On the edema-preventing effect of the calf muscle pump

Summary

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≤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. (2) An increased lymph flow, which removes fluid and osmotically active colloid proteins from the interstitial space. (3) An increase in muscle tissue pressure, which counteracts the intravascular pressure during the muscle contraction thus playing an important role as an edema-preventing factor, which has not been considered to date.