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BACKGROUND: Lower core temperatures than usual are required to trigger shivering during epidural and spinal anesthesia, but the etiology of this impairment remains unknown. In this investigation, we propose and test a specific mechanism by which a peripheral action of regional anesthesia might alter centrally mediated thermoregulatory responses. Conduction anesthesia blocks all thermal sensations; however, cold signals are disproportionately affected because at typical leg temperatures mostly cold receptors fire tonically. It thus seems likely that epidural and spinal anesthesia increase the leg temperature perceived by the thermoregulatory system. Because skin temperature reportedly contributes 5-20% to thermoregulatory control, increased apparent (as distinguished from actual) leg temperature would produce a complimentary decrease in the core temperature triggering thermoregulatory shivering. Accordingly, we tested the hypothesis that abnormal tolerance for hypothermia during epidural anesthesia coincides with an increase in apparent leg temperature. We defined apparent temperature as the leg-skin temperature required to induce a reduction in the shivering threshold comparable to that produced by epidural anesthesia. METHODS: Six women were studied on 4 randomly ordered days: (1) leg-skin temperature near 32 degrees C; (2) leg-skin temperature near 36 degrees C; (3) leg-skin temperature near 38 degrees C; and (4) epidural anesthesia without leg-warming (leg-skin temperature approximately 34 degrees C). At each designated leg temperature, core hypothermia sufficient to evoke shivering was induced by central venous infusion of cold fluid. Upper-body skin temperature was kept constant throughout. In each volunteer, linear regression was used to calculate the correlation between the shivering thresholds on the 3 non-epidural days and concurrent leg temperatures. The slope of these regression equations thus indicated the extent to which leg-warming increased thermoregulatory tolerance for core hypothermia, and was expressed as a percentage leg-skin and leg-tissue contribution to total thermal afferent input. The skin and tissue temperatures that would have been required to produce the observed shivering threshold during epidural anesthesia, the apparent temperatures, were then interpolated from the regression. RESULTS: There was a good linear relation between the shivering threshold and leg-skin temperature (r2 = 0.94 +/- 0.06). The contribution of leg-skin temperature to the shivering threshold was 11 +/- 3% of the total thermal input. Apparent leg-skin temperature during epidural anesthesia was 37.8 +/- 0.5 degrees C, which exceeded actual leg-skin temperature by approximately 4 degrees C. The contribution of leg-tissue temperature to the shivering threshold was 19 +/- 7% of the total. Apparent leg-tissue temperature during epidural anesthesia was 37.1 +/- 0.4 degrees C, which exceeded actual leg-skin temperature by approximately 2 degrees C. CONCLUSIONS: Because leg-skin contributed approximately 11% to the shivering threshold, it is unlikely that the entire skin surface contributes at much less than 20%. These data suggest that the shivering threshold during epidural anesthesia is reduced by a specific mechanism, namely that conduction block significantly increases apparent (as distinguished from actual) leg temperature.
Many-legged animals, such as crabs and cockroaches, utilize whole-body mechanics similar to that observed for running bipeds and trotting quadrupedal mammals. Despite the diversity in morphology, two legs in a quadrupedal mammal, three legs in an insect and four legs in a crab can function in the same way as one leg of a biped during ground contact. To explain how diverse leg designs can result in common whole-body dynamics, we used a miniature force platform to measure the ground reaction forces produced by individual legs of the cockroach Blaberus discoidalis. Hexapedal runners were not like quadrupeds with an additional set of legs. In trotting quadrupedal mammals each leg develops a similar ground reaction force pattern that sums to produce the whole-body pattern. At a constant average velocity, each leg pair of the cockroach was characterized by a unique ground reaction force pattern. The first leg decelerated the center of mass in the horizontal direction, whereas the third leg was used to accelerate the body. The second leg did both, much like legs in bipedal runners and quadrupedal trotters. Vertical force peaks for each leg were equal in magnitude. In general, peak ground reaction force vectors minimized joint moments and muscle forces by being oriented towards the coxal joints, which articulate with the body. Locomotion with a sprawled posture does not necessarily result in large moments around joints. Calculations on B. discoidalis showed that deviations from the minimum moments may be explained by considering the minimization of the summed muscle forces in more than one leg. Production of horizontal forces that account for most of the mechanical energy generated during locomotion can actually reduce total muscle force by directing the ground reaction forces through the leg joints. Whole-body dynamics common to two-, four-, six- and eight-legged runners is produced in six-legged runners by three pairs of legs that differ in orientation with respect to the body, generate unique ground reaction force patterns, but combine to function in the same way as one leg of a biped.
On the basis of behavioural studies the influences that coordinate the movement of the legs of a slowly walking cat have been investigated. The recording method applied here allows for the measurement of forward and backward movement of the legs which are called swing and stance movements, respectively. Influences between contralateral legs, i.e. both front legs or both hind legs, are stronger than those occurring between ipsilateral legs, i.e. front and hind leg of the same side. Influences which coordinate the front legs seem to be of the same kind as those for the hind legs. These influences are symmetrical, which means that the same type of influence acts from right to left leg and in the reverse direction. Two types of influences are described for contralateral legs: 1. When the influencing leg performs a swing movement, the influenced leg is prevented from starting a swing movement. 2. When the influencing leg performs a stance movement, the probability that the influenced leg starts a swing movement increases as the influencing leg moves backwards during its stance movement. In contrast to contralateral coupling, the ipsilateral influences are symmetric, i.e. a different influence acts from front to hind leg than does in the reverse direction. The front leg is influenced to start a swing when both legs have approached each other to a given value. The hind leg is influenced to start a stance movement after the front leg has begun its swing.
This paper reports the determination of blood flow of the lower leg in 50 cases of non-insulin dependent diabetes mellitus (NIDDM) using an XLJ-2 Bipolar Rheoencephalometry Impedance Rheogram. In patients with leg pain (but without obvious vascular pathological changes, 85 legs) the blood flow was decreased. In male patients the blood flow of the left leg (9 legs) was 3.28 +/- 0.47 ml/100ml.tissue.min (mean +/- S), while that in the right leg (11 legs) was 3.88 +/- 0.80; in females, the blood flow of the left leg (32 legs) was 2.72 +/- 0.8; while that in the right leg (33 legs) was 2.94 +/- 0.66. These figures were significantly (P less than 0.01-0.001) lower than those obtained from normals. In diabetic feet (15 painful legs) the decrease of blood flow of the lower leg was more apparent: it averaged 1.87 +/- 0.79 for the left leg (7 legs) and 2.66 +/- 0.87 for the right leg (5 legs) in male patients. The values were significantly different when compared with those of normals (P less than 0.001) or with those of the diabetic patients with leg pain (P less than 0.05). These results demonstrated that determination of the blood flow of the lower leg of diabetic patients might aid in early discovery of the abnormal changes of blood supply to the lower legs in diabetes mellitus and judge the degree of ischemia. Of the 50 cases of diabetics 32 were Qi-Yin deficiency with blood stasis while the remaining 18 cases were deficiency of both Yin and Yang with blood stasis.(ABSTRACT TRUNCATED AT 250 WORDS)
Integrating studies of mechanics, neural control and isolated muscle function are possible using arthropod legs. To evaluate leg performance, we measured the ground reaction forces generated by individual legs of the six-legged cockroach Blaberus discoidalis (3.1 g), during an emergency behavior, righting or over-turning. We used a photoelastic method to measure the forces generated by individual legs simultaneously. A gelatin track placed between crossed polarizing filters was illuminated from below, and a high-speed video camera recorded the stress-induced optical signals from above. The size and skew of the optical patterns were found to be related to the magnitude and direction of the force. We discovered that the ground reaction forces generated during the righting behavior of the death-head cockroach were eight times greater than those observed during high-speed running, supporting the possibility that relative leg forces (leg force per unit body weight) during running and maximal leg activity differ more in small arthropods than in larger vertebrates. Non-geometric scaling of relative leg force (i.e. scaling to less than body mass-0.33), along with the reduced force-generating ability of a single leg in animals with many legs, may help to explain why the maximum relative leg force production by six-legged cockroaches, as well as by some other small insects, can be similar to the relative single leg forces produced by two- and four-legged vertebrates that are almost 1000 times more massive. Leg number and body mass alone, however, appear to be insufficient to explain the variation observed in relative leg force production at a given body mass, because enormous diversity in musculo-skeletal parameters exists. The maximal relative leg force of the cockroach B. discoidalis during righting was at the low end of a 100-fold variation observed for smaller insects wedging (pushing through a small crevice) and pulling loads. Thus, this cockroach can be characterized as a moderately strong insect with the capacity for relatively high speed. Results from the present study question the predictive strength of the simple geometric scaling arguments involving a strength:weight ratio as they are applied to small arthropods and encourage further consideration of the importance of leg number, muscle force production and mechanical advantage in the derivation of general principles of leg performance.
Using an air-braked cycle ergometer, we sought to determine the relative contributions of the arms and legs in eliciting the maximal O2 uptake (VO2max). Ten healthy, non-arm-trained males did progressive exercise to exhaustion on the ergometer instrumented to partition the push-pull arm exercise from the cycling leg exercise. Exercise was done with arms only (100% arms), legs only (100% legs, with arms at sides), and in combinations of 10% arms/90% legs, 20% arms/80% legs, and 30% arms/70% legs. To approximate conventional bicycling, four subjects exercised to exhaustion doing leg cycling on the air-braked ergometer with the hands fixed to stationary bars. The maximal power output and VO2max were not significantly different (P greater than 0.05) for the 10% arms/90% legs and the 20% arms/80% legs combinations. Maximal power output and VO2max for 10% arms/90% legs was significantly greater than that for the 100% arms, 100% legs, and 30% arms/70% legs regimens (P less than 0.05). The highest VO2max measured in combined arm/leg exercise for four subjects using 10% arms/90% legs (N = 3) or 20% arms/80% legs (N = 1) was not significantly different from that measured in air-braked ergometer leg cycling with hands fixed to stationary bars (P greater than 0.05). We conclude that push-pull arm exercise of 10 or 20%, combined with leg cycling of 90 or 80%, respectively, or leg cycling with hands fixed to bars optimize the arm/leg contributions in eliciting VO2max. These findings suggest that the upper-body stabilizing effort in conventional cycling (legs cycling, hands fixed) contributes approximately 10-20% to inducing VO2max.(ABSTRACT TRUNCATED AT 250 WORDS)
Six young healthy male subjects performed submaximal and maximal exercise on bicycle ergometers with one leg and two legs before and after 8 wk of one-leg training with each of both legs. The following variables were measured during one- and two-leg exercise: oxygen uptake, heart rate, mean arterial blood pressure, cardiac output, leg blood flow, and iliac arteriovenous differences for oxygen and lactate. After training the maximal oxygen uptake during one- and two-leg exercise was increased by 19 and 11%, respectively. The corresponding cardiac outputs increased by 16 and 11%, respectively. During submaximal one-leg exercise, heart rate decreased by 11%, whereas a decrease of only 2% was seen during submaximal two-leg exercise. Mean blood pressure decreased by about 10 Torr in both types of exercise and during both submaximal and maximal exercise. Maximal leg blood flow increased only by 1.2 l/min during one-leg exercise. Leg blood flow and leg oxygen uptake were smaller during two-leg exercise than during one-leg exercise and more so after training. These findings indicate that one-leg exercise, compared with two-leg exercise, involves circulatory adaptations that respond differently to one-leg training. The findings further imply that oxygen supply to one large muscle group of exercising muscles may be limited by vasoconstriction when another large group of muscles is exercising simultaneously.
The effect of 4 days of continuous exposure to a cold environment on blood flow in, and oxygen and energy substrate uptake by the shivering hind leg has been studied in young steers. The animals shivered throughout the period of cold exposure and total oxygen consumption (total VO2) remained 40-50% greater than VO2 during thermoneutrality. Leg blood flow (leg Q) and oxygen uptake (leg VO2) increased two- and four-fold respectively on the first day of cold. Both had declined significantly by the final day, leg Q to a level 37% greater than, and leg VO2 to about double, pre-cold levels. The change in the relationships of leg Q and leg VO2 to total VO2 was examined by linear regression analysis, which suggested that the changing contribution of leg VO2 to total VO2 was entirely due to changes in leg Q, rather than in the arteriovenous difference in blood oxyhaemoglobin saturation across the leg. The net uptakes by the leg of free fatty acids (FFA), acetate, glucose and lactate all increased on the first day of cold. Both glucose and acetate uptakes were greater on day 4 than on day 1 in the cold, in spite of the lower leg VO2, but net uptakes of FFA and lactate were considerably lower. The decrease in net uptake of FFA is attributed mainly to an increase in the rate of lipolysis and release of FFA from fat depots in the leg, because of the associated progressive increase in the release of glycerol and oleic acid from the leg. The molar ratios of net carbohydrate substrate, acetate and FFA uptakes to leg VO2 are compared. The results suggest that tissues other than the leg muscles become increasingly important as sites of heat production, and that there are changes in the utilization of glucose, acetate and FFA by shivering muscle, during prolonged cold exposure.
It is known that periodic leg movements are frequently accompanied by full awakenings or by signs of EEG arousals. The time relationship of these EEG arousals with leg movements varies from patient to patient. They may precede or follow leg movements or occur simultaneously. It is not clear whether these arousals trigger leg movements or, alternatively, whether both EEG arousals and leg movements are separate expressions of a common pathophysiological mechanism. We investigated the temporal relationship of five EEG arousals, such as alpha activity, K-complexes, spindles, K-alpha, K-spindle activities and awakenings, with leg movements in 10 periodic leg movement patients. These EEG arousals were considered to be associated with leg movements if they occurred 10 s before/after or simultaneously with the onset of right or left tibialis muscle EMG potentials. It was found that 49.19% of EEG arousals occurred before leg movements, 30.61% occurred simultaneously and 23.18% occurred just after leg movements. The number of EEG arousals was significantly higher in the 10 s preceding leg movement than simultaneously or in the 10 s following. Alpha activity was the phenomenon associated most frequently with leg movements, irrespective of its temporal organization and was significantly higher during the 10 s preceding movement. Spindle and K-spindle activities were significantly higher before leg movement, whereas K-complex activity was significantly more frequent during leg movements. The number of awakenings was significantly higher after leg movements than simultaneously. These results indicated that leg movements are not primary, but rather are a phenomenon associated with an underlying arousal disorder.
During walking, the six legs of a stick insect can be coordinated in different temporal sequences or gaits. Leg coordination in each gait is controlled and stabilized by coordinating mechanisms that affect the action of the segmental neuronal networks for walking pattern generation. At present, the motor program for single walking legs in the absence of movement-related coordinating intersegmental influences from the other legs is not known. This knowledge is a prerequisite for the investigation of the segmental neuronal mechanisms that control the movements of a leg and to study the effects of intersegmental coordinating input. A stick insect single middle leg walking preparation has been established that is able to actively perform walking movements on a treadband. The walking pattern showed a clear division into stance and swing phases and, in the absence of ground contact, the leg performed searching movements. We describe the activity patterns of the leg muscles and motoneurons supplying the coxa-trochanteral joint, the femur-tibial joint, and the tarsal leg joints of the middle leg during both walking and searching movements. Furthermore we describe the temporal coordination between them. During walking movements, the coupling between the leg joints was phase-constant; in contrast during searching movements, the coupling between the leg joints was dependent on cycle period. The motor pattern of the single leg generated during walking exhibits similarities with the motor pattern generated during a tripod gait in an intact animal. The generation of walking movements also drives the activity of thoraco-coxal motoneurons of the deafferented and de-efferented thoraco-coxal leg joint in a phase-locked manner, with protractor motoneurons being active during swing and retractor motoneurons being active during stance. These results show that for the single middle leg, a basic walking motor pattern is generated sharing similarities with the tripod gait and that the influence of the motor pattern generated in the distal leg joints is sufficient for driving the activity of coxal motoneurons so an overall motor pattern resembling forward walking is generated.
Appropriate coordination of stepping in adjacent legs is crucial for stable walking. Several leg coordination rules have been derived from behavioural experiments on walking insects, some of which also apply to arthropods with more than six legs and to four-legged walking vertebrates. Three of these rules affect the timing of stance-swing transition [rules 1 to 3 (sensu Cruse)]. They can give rise to normal leg coordination and adaptive responses to disturbances, as shown by kinematic simulations and dynamic hardware tests. In spite of their importance to the study of animal walking, the coupling strength associated with these rules has never been measured experimentally. Generally coupling strength of the underlying mechanisms has been considered constant rather than context-dependent. The present study analyses stepping patterns of the stick insect Carausius morosus during straight and curve walking sequences. To infer strength and efficacy of coupling between pairs of sender and receiver legs, the likelihood of the receiver leg being in swing is determined, given a certain delay relative to the time of a swing-stance (or stance-swing) transition in the sender leg. This is compared to a corresponding measure for independent, hence uncoupled, step sequences. The difference is defined as coupling strength. The ratio of coupling strength and its theoretical maximum is defined as efficacy. Irrespective of the coordination rule, coupling strength between ipsilateral leg pairs is at least twice that of contralateral leg pairs, being strongest between ipsilateral hind and middle legs and weakest between contralateral middle legs. Efficacy is highest for inhibitory rule 1, reaching 84-95% for ipsilateral and 29-65% for contralateral leg pairs. Efficacy of excitatory rules 2 and 3 ranges between 35-56% for ipsilateral and 8-21% for contralateral leg pairs. The behavioural transition from straight to curve walking is associated with context-dependent changes in coupling strength, increasing in both outer leg pairs and decreasing between inner hind and middle leg. Thus, the coordination rules that are thought to underlie many adaptive properties of the walking system, themselves adapt in a context-dependent manner.
Neuronal coupling between the arms and legs allowing coordinated rhythmic movement during locomotion is poorly understood. We used the modulation of cutaneous reflexes to probe this neuronal coupling between the arms and legs using a cycling paradigm. Participants performed rhythmic cycling with arms, legs, or arms and legs together. We hypothesized that any contributions from the arms would be functionally linked to locomotion and would thus be phase-dependent. Reflexes were evoked by electrical stimulation of the superficial peroneal nerve at the ankle, and electromyography (EMG) was recorded from muscles in the arms and legs. The main finding was that the relative contribution from the arms and legs was linked to the functional state of the legs. For example, in tibialis anterior, the largest contribution from arm movement [57% variance accounted for (VAF), P < 0.05] was during the leg power phase, whereas the largest from leg movement (71% VAF, P < 0.05) was during leg cycling recovery. Thus the contribution from the arms was functionally gated throughout the locomotor cycle in a manner that appears to support the action of the legs. Additionally, the effect of arm cycling on reflexes in leg muscles when the legs were not moving was relatively minor; full expression of the effect of rhythmic arm movement was only observed when both the arms and legs were moving. Our findings provide experimental support for the interaction of rhythmic arm and leg movement during human locomotion.
During metamorphosis, the larval thoracic legs of the moth Manduca sexta are replaced by new adult legs. The leg motoneurons do not die after the loss of the larval muscles, but persist to innervate the new adult leg muscles (Kent and Levine, 1988). The adult muscles form from myoblasts that originate in specific production sites within the legs and migrate to the sites of muscle formation, where they accumulate, proliferate, and fuse to form myofibers (Consoulas et al., 1996b). Throughout adult leg muscle development, there is a close association between nerves and the developing muscles, suggesting a role for the nervous system in myogenesis (Consoulas et al., 1996a). This prediction was confirmed and the role of the nervous system clarified in the present study by cutting the larval leg nerves prior to metamorphosis. Although myoblasts were generated and migrated normally in the operated leg, they failed to accumulate in the appropriate regions. The myoblasts did not die, but failed to proliferate and remained in the denervated legs as dispersed cells or as aggregates in inappropriate regions. In about 26% of cases, this resulted in the formation of adult legs that lacked muscles. In the remaining cases, however, delayed regeneration of the leg nerve occurred and small muscles appeared in the more proximal segments of the denervated legs. Each muscle fiber in these operated legs bore motor terminals belonging to axons of the leg nerves which had grown out from the proximal nerve stump and invaded the leg. Following the delayed appearance of motor axons, myoblasts aggregated and underwent proliferation and differentiation into muscle fibers. In a second set of experiments, denervation was performed later, after myoblasts had aggregated to establish anlagen. Myoblast proliferation was reduced but differentiation continued. These observations suggest that motor nerves are essential for both the accumulation of myoblasts into the correct areas of muscle development and the appropriate level of proliferation.
The binding of exchange-labeled saxitoxin (STX) to sodium channels has been investigated in the nonmyelinated fibers of the walking leg nerves of the lobster. The properties of the STX binding site differed systematically among the nerves from different walking legs. The equilibrium dissociation constant for STX binding (KSTX) to the front legs is approximately twice that for the binding to the rear legs; the average ratio of KSTX (front): KSTX (rear) from five separate experiments was 1.80 +/- 0.21 (mean +/- SE). The actual KSTX values ranged from 124.0 to 22.7 nM for the front leg nerves and from 8.6 to 12.7 nM for the rear leg nerves. KSTX values for the middle two walking leg nerves fell between those for the front and rear legs. The inhibitory dissociation constant for tetrodotoxin (KTTX), calculated from tetrodotoxin's inhibition of labeled STX binding, was 3.02 +/- 0.27 nM for the front legs and 2.20 +/- 0.33 nM for the rear legs. The ratio KSTX: KTTX was different in the front and rear leg nerves, being 5.5 and 4.2, respectively. The apparent P pKa of the STX receptor also differed between the two legs, being 4.6 +/- 0.3 for the front legs and 5.1 +/- 0.1 for the rear legs. These results demonstrate that one tissue type in one organism can contain different toxin binding sites. The difference in the receptors can be qualitatively accounted for by the location of an additional negative charge near the receptor site of the rear walking leg.
Curve walking in two species of crayfish, Procambarus clarkii and Astacus leptodactylus, was investigated to test whether the mechanism underlying curve walking is the synchronous action of a centrally pre-programmed leg tripod or whether it is the action of one principal leg that produces the main body yaw torque. Curve walking was induced by an optomotor visual stimulus, and the yaw torque produced by the tethered animals was measured in open-loop conditions. Our main results suggest that the yaw torque oscillations in both P. clarkii and A. leptodactylus are related to the movement of outer leg 4 (i.e. leg 4 on the outside of the turn). That is, the peaks in the yaw torque occur, on average, in synchrony with the power stroke of outer leg 4. When comparing the results of this open-loop experiment on P. clarkii with results previously obtained for curve walking in untethered individuals of the same species, we found a much higher variability in leg coordination in the open-loop situation. Similarly, here we did not find the same level of synchrony in the tripod (formed by outer leg 4 and inner legs 2 and 5) observed during untethered free walking. Therefore, we suggest that tethered conditions may diminish the need for stability and thus allow outer leg 4 to produce a body rotation regardless of the leg stepping configuration. The characteristics of leg 4 are in line with its major role in turning. According to previous studies, legs 4 provide the largest force and the largest step amplitude during walking, and their force includes both a pulling and a pushing component which can facilitate the control of turning. Although it is apparent that outer leg 4 is not the only leg that can produce an inward yaw torque, its major role in modulating the yaw torque suggests that there may be a specific, centrally generated control of outer leg 4 during curve walking in crayfish.
CONTEXT: Persons with lower-extremity peripheral arterial disease (PAD) are often asymptomatic or have leg symptoms other than intermittent claudication (IC). OBJECTIVE: To identify clinical characteristics and functional limitations associated with a broad range of leg symptoms identified among patients with PAD. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 460 men and women with PAD and 130 without PAD, who were identified consecutively, conducted between October 1998 and January 2000 at 3 Chicago-area medical centers. MAIN OUTCOME MEASURES: Ankle-brachial index score of less than 0.90; scores from 6-minute walk, accelerometer-measured physical activity over 7 days, repeated chair raises, standing balance (full tandem stand), 4-m walking velocity, San Diego claudication questionnaire, Geriatric Depression Score Short-Form, and the Walking Impairment Questionnaire. RESULTS: All groups with PAD had poorer functioning than participants without PAD. The following values are for patients without IC vs those with IC. Participants in the group with leg pain on exertion and rest (n = 88) had a higher (poorer) score for neuropathy (5.6 vs 3.5; P<.001), prevalence of diabetes mellitus (48.9% vs 26.7%; P<.001), and spinal stenosis (20.8% vs 7.2%; P =.002). The atypical exertional leg pain/carry on group (exertional leg pain other than IC associated with walking through leg pain [n = 41]) and the atypical exertional leg pain/stop group (exertional leg pain other than IC that causes one to stop walking [n = 90]) had better functioning than the IC group. The group without exertional leg pain/inactive (no exertional leg pain in individual who walks </=6 blocks per week [n = 28]) and the leg pain on exertion and rest group had poorer functioning than those with IC. Adjusting for age, sex, race, and comorbidities and compared with IC, participants with atypical exertional leg pain/carry on achieved a greater distance on the 6-minute walk (404.3 vs 328.5 m; P<.001) and were less likely to stop during the 6-minute walk (6.8% vs 36%; P =.002). The group with pain on exertion and rest had a slower time for completing 5 chair raises (13.5 vs 11.9 seconds; P =.009), completed the tandem stand less frequently (37.5% vs 60.0%; P =.004), and had a slower 4-m walking velocity (0.80 vs 0.90 m/s; P<.001). CONCLUSIONS: There is a wide range of leg symptoms in persons with PAD beyond that of classic IC. Comorbid disease may contribute to these symptoms in PAD. Functional impairments are found in every PAD symptom group, and the degree of functional limitation varies depending on the type of leg symptom.
Leg compression devices have been used extensively by patients to combat chronic venous insufficiency and by astronauts to counteract orthostatic intolerance following spaceflight. However, the effects of elastic and inelastic leggings on the calf muscle pump have not been compared. The purpose of this study was to compare in normal subjects the effects of elastic and inelastic compression on leg intramuscular pressure (IMP), an objective index of calf muscle pump function. IMP in soleus and tibialis anterior muscles was measured with transducer-tipped catheters. Surface compression between each legging and the skin was recorded with an air bladder. Subjects were studied under three conditions: (1) control (no legging), (2) elastic legging, and (3) inelastic legging. Pressure data were recorded for each condition during recumbency, sitting, standing, walking, and running. Elastic leggings applied significantly greater surface compression during recumbency (20 +/- 1 mm Hg, mean +/- SE) than inelastic leggings (13 +/- 2 mm Hg). During recumbency, elastic leggings produced significantly higher soleus IMP of 25 +/- 1 mm Hg and tibialis anterior IMP of 28 +/- 1 mm Hg compared to 17 +/- 1 mm Hg and 20 +/- 2 mm Hg, respectively, generated by inelastic leggings and 8 +/- 1 mm Hg and 11 +/- 1 mm Hg, respectively, without leggings. During sitting, walking, and running, however, peak IMPs generated in the muscular compartments by elastic and inelastic leggings were similar. Our results suggest that elastic leg compression applied over a long period in the recumbent posture may impede microcirculation and jeopardize tissue viability.(ABSTRACT TRUNCATED AT 250 WORDS)