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PubMed2001

Community nurses', home carers' and patients' perceptions of factors affecting venous leg ulcer recurrence and management of services.

AIM: This study examines the feasibility of utilizing social service home carers (SSHC) to provide a collaborative approach with community nurses for the provision of leg ulcer aftercare in four National Health Service (NHS) Trusts. The purpose of this study was to gain insight into what community nurses and people with healed venous leg ulcers felt influenced leg ulcer recurrence. BACKGROUND: Studies have demonstrated that provision of community-based leg ulcer clinics has improved healing rates of venous leg ulcers, yet recurrence remains a problem. The reasons for this are far from clear, and further research is required before unequivocal support can be given to one approach to the provision of care for this client group. Collaborative approaches to the provision of leg ulcer aftercare are beginning to receive more attention. It has been recognized that social service health carers could be co-opted to provide essential aftercare once healing has occurred, although the logistics of this approach have not been fully explored. METHODS: This study was conducted in four NHS Trusts. Stage one used focus groups to explore the perceptions of district nurses (n = 15) and social service health carers (n = 15) of a leg ulcer shared care project and to gain insight into factors that they felt influenced recurrence. The second stage used semistructured interviews (n = 12) to explore the perceptions that people with healed leg ulcers have about factors influencing ulcer recurrence. FINDINGS: Key themes emerging from this study were: health promotion is perceived by community nurses and patients to be ineffective and leg ulcer aftercare services are fragmented. Organizational factors such as time constraints and limited resources were cited by community nurses and home carers as being responsible for high leg ulcer recurrence rates. Community nurses expressed a desire to delegate preventative aspects of leg ulcer care to home carers rather than participate in health promotion strategies to support healing behaviours. CONCLUSIONS: A strategy aimed at supporting healing behaviour in elderly people has the potential to reduce the recurrence of leg ulceration and improve quality of life. The findings suggest that such a strategy needs to rationalize delivery of leg ulcer aftercare to provide seamless care. It needs to improve carers' and patients' understanding of factors influencing leg ulcer recurrence and facilitate development of a more balanced professional--patient relationship.

Adult↗
PubMed2004

Restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survival.

BACKGROUND: Symptoms of restless legs are common among patients treated with long-term hemodialysis. We investigated the relation between symptoms of restless legs, quality of life, and survival among incident hemodialysis and peritoneal dialysis patients. METHODS: This report includes 894 dialysis patients who responded to an item regarding severity of restless legs symptoms in the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease Study. We examined participant responses both as categorized by the 5-point symptoms of restless legs item and classified with severe symptoms of restless legs if they reported they were very or extremely bothered by symptoms. Independent predictors of restless legs symptoms were estimated using logistic regression. The association of restless legs symptoms with quality of life was examined by means of mixed-model regression, and adjusted mortality risk was estimated by means of Cox proportional hazards. RESULTS: Fifteen percent of dialysis patients were classified as having severe restless legs. Those characterized by severe restless legs were significantly more likely to be administered benzodiazepines, antidepressants, and antiepileptics. Age and diabetes mellitus were independently associated with severe symptoms of restless legs. Symptoms of restless legs were associated with lower Physical and Mental Component Scores, vitality, bodily pain, and sleep quality (all P < 0.001). After adjustment, severe symptoms of restless legs were significantly associated with an increased mortality hazard ratio of 1.39 (95% confidence interval, 1.08 to 1.79). CONCLUSION: Symptoms of restless legs were associated with lower quality of life and increased risk for death. The effect of treatment for symptoms of restless legs on quality of life and survival awaits additional study.

Adult↗
PubMed1999

The role of low resistance blood flow pathways in the pathogenesis and healing of venous leg ulcers.

In an attempt to clarify the pathophysiology of haemodynamics in legs with venous ulcer we investigated the effect of a single intermittent pneumatic compression treatment on the peripheral resistance of leg arteries and the cutaneous laser Doppler flux in the leg. Eight patients with venous leg ulcers and 10 subjects with healthy legs were investigated. Doppler waveforms of the leg arteries and laser Doppler flux of the leg skin were recorded before and after a single intermittent pneumatic compression treatment with the subjects in a recumbent position. In the legs with venous ulcer, the peripheral resistance of the arteries was lower and the laser Doppler flux was greater, compared with healthy legs (p = 0.003 and p = 0.002, respectively). A single intermittent pneumatic compression treatment raised the peripheral resistance in the arteries of legs with ulcer and laser Doppler flux of the skin more in ulcer legs than in healthy legs (p = 0.046 and p = 0.034, respectively). These findings suggest that removal of oedema causes redistribution of skin blood flow in the legs with venous ulcer favouring the superficial capillary perfusion. This could explain why compression treatment promotes the healing of venous leg ulcers.

Adult↗
PubMed1991

Effect of training on central factors in fatigue following two- and one-leg static exercise in man.

Leg strength and fatigue developed during 150 repeated two- and one-leg isometric maximal voluntary contractions were determined before and after a 5-week one- (n = 6) or two- (n = 7) leg training programme including a control group of five subjects. Two- and one-leg training increased two- and one-leg strength by 59 (range 8-107) and 36% (-1-69) respectively (P less than 0.01) with no significant difference between the two groups. Two-leg training decreased (P less than 0.05) fatigue only during two-leg maximal voluntary contractions (from 20 [11-26] to 13% [6-27]); and one-leg training fatigue only during one-leg maximal voluntary contractions (from 20 [15-23] to 11% [9-24]) despite the fact that both legs were trained. Surface electromyographic activity decreased during both repeated two- and one-leg maximal voluntary contractions (P less than 0.01) but a reduction in electromyographic decay was seen (P less than 0.05) during two-leg maximal voluntary contractions after two-leg training. Training increased fast-twitch b fibre size (P less than 0.01), and glycogen depletion was seen in fast-twitch (a and b) fibres, but the relative fast-twitch b area did not increase significantly. No training effects were seen in the control group. The results show that an approximately 47% increase in muscle strength may take place without a significant change in the relative percentage of muscle fibre types or in the average muscle fibre size. Furthermore, the specificity of the training response to fatigue developed during repeated two- and one-leg maximal voluntary contractions suggests a change in the nervous influence on the motor units.

Adult↗
PubMed2004

Interlimb influences on paretic leg function in poststroke hemiparesis.

After stroke, paretic leg motor impairment is typically viewed as a unilateral control deficit. However, much of the neural circuitry controlling normal leg function is organized bilaterally to produce coordinated, task-specific activity in the two legs. Thus, as a result of contralesional neural control processes, paretic leg motor pattern generation may be substantially influenced by the nonparetic leg sensorimotor state during bilateral lower limb tasks. Accordingly, we investigated whether different paretic leg motor patterns are observed during mechanically equivalent bilateral and unilateral tasks and, if so, whether nonparetic leg participation improved or exacerbated paretic leg coordination deficits. A pedaling apparatus that mechanically decoupled the legs was used to present subjects with increasingly complex bi- and unilateral motor tasks: isometric force generation, discrete movement, and pedaling. Bilateral electromyographic and pedal force data were collected from 21 persons with chronic poststroke hemiparesis and 11 similarly aged controls. During isometric force generation and discrete movements, nonparetic leg influences on paretic leg coordination were similar and not markedly different from interlimb influences in controls. In bilateral pedaling, however, interlimb influences differed from controls such that paretic leg coordination deficits were exacerbated. During pedaling movements, the suppression of interlimb influences similar to those observed in isometric and discrete movement may occur in controls but may be disrupted in hemiparesis. We suggest that the coupling of pattern generation between the two legs may result in greater, albeit more impaired, paretic leg motor output during bilateral pedaling than during unilateral pedaling.

Aged↗
PubMed1989

Interlimb coordination of leg-muscle activation during perturbation of stance in humans.

1. Electromyographic (EMG) responses were recorded in both legs, along with corresponding joint movements, after uni- and bilateral perturbations during stance on a treadmill with split belts. Displacements were directed forward, backward, or in opposing directions. They were induced by randomly timed ramp impulses at one of four different rates of treadmill acceleration. 2. Unilateral perturbations directed backward were followed by a bilateral gastrocnemius-EMG response, forward-directed perturbations by a bilateral tibialis anterior-EMG response. The amplitude of these responses was dependent on the rate of treadmill acceleration. Relative to the response of the displaced leg, the amplitude of the EMG response on the nondisplaced side was smaller when a gastrocnemius EMG response was induced, and about equal when the tibialis anterior muscle was activated. The onset latencies were shorter on the displaced side (displaced leg 75-96 ms, non-displaced leg 93-112 ms). 3. Bilateral perturbations in one direction were followed by larger EMG responses in both legs (in the gastrocnemius for backward-directed impulses, in the tibialis anterior for forward-directed impulses). For a given acceleration rate, their amplitude was about equal to the sum of the EMG amplitude of the displaced leg and that of the nondisplaced leg obtained during unilateral displacement. The inverse result was obtained when the legs were simultaneously displaced in opposite directions: EMG responses in both legs were significantly smaller than those obtained after unilateral displacement. 4. It is concluded that a unilateral displacement evokes reflex EMG responses in the synergistic muscles of both legs, which are graded according to the size of the proprioceptive input from the primarily displaced joint. During bilateral displacements, the activity induced by the respective contralateral leg is linearly summed or subtracted, depending on whether the legs are displaced in the same or in opposite directions. In view of the short latencies of these bilateral responses, it would seem that they are mediated by a spinal mechanism. 5. Distinct differences in the behavior of the antagonistic leg muscles were observed: 1) the coactivation of the contralateral leg muscle was significantly smaller when the gastrocnemius was stretched unilaterally, whereas it was about equal for the tibialis anterior; and 2) the gastrocnemius EMG responses were closely correlated with the displacement velocity, whereas the tibialis anterior response was more closely correlated with acceleration, i.e., the tibialis anterior response was more dynamic in nature.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2006

Intersegmental transfer of sensory signals in the stick insect leg muscle control system.

Intersegmental coordination during locomotion in legged animals arises from mechanical couplings and the exchange of neuronal information between legs. Here, the information flow from a single leg sense organ of the stick insect Cuniculina impigra onto motoneurons and interneurons of other legs was investigated. The femoral chordotonal organ (fCO) of the right middle leg, which measures posture and movement of the femur-tibia joint, was stimulated, and the responses of the tibial motoneuron pools of the other legs were recorded. In resting animals, fCO signals did not affect motoneuronal activity in neighboring legs. When the locomotor system was activated and antagonistic motoneurons were bursting in alternation, fCO stimuli facilitated transitions from flexor to extensor activity and vice versa in the contralateral leg. Following pharmacological treatment with picrotoxin, a blocker of GABA-ergic inhibition, the tibial motoneurons of all legs showed specific responses to signals from the middle leg fCO. For the contralateral middle leg we show that fCO signals encoding velocity and position of the tibia were processed by those identified local premotor nonspiking interneurons known to contribute to posture and movement control during standing and voluntary leg movements. Interneurons received both excitatory and inhibitory inputs, so that the response of some interneurons supported the motoneuronal output, while others opposed it. Our results demonstrate that sensory information from the fCO specifically affects the motoneuronal activity of other legs and that the layer of premotor nonspiking interneurons is a site of interaction between local proprioceptive sensory signals and proprioceptive signals from other legs.

Animals↗
PubMed1975

Acute cold exposure and the metabolism of blood glucose, lactate and pyruvate, and plasma amino acids in the hind leg of the fed and fasted young ox.

1. Young steers were fed either 3-4 or 20 h before exposure to a thermoneutral or a moderately cold environment. Measurements were made of total oxygen consumption (total V 0-2), respiratory quotient (rq), blood packed cell volume (PCV), and hind-leg blood flow (leg Q) and oxygen uptake (leg VO-2). The arteriovenous differences in whole blood glucose, lactate and pyruvate, and individual amino acid and urea concentrations across the leg were also measured. Net exchange and fractional uptake of these metabolites by the leg were calculated from these results. 2. Cold exposure doubled total VO-2, significantly decreased RQ and significantly increased PCV. Leg Q and leg VO-2 increased 3- to 5-fold and 4- to 13-fold respectively in both feeding groups. Arterial blood glucose increased slightly but significantly in both 20 h- and 3 h-fed steers. There was a substantial increase in mean net leg uptake of glucose in both feeding groups. This was much greater in the 20 h-fed group because of the significant increase in fractional uptake occurring only in this group. Cold did not significantly affect arterial blood lactate or pyruvate levels, but the net leg output of lactate found in both feeding groups in thermoneutrality was increased in the 20 h-fed steers, and reversed to a net uptake in the 3 h-fed animals. Cold caused a small but significant decrease in the total plasma amino acid level in the 20 h-fed but not in the 3 h-fed group; individual amino acid levels or leg uptakes were not affected. 3. Feeding before the experiment caused a significant increase in RQ. Leg Q, leg uptake of glucose and leg output of lactate increased after feeding in the thermoneutral environment only. Arterial pyruvate increased significantly, but net leg output was not significantly affected by feeding. Arterial plasma concentration of several individual, but not of total amino acids, increased significantly in both environments, and the net output of many individual amino acids in the 20 h-fed steers was decreased or reversed to a net uptake in the 3 h-fed group in thermoneutrality only. 4. The results suggest that blood glucose could be a significant fuel for oxidation in shivering skeletal muscle in young steers, and that output of amino acids from skeletal muscle could not contribute significantly to this increased glucose supply by hepatic gluconeogenesis.

Acclimatization↗
PubMed2006

Response to one-legged cycling in patients with COPD.

BACKGROUND: In patients with COPD, exercise intensity is often limited by the ventilatory system. We hypothesized that by exercising with a smaller muscle mass, ventilatory-limited patients would perform more high-intensity, muscle-specific work. The study objectives were as follows: (1) to determine the limitations of exercising with a smaller muscle mass, compared with conventional two-legged exercise; and (2) to determine the endurance time, using the same muscle-specific intensity, during one-legged vs two-legged exercise. METHODS: Nine patients (mean +/- SD FEV1, 36 +/- 13% of predicted) completed incremental exercise, and nine other patients (mean FEV1, 42 +/- 16% of predicted) completed constant-power exercise. Nine healthy subjects (FEV1, 104 +/- 14% of predicted) completed both tests. All subjects completed tests using two-legged and one-legged pedaling. RESULTS: Peak oxygen uptake (VO2peak) was similar during one-legged and two-legged incremental exercise among patients (difference, 0.03 L/min; 95% confidence interval [CI], -0.10 to 0.16 L/min; p = 0.60), as were ventilation and dyspnea scores. VO2peak was lower during one-legged vs two-legged exercise (-0.57 mL/min; 95% CI, -0.81 to -0.32 mL/min; p < 0.001) among healthy subjects with substantial ventilatory and heart rate reserve. Patients endured one-legged pedaling at a constant power longer than two-legged pedaling (16.97 min; 95% CI, 9.98 to 23.96 min; p < 0.001), resulting in greater work (12.48 kilojoules [kJ]; 95% CI, 2.58 to 22.39 kJ; p = 0.02). Healthy subjects completed similar work (-4.02 kJ; 95% CI, -18.59 to 10.55 kJ; p = 0.54) with one-legged vs two-legged pedaling. CONCLUSION: These observations demonstrate the effectiveness of using one-legged exercise at the same muscle-specific intensity in extending the duration of exercise among patients with COPD. This has important implications for training approaches designed to enhance exercise function among ventilatory-limited patients.

Adult↗
PubMed2001

Triggering of balance corrections and compensatory strategies in a patient with total leg proprioceptive loss.

Triggering of balance corrections may depend on both leg and trunk proprioceptive inputs. To study this issue and to determine how a total proprioceptive loss in the legs (ToLPL) would affect postural reactions in different directions, we investigated the postural control of a patient with a long-standing dorsal root ganglionopathy. This patient had absent stretch reflexes at the ankle and knee joints, delayed reflexes at the hips, but normal muscle strength. Postural control was probed with support-surface movements driven by two different experimental protocols. The first protocol concentrated on leg muscle responses by varying ankle inputs during pitch plane perturbations. The second protocol focussed on the directional sensitivity of upper body responses using combined roll and pitch tilt perturbations. For both protocols, identical techniques were used to record ankle torques, angular velocities of the upper legs and trunk, and surface EMG from leg, hip and trunk muscles. For the first protocol, pitch plane stance perturbations with three different ankle inputs were imposed by a movable support surface. A simultaneous 4-cm rearward translation and 4-deg toe-up rotation produced an 80-deg/s "enhanced ankle input", a simple toe-up rotation gave a 40-deg/s "normal" ankle input and a simultaneous 4-cm rearward translation and 4-deg "toe-down" rotation yielding a 0-deg/s "nulled ankle input". Responses in the ToLPL patient were compared to those of healthy controls and those of patients with lower-leg proprioceptive loss (LLPL). Following normal and enhanced ankle input perturbations, stretch reflexes were absent in ankle and knee joint muscles of the ToLPL patient. Balance correcting responses in the lower legs were diminished and delayed by some 45 ms. In quadriceps, balance-correcting responses were larger than normal, peaked earlier and were not delayed. During the nulled ankle input condition, the ankle muscle responses in the ToLPL patient were again diminished and delayed by 40 ms with respect to both normal subjects and LLPL patients. However, the ToLPL patient again generated an earlier, larger, balance correcting response in quadriceps. For the second protocol, combinations of roll and pitch perturbations were also delivered by a moving support surface. The amplitude was 7.5 deg at 50 deg/s. Eight different directions were applied randomly (pure "toes down", pure "toes up" and directions at 45-deg intervals of roll). As with the first protocol pre-stimulus background muscle activity was excessive in all trunk and most leg muscles. Responses to roll tilt produced several striking changes from normal in the ToLPL patient. First reflexes in gluteus medius were delayed. Second, the trunk roll which commences around 30 ms in normals was in the opposite direction. This roll was accompanied by oppositely directed stretch reflexes in paraspinal muscles. Third, directional sensitivity of balance corrections was far more roll oriented in leg and trunk muscles. Fourth, some tilt directions caused a deactivation response of background activity. This "deactivation strategy" strongly contrasted with the strategy of controls who had low pre-stimulus background activity and activated responses around 100 ms to correct postural instability. These findings provide new insights into the generation of pitch and roll plane directed balance corrections based on the interaction of proprioceptive trigger signals from the ankles, knees and hips. Without proprioceptive input from the ankle and knee, ankle muscle responses are delayed but not absent. Upper leg and trunk responses are not delayed. This suggests that most, if not all, lower leg balance correcting responses are triggered by hip and, possibly, trunk proprioceptive inputs. When leg proprioceptive input is absent, balance correcting responses lose pitch plane sensitivity. The solution used by the patient to overcome these deficits was to markedly raise background muscle activity levels, presumably to provide a stiffer body structure. The lack of trunk flexibility and lateral instability this produced for roll tilts was offset by the ability to compensate by using a hitherto not described "deactivation response" strategy. The patient had a clinical picture usually described as "deafferented"; yet our roll tilt perturbations revealed delayed reflex responses in hip muscles. With vestibulospinal and neck-proprioceptive inputs, these responses may have helped with the development of compensation processes for the total leg proprioceptive deficit.

Adaptation, Physiological↗
PubMed2004

Venous leg ulcer patients: a review of the literature on lifestyle and pain-related interventions.

BACKGROUND: Having a leg ulcer has a major impact on daily life. Lifestyle is mentioned in most leg ulcer guidelines but mostly without much emphasis on the subject. AIMS AND OBJECTIVES: Evidence for the effect of nutrition, leg elevation and exercise on the healing of leg ulcers was reconsidered. Furthermore, the evidence for effective pain-related interventions was investigated. DESIGN: Systematic literature review. METHODS: Medline, Cinahl, Psychinfo and Cochrane were searched for studies on pain related interventions, and the effectiveness of leg elevation, leg exercise and nutritional interventions in patients with venous leg ulceration. RESULTS: Some evidence was found to support a positive effect of leg exercises on the endurance and power of the calf muscle and on the haemodynamic status of the limb. There is also evidence for a positive effect of leg elevation during bed rest without compression. No hard evidence was found concerning the effect of enriched or altered nutrition on wound healing. However, there is some evidence of nutritional deficits in this patient group. The use of eutectic mixture of local anaesthetic cream is effective for reducing pain in wound debridement, but pain relief in daily life is insufficiently treated. CONCLUSION: There is no real evidence of effectiveness of the investigated lifestyle interventions but there are indications that lifestyle interventions might contribute to healing or prevention of venous leg ulceration. RELEVANCE TO CLINICAL PRACTICE: Although there is no hard evidence, it can be expected that interventions such as nutritional monitoring, guided exercise and leg elevation will have a substantial impact on wound healing in patients with venous leg ulceration. The use of eutectic mixture of local anaesthetic cream can be advised for pain relief with wound debridement. The current lack of effective pain treatment with venous leg ulceration emphasizes the need for effective pain treatment.

Chronic Disease↗
PubMed1988

Strength of two- and one-leg extension in man.

Two- and one-leg extension strengths were compared in 155 female and male, untrained and trained (eight bicyclists, 38 weight-lifters) subjects and in a polio patient with almost no strength in one leg. On average two-leg strength was 82 +/- 1.3% (SE) of the sum of the strength of the right and left legs (leg-strength ratio) with no significant difference between the untrained and trained subjects. In the polio patient two-leg strength was lower than the strength of the strongest leg. A similar leg-strength ratio was found when measurements were made with a knee angle of 150 degrees (n = 128) and 90 degrees (n = 25). The ratio did not change when re-determined after 1 year (n = 9). Moderate changes in the subjects' position during measurements did not affect one-leg strength (n = 13). However, familiarization with the experimental apparatus increased the leg-strength ratio from 80 +/- 2.5% to 97 +/- 2.9% (P less than 0.01) (n = 18). In contrast, two-arm extension strength was similar to the sum of the strength of the right and left arms (n = 15). The results demonstrate that two-leg strength in general is lower than the sum of the strength of the right and left legs, and that this phenomenon is found even after intensive endurance or strength training. However, familiarization with the experimental apparatus can increase the relative two-leg strength which suggests that muscle strength in man may be limited by the central nervous systems' ability to activate maximally all synergistic muscles and/or to control antagonistic muscles.

Adult↗
PubMed1993

Muscle fibre types and enzyme activities after training with local leg ischaemia in man.

Eight healthy men performed supine one-legged training on a bicycle ergometer 45 min per leg four times per week for 4 week. The ergometer and lower body were inside a pressure chamber, the opening of which was sealed at the level of the crotch. One leg trained with impeded leg blood flow (I-leg), induced by an increased (50 mmHg) chamber pressure, at the highest tolerable intensity. The contralateral leg trained at the same power under normal pressure (N-leg). Before and after training biopsies were taken from the vastus lateralis of both legs and maximal one-legged exercise tests were executed with both legs. Biopsies were repeated when the subjects had been back to their habitual physical activity for 3 months. Training increased exercise time to exhaustion, but more in the I-leg than in the N-leg. After training, the I-leg had higher activity of citrate synthase (CS), a marker of oxidative capacity, and lower activity of the M-subunit of lactate dehydrogenase isoenzymes. It also had a higher percentage of type-I fibres and a lower percentage of IIB fibres, larger areas of all fibre types and a greater number of capillaries per fibre. It is concluded that ischaemic training changes the muscle metabolic profile in a direction facilitating aerobic metabolism. An altered fibre-type composition may contribute, but is not enough prerequisite for the change.

Adult↗
PubMed1994

Reflex increase in blood pressure induced by leg compression in man.

1. We tested the hypotheses that the increase in mean arterial pressure with the application of external leg compression in man is (i) blocked with epidural anaesthesia, and (ii) dependent upon the level of external pressure applied, the quantity of leg muscle mass compressed and the vascular volume of the leg. Fourteen healthy subjects were fitted with an anti-shock trouser garment to provide three levels (30, 60 and 90 mmHg) of leg compression, while cephalad translocation of fluid was prevented by upper-thigh cuffs inflated to a supra-systolic pressure. Cardiovascular responses were recorded during leg compression before and after the administration of epidural anaesthesia in eight subjects, while blood pressure responses from six subjects were compared with their single leg pressor response. 2. Both mean arterial and diastolic pressures were elevated with increasing leg compression, with no changes in heart rate, cardiac output, thoracic impedance, and central venous pressure. The leg compression-induced blood pressure increases were abolished by epidural anaesthesia. Furthermore, when only one leg was compressed at 90 mmHg, the pressor response was less than that elicited from compression of both legs at the same external pressure. Changes in vascular volume of the leg did not influence the pressor response to leg compression. 3. The results indicate that the mean arterial pressure increases in response to external compression of the legs and that a reflex mechanism, mediated by muscle afferent nerves, is involved. The response is dependent upon both the changes in intramuscular pressure and the quantity of muscle mass compressed.

Adult↗
PubMed2002

Basal leg blood flow in healthy women is related to age and hormone replacement therapy status.

Basal leg blood flow declines with age in healthy men, an effect that is mediated by augmented sympathetic vasoconstriction. However, in women the presence or absence of oestrogen and selective use of hormone replacement therapy (HRT) may alter these relationships with ageing. We studied 103 healthy women: 73 postmenopausal (41 HRT, mean +/- S.E.M. 61 +/- 1 years; 32 no-HRT, 63 +/- 2 years) and 30 premenopausal (29 +/- 1 years). Compared with the premenopausal controls, absolute femoral artery blood flow (duplex ultrasound) was 23 % lower (P < 0.001) in the postmenopausal no-HRT group, but only 13 % lower in the HRT group (P < 0.01). The age and HRT group differences in leg blood flow were consistently associated with differences in leg vascular conductance, but not with femoral artery lumen diameter, leg muscle sympathetic nerve activity or cardiac output (systemic arterial blood flow). Leg fat-free mass was smaller in the postmenopausal groups (P < 0.05). Femoral blood flow normalized for leg fat-free mass was 17 % lower (P < 0.01) in the postmenopausal no-HRT compared with the premenopausal women, but was not different in the postmenopausal HRT and premenopausal groups. Femoral artery shear stress was similar in the postmenopausal HRT and premenopausal women, but was lower in the postmenopausal no-HRT group (P < 0.01). Basal whole-leg blood flow declines with age in healthy, oestrogen-deficient women, a phenomenon that is mediated primarily by reductions in leg vascular conductance. Among postmenopausal women, chronic HRT use is associated with augmented basal leg blood flow and vascular conductance. Leg blood flow normalized for leg fat-free mass is preserved with age in women taking chronic HRT. In contrast to men, differences in leg sympathetic vasoconstrictor nerve activity do not explain group differences in leg blood flow and vascular conductance with ageing in women.

Adult↗
PubMed2003

Impaired leg vasodilation during dynamic exercise in healthy older women.

The purpose of the present study was to test the hypothesis that leg blood flow responses during leg cycle ergometry are reduced with age in healthy non-estrogen-replaced women. Thirteen younger (20-27 yr) and thirteen older (61-71 yr) normotensive, non-endurance-trained women performed both graded and constant-load bouts of leg cycling at the same absolute exercise intensities. Leg blood flow (femoral vein thermodilution), mean arterial pressure (MAP; radial artery), mean femoral venous pressure, cardiac output (acetylene rebreathing), and blood O2 contents were measured. Leg blood flow responses at light workloads (20-40 W) were similar in younger and older women. However, at moderate workloads (50-60 W), leg blood flow responses were significantly attenuated in older women. MAP was 20-25 mmHg higher (P < 0.01) in the older women across all work intensities, and calculated leg vascular conductance (leg blood flow/estimated leg perfusion pressure) was lower (P < 0.05). Exercise-induced increases in leg arteriovenous O2 difference and O2 extraction were identical between groups (P > 0.6). Leg O2 uptake was tightly correlated with leg blood flow across all workloads in both subject groups (r2 = 0.80). These results suggest the ability of healthy older women to undergo limb vasodilation in response to submaximal exercise is impaired and that the legs are a potentially important contributor to the augmented systemic vascular resistance seen during dynamic exercise in older women.

Adult↗
PubMed2004

Alternate leg movement amplifies locomotor-like muscle activity in spinal cord injured persons.

It is now well recognized that muscle activity can be induced even in the paralyzed lower limb muscles of persons with spinal cord injury (SCI) by imposing locomotion-like movements on both of their legs. Although the significant role of the afferent input related to hip joint movement and body load has been emphasized considerably in previous studies, the contribution of the "alternate" leg movement pattern has not been fully investigated. This study was designed to investigate to what extent the alternate leg movement influenced this "locomotor-like" muscle activity. The knee-locked leg swing movement was imposed on 10 complete SCI subjects using a gait training apparatus. The following three different experimental conditions were adopted: 1) bilateral alternate leg movement, 2) unilateral leg movement, and 3) bilateral synchronous (in-phase) leg movement. In all experimental conditions, the passive leg movement induced EMG activity in the soleus and medial head of the gastrocnemius muscles in all SCI subjects and in the biceps femoris muscle in 8 of 10 SCI subjects. On the other hand, the EMG activity was not observed in the tibialis anterior and rectus femoris muscles. The EMG level of these activated muscles, as quantified by integrating the rectified EMG activity recorded from the right leg, was significantly larger for bilateral alternate leg movement than for unilateral and bilateral synchronous movements, although the right hip and ankle joint movements were identical in all experimental conditions. In addition, the difference in the pattern of the load applied to the leg among conditions was unable to explain the enhancement of EMG activity in the bilateral alternate leg movement condition. These results suggest that the sensory information generated by alternate leg movements plays a substantial role in amplifying the induced locomotor-like muscle activity in the lower limbs.

Adult↗
PubMed1998

Sensorimotor state of the contralateral leg affects ipsilateral muscle coordination of pedaling.

The objective of this study was to determine if independent central pattern generating elements controlling the legs in bipedal and unipedal locomotion is a viable theory for locomotor propulsion in humans. Coordinative coupling of the limbs could then be accomplished through mechanical interactions and ipsilateral feedback control rather than through central interlimb neural pathways. Pedaling was chosen as the locomotor task to study because interlimb mechanics can be significantly altered, as pedaling can be executed with the use of either one leg or two legs (cf. walking) and because the load on the limb can be well-controlled. Subjects pedaled a modified bicycle ergometer in a two-legged (bilateral) and a one-legged (unilateral) pedaling condition. The loading on the leg during unilateral pedaling was designed to be identical to the loading experienced by the leg during bilateral pedaling. This loading was achieved by having a trained human "motor" pedal along with the subject and exert on the opposite crank the torque that the subject's contralateral leg generated in bilateral pedaling. The human "motor" was successful at reproducing each subject's one-leg crank torque. The shape of the motor's torque trajectory was similar to that of subjects, and the amount of work done during extension and flexion was not significantly different. Thus the same muscle coordination pattern would allow subjects to pedal successfully in both the bilateral and unilateral conditions, and the afferent signals from the pedaling leg could be the same for both conditions. Although the overall work done by each leg did not change, an 86% decrease in retarding (negative) crank torque during limb flexion was measured in all 11 subjects during the unilateral condition. This corresponded to an increase in integrated electromyography of tibialis anterior (70%), rectus femoris (43%), and biceps femoris (59%) during flexion. Even given visual torque feedback in the unilateral condition, subjects still showed a 33% decrease in negative torque during flexion. These results are consistent with the existence of an inhibitory pathway from elements controlling extension onto contralateral flexion elements, with the pathway operating during two-legged pedaling but not during one-legged pedaling, in which case flexor activity increases. However, this centrally mediated coupling can be overcome with practice, as the human "motor" was able to effectively match the bilateral crank torque after a longer practice regimen. We conclude that the sensorimotor control of a unipedal task is affected by interlimb neural pathways. Thus a task performed unilaterally is not performed with the same muscle coordination utilized in a bipedal condition, even if such coordination would be equally effective in the execution of the unilateral task.

Adult↗