Abstract
Purpose
Orthostatic hypotension, leading to cerebral hypoperfusion, can result in postural instability and falls in older adults. We determined the efficacy of a novel, intermittent pneumatic compression system, applying pressure around the lower legs, as a countermeasure against orthostatic stress in older adults.
Methods
Data were collected from 13 adults (4 male) over 65 years of age. Non-invasive ultrasound measured middle cerebral artery blood velocity (MCAv) and finger photoplethysmography measured mean arterial blood pressure (MAP). Intermittent lower leg compression was applied in a peristaltic manner in the local diastolic phase of each cardiac cycle to optimize venous return during 1-min of seated rest and during a sit-to-stand transition to 1-min of quiet standing with compression initiated 15 s before transition.
Results
During seated rest, compression resulted in a 4.5 ± 6.5 mmHg increase in MAP, and 2.3 ± 2.1 cm/s increase in MCAv (p < 0.05). MAP and MCAv increased during the 15 s of applied compression before the posture transition (2.3 ± 7.2 mmHg and 2.1 ± 4.0 cm/s, respectively, p < 0.05) with main effects for both variables confirming continued benefit during the transition and quiet stand periods.
Conclusions
Application of carefully timed, intermittent compression to the lower legs of older adults increased MAP and MCAv during seated rest and maintained an elevated MAP and MCAv during a transition to standing posture. Future research could assess the benefits of this technology for persons at risk for orthostatic hypotension on standing and while walking in an effort to reduce injurious, unexplained falls in older adults.
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Abbreviations
- CO2 :
-
Carbon dioxide
- CVRi:
-
Cerebrovascular resistance index
- ECG:
-
Electrocardiogram
- HR:
-
Heart rate
- HHb:
-
Deoxygenated hemoglobin concentration
- MAP:
-
Mean arterial pressure
- MCAv:
-
Middle cerebral artery blood velocity
- O2Hb:
-
Oxygenated hemoglobin concentration
- PETCO2 :
-
Partial pressure of end tidal carbon dioxide
- \(\dot{Q}\) :
-
Cardiac output
- SD:
-
Standard deviation
- SFA:
-
Superficial femoral artery
- SV:
-
Stroke volume
- TCD:
-
Transcranial Doppler
- tHb:
-
Total hemoglobin concentration
- TSI:
-
Tissue saturation index
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Funding
This work was supported by a Spark 2018 grant from the Centre for Aging and Brain Health Innovation (Baycrest) [to J.D.M.]; Natural Sciences and Engineering Research Council of Canada operating grant [#RGPIN-6473 to R.L.H.]; Natural Sciences and Engineering Research Council of Canada Collaborative Research Development Grant [#CRD-493144-2015 to S.D.P]; and additional grant support from Lockheed Martin Corporation. R.L.H. is Schlegel Research Chair in Vascular Aging and Brain Health.
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The study was conceived and designed by KAZ, ETH, JDM, SDP and RLH, data were collected by KAZ and ETH, analysis was by KAZ, ETH, all authors contributed to the draft manuscript and final version.
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S.D.P. and R.L.H. are named inventors on U.S. Patent application number 15/564,054 titled “System and method for synchronizing external compression of a limb for increased blood flow”. The patent is owned by Pression LLC, a company aiming to commercialize compression technology. S.D.P. owns a 15% stake in Pression LLC.
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Communicated by Ellen Adele Dawson.
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Zuj, K.A., Hedge, E.T., Milligan, J.D. et al. Intermittent compression of the calf muscle as a countermeasure to protect blood pressure and brain blood flow in upright posture in older adults. Eur J Appl Physiol 121, 839–848 (2021). https://doi.org/10.1007/s00421-020-04547-7
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DOI: https://doi.org/10.1007/s00421-020-04547-7