Effects of compression stockings on sympathetic activity and heart rate variability in individuals with spinal cord injury

Integrated Yoga and Naturopathy Interventions to Modify Functional Disability in Patients With Spinal Cord Injury: A Randomized Controlled Trial

OBJECTIVE

This study aimed to evaluate the use of integrated yoga and naturopathy intervention to modify functional disability and improve independence in patients with spinal cord injury.

MATERIALS AND METHODS

In this randomized controlled trial, 48 spinal cord injury patients receiving residential rehabilitation, aged between 23 and 57 years (37.9±11.8) of both genders, were randomly allocated to two groups: (i) experimental group (naturopathy and yoga) and (ii) control group (waitlist with routine care). Subjects were assessed on day 1 (baseline), day 30 (intense phase), and day 90 (follow-up). Assessments were done using the Spinal Cord Independence Measure (SCIM), handheld myometry (HHM), time up and go (TUG), Berg Balance Scale (BBS), and 10-meter walk test (10MWT).

RESULTS

There were no significant differences at baseline between groups for all the variables (p>0.05) through one-way analysis of variance (ANOVA). Repeated measures ANOVAs (RM-ANOVAs) were performed to compare between assessments and the groups (p<0.05). Post hoc shows that there is significant SCIM (p<0.001), HHM (p<0.001), TUG (p<0.001), BBS (p<0.001), and 10MWT (p<0.001).

CONCLUSION

The present study shows that there is significant improvement in the functions of both yoga and naturopathy and the control group. So, yoga and naturopathy can be considered as adjuvant along with routine care of physical therapy in spinal cord injury rehabilitation programs.

Compression therapy, autonomic nervous system, and heart rate variability: A narrative review and our preliminary personal experience

Aims

To highlight the relationship among compression therapy (CT), the autonomic nervous system (ANS) (parasympathetic and sympathetic system), and the heart rate variability (HRV) analysis.

Background

Beyond the typical analgesic and anti-inflammatory effects of CT in patients affected by venous and/or lymphatic diseases, some literature about CT influence on wellbeing has been published as well. More specifically, CT influence on the ANS has been elucidated mostly through HRV application, providing useful quali-quantitative data for scientific and clinical purposes.

Material and Methods

A literature search was performed through several web-based search engines to investigate the available evidence concerning the possible influence of CT on the ANS and on psychoneuroendocrineimmunology. Moreover, we examined literature data regarding HRV use in the assessment of CT. Lastly, a preliminary cross-over study was performed on 10 patients affected by phlebolymphedema of the lower limbs, undergoing CT with 18–21 mmHg stockings for 10 h and investigated by means of HRV.

Results

A CT-based increase of the anti-inflammatory activity of the parasympathetic (vagal) system has been elucidated in most scientific literature. Similarly, CT application has generally resulted in an improvement of HRV, which indicates a beneficial influence on the ANS. In our preliminary experience with compression stockings and HRV, two parasympathetic-based parameters improved by 22.8% and 68.0% after 10 h, whereas they decreased in the same subjects without stockings by 2.7% and 8.2%, during normal breathing. The remaining HRV parameters did not show relevant variations, especially during diaphragmatic breathing.

Conclusions

From literature data and based on our very preliminary experience, it is possible to deduce that CT exerts different effects on the psychobiological parameters of the individual, overall improving HRV and parasympathetic activity. Incorporating both HRV/ANS assessment in phlebolymphology and the beneficial neural action of CT in health care may represent viable options in the future biomedical science.

Physiological parameters and the use of compression stockings in individuals with spinal cord injuries: a scoping review

STUDY DESIGN

Scoping review.

OBJECTIVE

To summarize information on the physiological effects of compression stockings (CS) in individuals with spinal cord injuries (SCI) and suggest areas for future research.

METHODS

We asked, "What are the physiological effects of CS use in individuals with SCI?" Original studies of patients with SCI regardless of sex and age that focused on SCI and CS were included. Five biomedical databases were searched. Studies were selected by three researchers in two stages, starting with an abstract and title screening and continuing with a full text review for application of the inclusion and exclusion criteria. A narrative synthesis was then performed.

RESULTS

An initial search yielded 283 titles, of which five met the inclusion criteria and were subjected to the full text review. Among them, there were 78 individuals with SCI. The studies found that the use of CS at rest reduced deep vein thrombosis (DVT) and vascular capacitance but increased systolic blood pressure and norepinephrine level., three studies tested the use of CS During exercise; one found that time of the last lap in a standard court test was negatively affected; however, the greatest benefits were observed after exercises, such as reduced blood lactate level, improved autonomic function, and increased blood flow to the upper limbs.

CONCLUSION

We conclude that future research should examine the physiological effects and relationship of CS with: (a) pharmacological interventions, (b) body position changes, (c) physical fitness level, (d) wheelchair use duration, (e) exercise-induced thermal stress, (f) thermal stress mitigation, and (g) edema reduction.

Effectiveness of non-pharmacological interventions to treat orthostatic hypotension in elderly people and people with a neurological condition: a systematic review

OBJECTIVE

The objective of this review was to summarize the best available evidence regarding the effectiveness of non-pharmacological interventions to treat orthostatic hypotension (OH) in elderly people and people with a neurological condition.

INTRODUCTION

Orthostatic hypotension is common in elderly people and people with a neurological condition and can interfere with or limit rehabilitation. Non-pharmacological interventions to treat OH could allow for longer and earlier mobilization, which is recommended in national clinical guidelines for rehabilitation in the acute or sub-acute phase following stroke or other neurological conditions.

INCLUSION CRITERIA

The review considered people aged 50 years and older, and people aged 18 years and elderly people with a neurological condition. Non-pharmacological interventions to treat OH included compression garments, neuromuscular stimulation, physical counter-maneuvers, aerobic or resistance exercises, sleeping with head tilted up, increasing fluid and salt intake, and timing and size of meals. The comparator was usual care, no intervention, pharmacological interventions, or other non-pharmacological interventions. Outcome measures included systolic blood pressure, diastolic blood pressure, heart rate, cerebral blood flow, observed/perceived symptoms, duration of standing or sitting in minutes, tolerance of therapy, functional ability, and adverse events/effects.

METHODS

Databases for published and unpublished studies available in English up to April 2018 with no lower date limit were searched. Critical appraisal was conducted using standardized instruments from JBI. Data were extracted using standardized tools designed for quantitative studies. Where appropriate, studies were included in a meta-analysis; otherwise, data were presented in a narrative form due to heterogeneity.

RESULTS

Forty-three studies - a combination of randomized controlled trials (n = 13), quasi-experimental studies (n = 28), a case control study (n = 1), and a case report (n = 1) - with 1069 participants were included. Meta-analyses of three interventions (resistance exercise, electrical stimulation, and lower limb compression bandaging) showed no significant effect of these interventions. Results from individual studies indicated physical maneuvers such as leg crossing, leg muscle pumping/contractions, and bending forward improved orthostatic hypotension. Abdominal compression improved OH. Sleeping with head up in combination with pharmacological treatment was more effective than sleeping with head up alone. Eating smaller, more frequent meals was effective. Drinking 480 mL of water increased blood pressure.

CONCLUSIONS

The review found mixed results for the effectiveness of non-pharmacological interventions to treat OH in people aged 50 years and older, and people with a neurological condition. There are several non-pharmacological interventions that may be effective in treating OH, but not all have resulted in clinically meaningful changes in outcome. Some may not be suitable for people with moderate to severe disability; therefore, it is important for clinicians to consider the patient's abilities and impairments when considering which non-pharmacological interventions to implement.

Lower Limb Graduated Compression Garments Modulate Autonomic Nervous System and Improve Post-Training Recovery Measured via Heart Rate Variability

Prior studies have examined the benefits of graduated compression garments (GCG) with regards to diverse exercise regimens; however, the relationship between GCG and the autonomic nervous system (ANS) has not been fully explored. The aim of this study was to examine Heart Rate Variability (HRV) trends-a proxy for ANS modulation-in response to donning GCG during a progressive overload training regimen designed to induce overtraining. Ten college-aged male novice runners were recruited for the 8-week crossover study. After three weeks of monitored free living, participants were randomized and blinded to an intervention group that donned a lower-body GCG during a two-week exercise regimen or a control group that donned a visually identical but non-compressive sham during identical training. No significant difference in HRV was calculated by the natural logarithm of the root mean square of successive RR-interval differences (lnRMSSD) between the 3-week free-living baseline and GCG intervention periods (P = 0.3040). The mean lnRMSSD was greater during the free-living phase and GCG intervention compared to the sham placebo (P < 0.001 and <0.001 respectively). With regard to the daily fluctuation of lnRMSSD, no significant differences were found between free-living and intervention (P = 1.000). Conversely, the intervention period demonstrated reduced daily fluctuation of lnRMSSD relative to the Sham placebo group (P = 0.010). These novel findings posit that post training use of a commercially available graduated compression garment in novice runners may be effective in counteracting some deleterious effects from overtraining while attenuating its effects on vagally-mediated HRV.

Influence of lower body compression garments on cardiovascular autonomic responses prior to, during and following submaximal cycling exercise

PURPOSE

The aim of the current study was to examine the impact of lower body compression garments (CG) on cardiac autonomic control of heart rate (HR) prior to, during and following submaximal exercise.

METHODS

Thirty (15 males, 15 females) healthy, active adults undertook consecutive 10-min stages of supine rest, moderate-intensity upright cycling and supine recovery while wearing either normal clothing (CONTROL) or normal clothing plus CG tights in a randomised order. Heart rate (HR) and rating of perceived exertion (RPE) were assessed every minute while cardiovascular autonomic responses were assessed during the final 5 min of each stage via HR variability (HRV). The change in HR at 1-min (HRR1) and 2-min (HRR2) post-exercise and the time constant of HR recovery (HR_tau) were assessed as indices of cardiac autonomic reactivation. Differences between variables were assessed via repeated measures ANOVA and corrected pairwise comparisons.

RESULTS

Compared to rest, exercise resulted in a reduction of HRV that was similar for CONTROL and CG. A main effect for condition was identified for one non-linear, long-term HRV variable only with a significantly lower value (61.4 ± 47.8 vs. 67.1 ± 50.2 ms, p < 0.05) for CG compared to CONTROL. Cardiac autonomic reactivation (HRR1, 42.0 ± 16.8 vs. 45.5 ± 13.4 bpm; HRR2, 58.9 ± 10.5 vs. 58.9 ± 8.2 bpm; HR_tau, 63.4 ± 22.3 vs. 65.1 ± 23.0 s, p > 0.05) was comparable for CONTROL and CG.

CONCLUSION

Lower body CG failed to alter most cardiac autonomic responses during rest, moderate-intensity exercise or recovery. Mechanisms for potential ergogenic benefits of CG remain to be characterised.

Enhanced External Counterpulsation and Short-Term Recovery From High-Intensity Interval Training

PURPOSE

Enhanced external counterpulsation (EECP) is a recovery strategy whose use has increased in recent years owing to the benefits observed in the clinical setting in some cardiovascular diseases (ie, improvement of cardiovascular function). However, its claimed effectiveness for the enhancement of exercise recovery has not been analyzed in athletes. The aim of this study was to determine the effectiveness of EECP on short-term recovery after a fatiguing exercise bout.

METHODS

Twelve elite junior triathletes (16 [2] y) participated in this crossover counterbalanced study. After a high-intensity interval training session (6 bouts of 3-min duration at maximal intensity interspersed with 3-min rest periods), participants were assigned to recover during 30 min with EECP (80 mm Hg) or sham (0 mm Hg). Measures of recovery included performance (jump height and mean power during an 8-min time trial), metabolic (blood lactate concentration at several time points), autonomic (heart-rate variability at several time points), and subjective (rating of perceived exertion [RPE] and readiness to compete) outcomes.

RESULTS

There were no differences between EECP and sham in mean RPE or power output during the high-intensity interval training session, which elicited a significant performance impairment, vagal withdrawal, and increased blood lactate and RPE in both EECP and sham conditions (all P < .05). No significant differences were found in performance, metabolic, or subjective outcomes between conditions at any time point. A significantly lower high-frequency power (P < .05, effect size = 1.06), a marker of parasympathetic activity, was observed with EECP at the end of the recovery phase.

CONCLUSION

EECP did not enhance short-term recovery after a high-intensity interval training session in healthy, highly trained individuals.

Compression stockings reduce the incidence of hypotension but not that of cerebral desaturation events in the beach-chair position: a randomized controlled trial

Background

The beach-chair position (BCP) results in decreases in venous return, cardiac output, and cerebral perfusion pressure. In this randomized, prospective study, we investigated whether applying thigh-high compression stockings affected the maintenance of regional cerebral tissue oxygen saturation (rSO₂) in the BCP.

Methods

Patients undergoing orthopedic surgery in the BCP under general anesthesia were included and assigned randomly to the control or the compression stocking group. Appropriately sized thigh-high compression stockings were applied to the patients in the stockings group. All patients were tilted, up to 45°, throughout the operation. Non-invasive blood pressure, invasive arterial blood pressure zeroed at the external auditory meatus, and rSO₂ were recorded.

Results

Data were analyzed from 19 patients per group. In the BCP, the values of rSO₂ and blood pressure decreased significantly compared with those at baseline, with no significant difference between the groups. The incidences of cerebral desaturation events (CDEs) were similar between the groups; however, that of hypotension was significantly lower in the compression stocking group. During 36 CDEs, the levels of rSO₂ and blood pressure decreased significantly compared with those at baseline in both groups. No significant correlation was found between rSO₂ and blood pressure.

Conclusions

Thigh-high compression stockings reduced the incidence of hypotension but not that of CDEs. Our results suggest that other factors, beyond hypotension itself, contribute to CDEs and in other words, efforts just to reduce the incidence of hypotension may not mainly contribute to a reduction of CDEs occurrence in the BCP under general anesthesia.

Assessing kinematics and kinetics of functional electrical stimulation rowing

Hybrid functional electrical stimulation (FES) rowing has positive effects on cardiovascular fitness, producing significantly greater aerobic power than either upper body or FES exercise alone. However, there is minimal information on the kinematics, kinetics, and mechanical efficiency of FES-rowing in the spinal cord injured (SCI) population. This study examined the biomechanics of FES-rowing to determine how motions, forces, and aerobic demand change with increasing intensity. Six individuals with SCI and six able-bodied subjects performed a progressive aerobic capacity rowing test. Differences in kinematics (motion profiles), kinetics (forces produced by the feet and arms), external mechanical work, and mechanical efficiency (work produced/volume of oxygen consumed) were compared in able-bodied rowing vs. SCI FES-rowing at three comparable subpeak workloads. With increasing exercise intensity (measured as wattage), able-bodied rowing increased stroke rate by decreasing recovery time, while FES-rowing maintained a constant stroke rate, with no change in drive or recovery times. While able-bodied rowers increased leg and arm forces with increasing intensity, FES-rowers used only their arms to achieve a higher intensity with a constant and relatively low contribution of the legs. Oxygen consumption increased in both groups, but more so in able-bodied rowers, resulting in able-bodied rowers having twice the mechanical efficiency of FES-rowers. Our results suggest that despite its ability to allow for whole body exercise, the total force output achievable with FES-rowing results in only modest loading of the legs that affects overall rowing performance and that may limit forces applied to bone.

Effect of lower limb compression on blood flow and performance in elite wheelchair rugby athletes

OBJECTIVE

To investigate the effects of compression socks worn during exercise on performance and physiological responses in elite wheelchair rugby athletes.

DESIGN

In a non-blinded randomized crossover design, participants completed two exercise trials (4 × 8 min bouts of submaximal exercise, each finishing with a timed maximal sprint) separated by 24 hr, with or without compression socks.

SETTING

National Sports Training Centre, Queensland, Australia.

PARTICIPANTS

Ten national representative male wheelchair rugby athletes with cervical spinal cord injuries volunteered to participate.

INTERVENTIONS

Participants wore medical grade compression socks on both legs during the exercise task (COMP), and during the control trial no compression was worn (CON).

OUTCOME MEASURES

The efficacy of the compression socks was determined by assessments of limb blood flow, core body temperature, heart rate, and ratings of perceived exertion, perceived thermal strain, and physical performance.

RESULTS

While no significant differences between conditions were observed for maximal sprint time, average lap time was better maintained in COMP compared to CON (P<0.05). Lower limb blood flow increased from pre- to post-exercise by the same magnitude in both conditions (COMP: 2.51 ± 2.34; CON: 2.20 ± 1.85 ml.100 ml.(-1)min(-1)), whereas there was a greater increase in upper limb blood flow pre- to post-exercise in COMP (10.77 ± 8.24 ml.100 ml.(-1)min(-1)) compared to CON (6.21 ± 5.73 ml.100 ml.(-1)min(-1); P < 0.05).

CONCLUSION

These findings indicate that compression socks worn during exercise is an effective intervention for maintaining submaximal performance during wheelchair exercise, and this performance benefit may be associated with an augmentation of upper limb blood flow.

Postural Hypotension Associated with Nonelastic Pantyhose during Lymphedema Treatment

The case of a 72-year-old female patient with elephantiasis is reported. The patient was submitted to two surgeries to remove the edema. After surgery, the leg again evolved to elephantiasis and eventually she was referred to the Clinica Godoy for clinical treatment. Intensive treatment was carried out (6 to 8 hours per day) and the patient lost more than 70% of the limb volume within one week. After this loss, the volume was maintained using grosgrain compression pantyhose for 24 hours per day. During the return appointment, the patient suffered from systemic hypotension (a drop of more than 30 mmHg within three minutes) while she was standing after removing the stocking. A further investigation showed that the symptoms only appeared when the stocking was worn for 24 hours. Thus, the patient was advised to use the stocking only during the day thereby avoiding the symptoms of hypotension.

Special considerations for mobilizing patients in the neurointensive care unit

Patients with neurologic illness or injury benefit from early interventions to increase physical activity and mobility, but they also have special needs related to hemodynamic stability and intracranial pressure dynamics. After brain injury, moving paralyzed limbs--even passively--helps promote neural plasticity, "rerouting" signals around the injured area and forming new connections, resulting in improved functional recovery. Neurologic deficits may impede a patient's functional and language abilities, so a mobility program must take into account the need for assistive devices, communication strategies, and additional personnel. Because cerebral autoregulation may be impaired, stability of blood pressure and intracranial pressure must be considered when planning mobility activities. The clinical team must consider the full spectrum of mobility for the neuroscience patient, from having the bed in the chair position for a comatose patient to ambulation of the patient with ventriculostomy whose intracranial pressure will tolerate having drainage clamped for a short period of time. Those involved with mobility need to understand the patient's disease process, the implications of increasing activity levels, and the monitoring required during activity.