutaneous vasodilation. Understanding the mechanisms within this complex regulatory system will allow for the development of treatment recommendations and countermeasures to reduce risks during the ever-increasing frequency of severe heat events that are predicted to occur.

Time courses of central hemodynamics during rapid changes in posture

Changes in posture cause blood volume redistribution, affecting cardiac filling and stroke volume (SV). We hypothesized that the time courses of ventricular filling would differ between the right and left ventricle during a rapid (2 s) tilt and that changes in right ventricular filling pressure would be more swift because of the direct coupling to the systemic circulation. We further hypothesized that the transient imbalance between right and left ventricular filling pressure would influence left ventricular SV changes. Right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP), left ventricular stroke volume, heart rate, and arterial pressure were recorded beat-by-beat during rapid tilts from supine to upright positions and back again, during rest and dynamic 100-W leg exercise. RAP changes had a faster time course than PCWP during down-tilts, both during rest and exercise (1 ± 1 vs. 6 ± 2 s and 2 ± 2 vs. 6 ± 2 s, respectively; P < 0.05). This discrepancy caused a transient decrease in the end-diastolic pressure difference between the right and left ventricle. The decreased pressure difference in diastole impeded left ventricular filling because of ventricular interdependence, causing SV to fall transiently. The mechanisms of ventricular interdependence were also involved in reverse during up-tilt, where SV was maintained for 2–3 s despite falling PCWP. Furthermore, the decrease in RAP during up-tilt in the resting condition was biphasic with an initial fast and a second slower component, which might suggest the effect of venous valves. This was not seen during dynamic leg exercise where blood pooling is prevented by the venous muscle pump.

Influence of wearing an unstable shoe on thigh and leg muscle activity and venous response in upright standing

PURPOSE

To quantify the effect of unstable shoe wearing on muscle activity and haemodynamic response during standing.

METHODS

Thirty volunteers were divided into 2 groups: the experimental group wore an unstable shoe for 8 weeks, while the control group used a conventional shoe for the same period. Muscle activity of the medial gastrocnemius, tibialis anterior, rectus femoris and biceps femoris and venous circulation were assessed in quiet standing with the unstable shoe and barefoot.

RESULTS

In the first measurement there was an increase in medial gastrocnemius activity in all volunteers while wearing the unstable shoe. On the other hand, after wearing the unstable shoe for eight weeks these differences were not verified. Venous return increased in subjects wearing the unstable shoe before and after training.

CONCLUSIONS

The unstable shoe produced changes in electromyographic characteristics which were advantageous for venous circulation even after training accommodation by the neuromuscular system.

Colloid volume loading does not mitigate decreases in central blood volume during simulated haemorrhage while heat stressed

Heat stress results in profound reductions in the capacity to withstand a simulated haemorrhagic challenge; however, this capacity is normalized if the individual is volume loaded prior to the challenge. The present study tested the hypothesis that volume loading during passive heat stress attenuates the reduction in regional blood volumes during a simulated haemorrhagic challenge imposed via lower-body negative pressure (LBNP). Seven subjects underwent 30 mmHg LBNP while normothermic, during passive heat stress (increased internal temperature ∼1◦C), and while continuing to be heated after intravenous colloid volume loading (11 ml kg⁻¹). Relative changes in torso and regional blood volumes were determined by gamma camera imaging with technetium-99m labelled erythrocytes. Heat stress reduced blood volume in all regions (ranging from 7 to 16%), while subsequent volume loading returned those values to normothermic levels. While normothermic,LBNP reduced blood volume in all regions (torso: 22 ± 8%; heart: 18 ± 6%; spleen: 15 ± 8%). During LBNP while heat stressed, the reductions in blood volume in each region were markedly greater when compared to LBNP while normothermic (torso: 73 ± 2%; heart: 72 ± 3%; spleen: 72 ± 5%, all P<0.001 relative to normothermia). Volume loading during heat stress did not alter the extent of the reduction in these blood volumes to LBNP relative to heat stress alone (torso: 73 ± 1%; heart: 72 ± 2%; spleen: 74 ± 3%, all P>0.05 relative to heat stress alone). These data suggest that blood volume loading during passive heat stress (via 11 ml kg⁻¹ of a colloid solution) normalizes regional blood volumes in the torso, but does not mitigate the reduction in central blood volume during a simulated haemorrhagic challenge combined with heat stress.

Age-related changes in vasomotor reflex control of calf venous capacitance response to lower body negative pressure in humans

The present study was performed to test the hypothesis that calf venous capacitance would be reduced by mild gravitational stress through a vasomotor reflex in humans, and this response could be diminished with advancing age. Nine young (31 +/- 1 years, mean +/- SE) and 9 elderly (69 +/- 1 years) healthy males were exposed to a lower body negative pressure (LBNP) of 15 mmHg. Venous occlusion plethysmography was used to measure calf venous capacitance and calf blood flow. Muscle sympathetic nerve activity (MSNA) was recorded microneurographically from the tibial nerve along with cardiovascular variables. It was found that baseline MSNA was higher [21 +/- 4 (mean +/- SE) vs. 37 +/- 5 bursts x min(-1), young vs. elderly; p < 0.05] and calf venous capacitance was lower (1.71 +/- 0.12 vs. 1.44 +/- 0.10, ml x 100 ml(-1), young vs. elderly; p < 0.05) in the elderly group. At 15 mmHg-LBNP, heart rate and mean arterial pressure both remained unchanged, MSNA was enhanced, and calf blood flow was reduced in all subjects. Calf venous capacitance during LBNP decreased in the young, but did not change in the elderly. A significant negative correlation between percent changes in MSNA and percent changes in calf venous capacitance existed in the young group (y = 20.171x-11.863, r = 20.682; p = 0.0432), but disappeared in the elderly group. The ratio of percent changes in calf venous capacitance to percent changes in MSNA was markedly lower in the elderly (p < 0.01). In conclusion, these results substantiate our hypothesis that calf venous capacitance is reduced by mild LBNP through the vasomotor reflex, and this response is diminished in the elderly.

A model for time-dependent flow in (giraffe jugular) veins: uniform tube properties

Computations are reported for a one-dimensional model of time-dependent flow in collapsible tubes representing long mammalian veins. The tubes are taken to have uniform intrinsic properties and we concentrate on the effect of longitudinal gravity. The main application is to the jugular vein of the upright giraffe, with given inflow rate from the head, a given pressure, slightly above the external, atmospheric pressure, at the downstream (vena caval) end, and a variety of initial conditions. We show that: (i) previously calculated steady flows are the long time limits of unsteady computations, although only after a considerable time in which slowly-decaying waves and elastic jumps propagate up and down, (ii) steady flows are indeed not found when the steady-flow analysis shown them not to exist, although the consequent unsteadiness is of such small amplitude as to be practically unimportant, (iii) the time taken for the flow to become steady when the neck is raised from the horizontal or the head-down position can be several seconds longer than the neck-raising time itself (3-7s). We also find that roll-waves do not develop despite having been previously predicted for long collapsible tubes. Further application is made to the effect of postural changes on human neck and leg veins.

Exercise in the heat. I. Fundamentals of thermal physiology, performance implications, and dehydration

OBJECTIVE

To present the critical issue of exercise in the heat in a format that provides physiologic foundations (Part I) and then applies the established literature to substantial, usable guidelines that athletic trainers can implement on a daily basis when working with athletes who exercise in the heat (Part II).

DATA SOURCES

The databases MEDLINE and SPORT Discus were searched from 1980 to 1999, with the terms "hydration," "heat," "dehydration," "cardiovascular," "thermoregulatory," "physiology," and "exercise," among others. The remaining citations are knowledge base.

DATA SYNTHESIS

Part I introduces athletic trainers to some of the basic physiologic and performance responses to exercise in the heat.

CONCLUSIONS/RECOMMENDATIONS

The medical supervision of athletes who exercise in hot environments requires an in-depth understanding of basic physiologic responses and performance considerations. Part I of this article aims to lay the scientific foundation for efficient implementation of the guidelines for monitoring athletic performance in the heat provided in Part II.

Venous hemodynamics of the lower extremities in response to electrical stimulation

OBJECTIVE

To evaluate the calf muscle pump function using an air plethysmograph (APG) applied to the lower leg of subjects during three different tiptoe exercises.

DESIGN

A controlled trial design was selected to compare the hemodynamic effects of three exercise conditions on a group of able-bodied, healthy patients.

SETTING

Testing was performed in an outpatient clinic at a rehabilitation hospital.

SUBJECTS

Patient groups were selected from a convenience sample of 10 healthy volunteers with normal venous capacitance and no reflux, determined through impedance pleythysmography before the study.

INTERVENTIONS

Three exercise conditions undertaken by each subject consisted of loaded and unloaded lower leg muscle contractions produced by (1) voluntary contraction (VOL), (2) electrical stimulation of the gastocnemius-soleus and tibialis anterior muscles (ES), and (3) combined ES and VOL (ES/VOL).

MAIN OUTCOME MEASURE

Hemodynamic measurements of venous filling index upon standing from the supine (VFI), ejection fraction (EF), ejection volume (EV), residual volume (RV), and residual volume fraction (RVF) were recorded after each protocol. These results were used to compare the lower leg hemodynamic effects of the treatments.

RESULTS

Combined ES/VOL single tiptoe exercise produced the highest EV (97.8mL), followed by VOL (80.6mL) and ES (51.7mL) (p < .0008). The EF was also highest for combined ES/VOL (73.1%), followed by VOL (64.5%) and ES (37.8%) (p < .0001). Ten tiptoe ES exercises produced the highest RV (96.2mL), followed by ES/VOL (44.7mL) and VOL (28.2mL) (p < .0001). RVF was also highest in the ES group (71%), followed by ES/VOL (33.4%) and VOL (22.8%) (p < .0001).

CONCLUSION

Periodic single ES-induced calf muscle contractions produced significant muscle pump function and could be used to improve venous blood flow and reduce stasis in the lower leg. Continuous ES-induced contractions, on the other hand, could improve lower leg peripheral perfusion while eliciting the physiologic venous muscle pump. Higher RV and RVF after 10 ES-induced contractions in this sample of healthy subjects with normal VFI may be caused by an increase in arterial blood perfusion after repeated ES-induced contractions.

Venous pressure in the saphenous vein near the ankle during changes in posture and exercise at different ambient temperatures

The venous pressure in the saphenous vein at the ankle was measured in ten healthy subjects (5 men, 5 women) aged 19-33 years during supine posture, orthostasis and cycle ergometer exercise (50 W, 50 rpm). Measurements were made at 20, 28 and 36 degrees C at 50% relative humidity. A custom-built setup consisting of two pressure transducers and a differential amplifier was used to compensate for the hydrostatic effects, temperature influences and movement artefacts that disturbed the pressure measurements. Pressure was lowest in the supine position and varied only slightly with the ambient temperature. The mean pressures were 7 (SEM 1) mmHg [0.9 (SEM 0.13) kPa], 7 (SEM 1) mmHg [0.9 (SEM 0.13) kPa], 4 (SEM 1) mmHg [0.5 (SEM 0.13) kPa] at 20, 28 and 36 degrees C. The venous pressure increased when the subjects were passively tilted from a supine to an upright posture. The rate of the increase was smaller at 20 degrees C than at 28 degrees and 36 degrees C. The final level the pressure reached during motionless standing differed slightly. The mean pressures were 76 (SEM 2) mmHg [10.1 (SEM 0.27) kPa], 79 (SEM 7) mmHg [10.5 (SEM 0.93) kPa] and 75 (SEM 3) mmHg [10.0 (SEM 0.40)] at the three temperatures. When starting exercising, venous pressure decreased within the 1st min to a level which remained virtually constant until the end of exercise. However, this level was found to be temperature dependent. It was lowest at 20 degrees C (26 (SEM 3) mmHg [3.5 (SEM 0.40) kPa]) and increased with temperature.(ABSTRACT TRUNCATED AT 250 WORDS)

Volume changes in the lower leg during quiet standing and cycling exercise at different ambient temperatures

The purpose of this study was to investigate whether ambient temperature influences both the rate of leg swelling during orthostasis and the oedema-preventing effect of the skeletal muscle pump. Using mercury-in-rubber strain gauges, volume changes were measured in the calf (n = 34) and near the ankle (n = 24) in healthy volunteers aged 19-33 years. Measurements were performed during 12 min of motionless standing in an upright posture and during 17 min of cycle exercise at intensities of 50 W and a pedalling rate of 50 rpm. The experiments were done in an air-conditioned chamber at temperatures of 20, 28 and 36 degrees C and 50% relative humidity. The rate of leg swelling, which occurred while standing, did not differ significantly among the three temperatures. The mean increases in calf volume during 10 min (min 2-12) orthostasis were 1.6 (SEM 0.1)%, 1.9 (SEM 0.2)% and 2.0 (SEM 0.2)% at 20, 28 and 36 degrees C respectively. In the ankle region the mean values were 0.9 (SEM 0.1)%, 1.0 (SEM 0.1)%, and 1.0 (SEM 0.1)% at the three temperatures, respectively. Exercising at low temperatures continuously reduced the volume of the leg, but at 36 degrees C the leg volume did not change significantly either at the calf or near the ankle. The mean volume changes measured between min 2 and min 15 were, at the calf, -1.1 (SEM 0.1)%, -0.8 (SEM 0.2)%, and -0.02 (SEM 0.1)% at 20, 28 and 36 degrees C, respectively. Near the ankle the mean changes were -0.7 (SEM 0.1)%, -0.3 (SEM 0.1)%, and +0.2 (SEM 0.1)%.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation of Doppler ultrasound and photoplethysmography in the investigation of venous insufficiency

Non-invasive methods of venous assessment have been developed to improve diagnostic accuracy in the assessment of venous insufficiency. Of these, continuous wave Doppler (CWD) ultrasound and photoplethysmography are the cheapest and most simple to perform. In this study duplex scanning was used to test the accuracy of these two methods. One hundred and thirty-six patients attending the venous outpatient clinic at Middlesex Hospital, London were examined by all three techniques and a diagnosis was reached using each technique. The technicians performing the examinations were unaware of the diagnoses reached by the other methods. Continuous wave Doppler ultrasound was found to be most accurate in the diagnosis of long saphenous incompetence (sensitivity 73%, specificity 85%). Due to the variability of venous anatomy at the popliteal fossa and the 'blindness' of the technique, it was inaccurate in the diagnosis of short saphenous incompetence (sensitivity 33%) and deep vein reflux (sensitivity 48%). Photoplethysmography was found to be most accurate in the diagnosis of deep vein reflux (sensitivity 79%, specificity 70%) but was inaccurate in identification of the site of superficial vein reflux. Inaccuracies may be attributed to the presence of incompetent perforating veins and variation in arterial inflow.

Fibrinolytic activity and calf pump failure

The interstitial fibrinolytic activity of the upper and lower limbs was investigated in subjects with abnormal calf pump function by measuring the lysis rate of experimentally produced subcutaneous 125I-fibrin clots. Thirty-three subjects with healed venous ulcers, five with varicose veins and 11 controls were studied. 125I-fibrin clots were produced in the subcutaneous tissue of the forearms and legs and clearance half-life was calculated. Calf pump function was assessed by foot volumetry and the 'gaiter' skin nutritive circulation by measuring the transcutaneous oxygen tension (PtcO2). Fibrin clearance was prolonged from the subcutaneous tissues of the legs of subjects with varicose veins and healed ulcers compared with controls. Negative correlations were found between fibrin clearance half-life and the half-volume refilling time (P less than 0.01) and the PtcO2 (P less than 0.01).

On the edema-preventing effect of the calf muscle pump

During motionless standing an increased hydrostatic pressure leads to increased transcapillary fluid filtration into the interstitial space of the tissues of the lower extremities. The resulting changes in calf volume were measured using a mercury-in-silastic strain gauge. Following a change in body posture from lying to standing or sitting a two-stage change in calf volume was observed. A fast initial filling of the capacitance vessels was followed by a slow but continuous increase in calf volume during motionless standing and sitting with the legs dependent passively. The mean rates of this slow increase were about 0.17%.min-1 during standing and 0.12%.min-1 during sitting, respectively. During cycle ergometer exercise the plethysmographic recordings were highly influenced by movement artifacts. These artifacts, however, were removed from the recordings by low-pass filtering. As a result the slow volume changes, i.e. changes of the extravascular fluid were selected from the recorded signal. Contrary to the increases during standing and sitting the calf volumes of all 30 subjects decreased during cycle ergometer exercise. The mean decrease during 18 min of cycling (2-20 min) was -1.6% at 50 W work load and -1.9% at 100 W, respectively. This difference was statistically significant (p less than or equal to 0.01). The factors which may counteract the development of an interstitial edema, even during quiet standing and sitting, are discussed in detail. During cycling, however, three factors are most likely to contribute to the observed reduction in calf volume: (1) The decrease in venous pressure, which in turn reduces the effective filtration pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

The cardiac filling pressure following exercise and thermal stress

Under heat stress, a decrease of the central venous pressure (CVP) was regularly observed, raising the question of whether this reaction is a limiting factor for the circulation. In animal experiments it could be shown, however, that despite a lowered CVP, which depended on the elevated body temperatures, a high cardiac output (CO), as well as an elevated stroke volume could be maintained. A low CVP went hand in hand with a low total peripheral resistance. It was argued that under these circumstances the low CVP was not limiting because the intrinsic factors of the heart (sympathetic stimulation) were capable of maintaining a high CO. In human experiments the lowered CVP had to be seen in relation to the degree of dehydration. Regardless of whether the plasma volume remained constant, as in exercise, or declined, as in thermal stress (sauna), the CVP followed the volume depletion of the vascular and extravascular space, and it might well be that under these circumstances CVP is limiting. In this case, however, the altered CVP must be seen first as a monitor for the fluid deficit and not as a factor controlling cardiac function.

Non-thermal factors are important in the control of skin blood flow during exercise only under high physiological strain

Several authors have argued that skin blood flow (SkBF) during exercise is less than during rest at the same levels of body core and whole-body skin temperatures (Tc and Tsk). Since such an effect does not prevent SkBF during exercise from rising above pre-exercise levels, it is sometimes called a relative cutaneous vasoconstriction. Such a vasoconstriction is considered to be either part of a thermoregulatory adjustment during exercise (elevated thermoregulatory "set-point") or a compensatory response to allow adequate perfusion of exercising muscle. In this paper, some of the pertinent experimental evidence is reviewed, and the following conclusions are reached: the evidence does not support a change in thermoregulatory set-point during exercise; under conditions of high physiological strain (high Tsk and intense exercise), there is quite clearly a relative cutaneous vasoconstrictor effect of exercise; the evidence does not support such an effect under more moderate conditions; and it is likely that, under mild to moderate conditions, other compensatory cardiovascular responses are sufficient to allow adequate perfusion of exercising muscle and are invoked in preference to relative cutaneous vasoconstriction, which has been demonstrated only at higher levels of strain. The thermoregulatory SkBF required during sustained exercise is thus maintained as much as possible.

On physiological edema in man's lower extremity

To examine whether the so-called musculovenous pump counteracts the development of interstitial edema in the lower extremities of man in the upright position, the volume changes in the calf which occurred during twenty minutes of rhythmic muscular exercise were measured in twenty-three subjects by impedance-plethysmography. The results were compared with the volume increase found during quiet relaxed standing for the same length of time. Contrary to the hypothesis, and edema-protective effect of the musculovenous pump could only be shown in about half the number of the subjects. In the others, muscular exercise led to increases in calf volume which were higher than those measured in the normal upright position. These results show that the calf muscle pump does not generally have a edema-protective effect but rather that muscle contractions also activate mechanisms which stimulate the extravasation of fluid. In a second test-series with twenty subjects, changes in calf volume were measured during the course of the day. In nearly all cases, the calf volume was greater in the evening than in the morning. It could be shown that the volume increases in the evening are caused by an increase in extravascular fluid. Compared to the increase in extravascular volume occurring during twenty minutes, in a normal upright position, the accumulation of extravascular fluid during the day is, however, remarkably low. Although it is still unknown how interstitial edema in man's lower extremities is prevented during the day, these findings lead to the hypothesis that the edema-preventing mechanisms, for instance the muscle-lymphpump, do not become maximally effective until a certain volume has accumulated in the interstitial space.

Cardiovascular responses to heat stress and blood volume displacements during exercise in man

Subjects exercised in the upright position at approximately 50% of maximal oxygen consumption in four situations: in 25 degrees C air, in 45 degrees C air [mean skin temperature (Tsk) 35 degrees C], in 35 degrees C water immersed to the level of the xiphoid process, and finally wearing a suit perfused with 35 degrees C water. The water immersion prevented gravitational shifts of blood volume to the legs. In this situation the forearm blood flow (FBF) rose continually with increasing core temperature (Tes) in contrast to the attenuation in rise above 38 degrees C Tes in 45 degrees C air. The differences were significant above 38.6 degrees C Tes in experiments in eight subjects. The effects of immersion on cardiac output (CO), stroke volume (SV), and heart rate (HR) were studied in five of the subjects in relation to Tes, since the rate of rise of Tes was different in the four situations. CO and SV tended to be higher during both rest and exercise in the water than in the other three conditions, while HR rose in the same manner with increasing core temperature, except that it was lower in 25 degrees C air, where Tsk was lower. Thus, the prevention of hydrostatic shifts of peripheral venous volume permitted the maintenance of a higher SV and peripheral blood flow, and enhanced the ability of the circulation to deal with the combined exercise and heat stress.

The effects of intermittently applied external pressure on the haemodynamics of the hind-limb in greyhound dogs

The application of intermittent compression of 30 mm. Hg to the hind-limb of a greyhound results in an increase of about 400 per cent in the pulsatility of femoral vein flow and of 250 per cent in the peak femoral vein flow. This effect may result in adequate filling and emptying of the deep venous channels and sinuses of the lower limb of man, thereby preventing stasis in them. Intermittent compression of the calf seems, therefore, to have an obvious place in the prophylaxis of deep-vein thrombosis.

Muscle Pumping in the Dependent Leg

Since the exercising dependent leg displaces blood toward the heart, against a potential gradient, it must perform useful circulatory work. We studied the peripheral circulation in healthy, sedentary males by measuring calf circumference (using mercury-in-Silastic strain gages), muscle pump ejection velocity (using a transcutaneous Doppler flowmeter), intrathoracic and intra-abdominal pressures (through catheters in the esophagus and rectum) and power of the leg muscle pump (product of blood flow and the upstream-downstream venous pressure difference). Measurements of pressure, flow velocity, and volume changes in the dependent venous beds of healthy young men demonstrated that during running in place, (1) the abdominal contraction necessary to fix the pelvis raised inferior caval pressure and impeded venous outflow from the legs, but that, (2) the leg muscles themselves were capable of effectively pumping blood past this functional obstruction. By doing so, these peripheral pumps contributed more than 30% of the energy required to circulate blood during running.