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Contribution of non-extensor muscles of the leg to maximal-effort countermovement jumping.

BACKGROUND: The purpose of this study was to determine the effects of non-extensor muscles of the leg (i.e., muscles whose primary function is not leg extension) on the kinematics and kinetics of human maximal-effort countermovement jumping. Although it is difficult to address this type of question through experimental procedures, the methodology of computer simulation can be a powerful tool. METHODS: A skeletal model that has nine rigid body segments and twenty degrees of freedom was developed. Two sets of muscle models were attached to this skeletal model: all (most of) major muscles in the leg ("All Muscles" model) and major extensor muscles in the leg (i.e., muscles whose primary function is leg extension; "Extensors Only" model). Neural activation input signal was represented by a series of step functions with a step duration of 0.05 s. Simulations were started from an identical upright standing posture. The optimal pattern of the activation input signal was searched through extensive random-search numerical optimization with a goal of maximizing the height reached by the mass centre of the body after jumping up. RESULTS: The simulated kinematics was almost two-dimensional, suggesting the validity of two-dimensional analyses when evaluating net mechanical outputs around the joints using inverse dynamics. A greater jumping height was obtained for the "All Muscles" model (0.386 m) than for the "Extensors Only" model (0.301 m). For the "All Muscles" model, flexor muscles developed force in the beginning of the countermovement. For the "All Muscles" model, the sum of the work outputs from non-extensor muscles was 47.0 J, which was 13% of the total amount (359.9 J). The quantitative distribution of the work outputs from individual muscles was markedly different between these two models. CONCLUSION: It was suggested that the contribution of non-extensor muscles in maximal-effort countermovement jumping is substantial. The use of a computer simulation model that includes non-extensor muscles seems to be more desirable for the assessment of muscular outputs during jumping.

Computer Simulation↗

Influence of passive leg elevation on the right ventricular function in anaesthetized coronary patients.

INTRODUCTION: The aim of the present study was to evaluate the haemodynamic effects of passive leg elevation on the right ventricular function in two groups of patients, one with a normal right ventricular ejection fraction (RVEF) and one with a reduced RVEF. METHODS: Twenty coronary patients undergoing elective coronary artery bypass grafting surgery were studied by a RVEF pulmonary artery catheter. The haemodynamic data reported were collected before the induction of anaesthesia (time point 1), just before (time point 2) and 1 min (time point 3) after the legs were simultaneously raised at 60 degrees, and 1 min after the legs were lowered (time point 4). The patients were divided into two groups: group A, with preinduction RVEF > 45%; and group B, with preinduction RVEF < 40%. RESULTS: In group A (n = 10), at time point 3 compared with time point 2, the heart rate significantly decreased (from 75 +/- 10 to 66 +/- 7 beats/min). The right ventricular end diastolic volume index (from 105 +/- 17 to 133 +/- 29 ml/m2), the right ventricular end systolic volume index (from 61 +/- 13 to 77 +/- 24 ml/m2), the systolic systemic arterial/right ventricular pressure gradient (from 93 +/- 24 to 113 +/- 22 mmHg) and the diastolic systemic arterial/right ventricular pressure gradient (from 58 +/- 11 to 66 +/- 12 mmHg) significantly increased. Also in group A, the cardiac index did not significantly increase (from 3.28 +/- 0.6 to 3.62 +/- 0.6 l/min/m2), the RVEF was unchanged, and the right ventricular end diastolic volume/pressure ratio (RVED V/P) did not significantly decrease (from 48 +/- 26 to 37 +/- 13 ml/mmHg). In group B (n = 6) at the same time, the heart rate (from 72 +/- 15 to 66 +/- 12 beats/min), the right ventricular end diastolic volume index (from 171 +/- 50 to 142 +/- 32 ml/m2) and the RVED V/P (from 71 +/- 24 to 39 +/- 7 ml/mmHg) significantly decreased. The cardiac index and the diastolic systemic arterial/right ventricular pressure gradient were unchanged in group B, while the RVEF and the systolic systemic arterial/right ventricular pressure gradient did not significantly increase, and the right ventricular end-systolic volume index did not significantly decrease. All results are expressed as mean +/- standard deviation. CONCLUSIONS: We conclude that passive leg elevation caused a worse condition in the right ventricle of group B because, with stable values of cardiac index, of systolic systemic arterial/right ventricular pressure gradient and of diastolic systemic arterial/right ventricular pressure gradient (which supply oxygen), the RVED V/P (to which oxygen consumption is inversely related) markedly decreased. This is as opposed to group A, where the cardiac index, the systolic systemic arterial/right ventricular pressure gradient and the diastolic systemic arterial/right ventricular pressure gradient increased, and the RVED V/P slightly decreased. Passive leg elevation must therefore be performed cautiously in coronary patients with a reduced RVEF.

Aged↗

Height, leg length, and cancer: the Caerphilly Study.

The incidence of several cancers increases with height. Some studies report that leg length, a marker of prepubertal growth, is the component of height underlying these associations, but few prospective studies have investigated this issue. We examined height-cancer associations in a 21-yr follow-up of a cohort based on 2,512 men aged 45-59 living in the town of Caerphilly, South Wales, U.K., between 1979 and 1983. The men underwent a detailed examination, and 2,393 (95.3%) had measures of height and sitting height (from which leg length and trunk length were derived) recorded and were cancer-free at baseline. Cox proportional hazards models were used to investigate associations of height, leg length, and trunk length with overall and site-specific cancer incidence; 328 men developed cancer over the follow-up period. Associations with height were weak and did not reach conventional levels of statistical significance. In models controlling for age, socioeconomic position, smoking, and body mass index, cancer incidence was weakly positively associated with increases in height; hazard ratio (HR, 95% confidence interval) per standard deviation (6 cm) increase in height was 1.09 (0.97, 1.21; P = 0.14). Associations were somewhat stronger in relation to leg length (HR 1.09; (0.97-1.22) than trunk length (HR 1.05; 0.94-1.18). Height-cancer associations were strongest for lung cancer (HR 1.21; 0.96-1.51). This analysis provides limited support for the suggestion that leg length is the component of height underlying height-cancer associations

Body Height↗

Periodic leg movements in sleep: effect of clonazepam treatment.

Periodic leg movements in sleep were diagnosed in 8 patients with insomnia and in 12 patients with hypersomnia. Polysomnography did not reveal any difference in the number of leg movements in these groups, the mean duration of a leg movement, or the number of activity epochs. Those with insomnia, however, had a shorter intermovement interval than those with hypersomnia, with more leg movements in each activity epoch. Treatment with 0.5 to 2 mg clonazepam improved subjective complaints and decreased the number of leg movements without affecting the intermovement interval or movement duration.

Adult↗

Electrical stimulation alters FMD and arterial compliance in extremely inactive legs.

PURPOSE: The main aim of the study was to assess the effect and time course of 4 wk of electrically induced leg training on arterial compliance and endothelial function. METHODS: Six spinal cord-injured (SCI) individuals participated in 4 wk of daily one-leg functional electrical stimulation (FES) training for 30 min per session. Eight able-bodied individuals served as a control group (C) and were tested on one occasion. Echo Doppler measurements were performed before the FES training and after 1, 2, and 4 wk of training to measure vascular characteristics of femoral artery (FA), brachial artery (BA), and carotid artery (CA). RESULTS: Baseline arterial compliance of FA (SCI: 0.0185 +/- 0.063 mm2 x mm Hg(-1); C: 0.066 +/- 0.017 mm2 x mm Hg(-1), P = 0.001) and CA (SCI: 0.073 +/- 0.02 mm2 x mm Hg(-1); C: 0.102 +/- 0.02 mm2 x mm Hg(-1), P = 0.02) was significantly decreased in SCI. Baseline endothelial function in the leg was significantly enhanced in SCI compared with C (SCI: 11 +/- 1.3%; C: 7.9 +/- 0.9%, P = 0.001). No differences between the groups were found for arterial compliance and endothelial function in the arm. Vascular changes after FES training showed an increase in arterial compliance (significant at week 4, P < 0.05) and a decrease in FMD response (significant at weeks 2 and 4, P < 0.05) in the FA of the trained leg only, with no changes evident in the other arteries examined. CONCLUSION: Daily electrically induced training of an extremely deconditioned leg appears to enhance arterial compliance in the femoral artery and may normalize endothelial function.

Adult↗

Is there a difference in vascular reactivity of the arms and legs?

The arterial vessels within the arms and legs are exposed to different hydrostatic pressures and blood-flow demands during the course of daily life. There is compelling indirect evidence that arterial reactivity differs in the arms and legs of humans; greater blood-flow responses to physiological vasodilator stimuli are generally reported in the arms of healthy younger subjects, whereas greater sympathetically mediated vasoconstrictor responsiveness is generally observed in the legs. Limb blood-flow responses to local arterial infusions of vasoactive agents reveal a similar pattern of heterogeneity in human arms versus legs. The advantages and assumptions of these pharmacological approaches for evaluating limb arterial reactivity are discussed, and methodological issues pertaining to the normalization and interpretation of vascular responses in the human arm and leg are critically examined. The article concludes with recent data from our laboratory indicating that limb-specific variation in arterial function may be age-, sex-, and physical activity dependent.

Aging↗

Managing and promoting change: implementing the Leg Club model.

Patient knowledge of their disease may increase concordance to compression therapy. The Lindsay Leg Club model (Lindsay, 2004) empowers the community nursing team to truly get to know their communities and deliver local, high-quality, evidence-based care for patients with leg ulcers and leg related problems. The author's experience of opening a Leg Club has lead to changes in clinical practice: re-evaluation of the use of long stretch bandages in favour of short stretch; replacing conventional compression bandage systems with two piece graduated compression hosiery; increased patient concordance post healing with increased use of compression hosiery; the introduction of toe bandaging and appropriate long-term management for those patients with lymphoedema; and developing the role of the nursing auxiliary in leg ulcer care.

Bandages↗

Developing skills in leg ulcer nursing: the lessons learned.

The high treatment costs of inappropriate leg ulcer management are well referenced. Wide variations in practice have also been reported. A training programme for community nurses has been in place in Leicestershire and Rutland NHS Trust for five years. Its objective is to promote evidence-based leg ulcer management. The aim of this prospective audit was to assess and compare the effectiveness of the compression bandage systems used in the trust: the original Charing Cross system (August 1996 to September 1997) and Robinson's Ultra Four kit (October 1997 to December 1998). All patients with leg ulceration were assessed using the Leicestershire leg ulcer assessment form. This was submitted along with an audit tool to the tissue viability service in exchange for a 12-week supply of compression bandages. The audit form was resubmitted after each subsequent 12-week period until the patient either had healed or was withdrawn from the audit. Differences between the two groups in mobility, previous deep vein thrombosis, fixed ankle deformity, the male to female ratio, duration of ulcer and ulcer surface area were noted. Patients using the Ultra Four kit had faster healing times than those given the Charing Cross system, but this was not statistically significant. Cost comparisons between the previous dressing regimen and compression bandaging showed a significance difference (p < 0.001). There was also a significant reduction in nurse time (p < 0.001). The audit results showed that compression bandaging therapy was an effective method of achieving healing in patients with venous leg ulcers and that significant cost savings were made in terms of dressing cost and nurse time. Furthermore, there were potential benefits in continuing compression therapy for the group of non-healers.

Adult↗

Do leg ulcer clinics improve patients' quality of life?

The aim of this prospective study was to measure quality of life in patients with chronic leg ulcers. All eligible, consenting patients who attended the leg ulcer clinic at the Repatriation General Hospital (Tasmania, Australia) during the 16-month study period were included. Patients completed questionnaires on their first visit and at follow-up which occurred, on average, eight weeks later. This study found an improvement in three quality-of-life indicators--pain, sleep and mobility--over an average of eight weeks' treatment involving one to three visits to the clinic and home visits by primary care nurses. Of the 57 patients, 53 (93%) indicated that their wound had improved following attendance at the clinic. The cost-effectiveness of providing treatment in a dedicated leg ulcer clinic has been the focus of many previous studies. This study emphasises the additional benefits a dedicated clinic may have in improving quality of life in patients with chronic leg ulcers. Such benefits ought to be considered when allocating resources to leg ulcer services.

Adult↗

Can individualised nutritional support improve healing in therapy-resistant leg ulcers?

OBJECTIVE: This study investigated whether an individually designed programme of nutritional support can improve healing in otherwise therapy-resistant venous leg ulcers. METHOD: Six primary health-care patients, aged between 79 and 93 years, with venous ulcers that had been open for one year or more (range: 1.5-8 years) were recruited into the study. The patients were asked to follow an individualised diet plan which included the use of liquid dietary supplements. Ulcer area, anthropometric and biochemical variables, and energy and nutrient intake were assessed before intervention and then regularly for nine months. RESULTS: At nine months ulcer healing had occurred in two patients, of whom one had had ulcers on both legs. In a third patient the ulceration on one leg had healed and that on the other leg had almost healed. In a fourth patient, the ulcer area reduced by approximately 90%. CONCLUSION: The use of nutritional support might have assisted the wound healing in these patients. Although the relationship between nutritional supplementation and wound healing is not well defined, an appropriate nutritional plan is recommended if undernourishment is suspected and leg ulcers are not healing.

Aged↗

The healing properties of Promogran in venous leg ulcers.

OBJECTIVE: To evaluate the healing rate of venous leg ulcers treated with Promogran. METHOD: Patients with stagnating venous leg ulcers were recruited. Target wounds were > or = 2 cm but < or = 10 cm in any one dimension. Subjects were randomly allocated to receive either Promogran or a non-adherent dressing (Adaptic) with a secondary dressing of gauze followed by short-stress compression (Biflex). Weekly wound assessments occurred over 12 weeks and dressings were changed twice weekly by the investigator and/or nurse team. Planimetry tracings and photographs were blindly reviewed and assessed by two independent investigators. An intent-to-treat analysis was performed. RESULTS: Seventy-three patients were included. Thirty-seven were randomly allocated Promogran and 36 Adaptic. Twenty-nine patients completed the 12-week follow-up visit, 25 healed before week 12 and 19 stopped follow-up before week 12 for reasons unrelated to healing. Significantly more patients in the Adaptic group than in the Promogran group switched to another dressing (22.2% versus 5.4%; p = 0.035). Eleven venous leg ulcers healed in the control group (31%) and 15 in the Promogran group (41%) (p = 0.373). Overall, 15 venous leg ulcers healed or improved in the control group (42%) and 23 in the Promogran group (62%) (p = 0.079). Surface area decreased, on average, by 36.5 +/- 11.4% (median decrease: 44.6%) in the Adaptic group and by 54.4 +/- 10.9% (median decrease: 82.4%) in the Promogran group (p < 0.001). A < or = 20% surface area reduction was observed in 15 patients in the Adaptic group and in seven in the Promogran group (42% versus 19%; p = 0.034). No severe local adverse events were noted in either group, although poor tolerability caused a dressing switch in five patients in the control group and three in the Promogran group. Dressing acceptability was good or excellent in more than 60% of subjects in both groups. CONCLUSION: The results suggest that Promogran may accelerate healing in venous leg ulcers and was well tolerated compared with the current standard of care.

Adult↗

How living with a leg ulcer affects people's daily life: a nurse-led study.

OBJECTIVE: This descriptive phenomenological study explored patients' experiences of living with a leg ulcer. METHOD: Eight participants (five female and three male) were recruited from a secondary care leg ulcer clinic in a large UK teaching hospital. All had current venous leg ulceration, lasting between five months and 34 years. Data collection was via in-depth semi-structured interviews. Data categories were: symptoms; treatment; perceptions, emotions and coping strategies; and restrictions. RESULTS: Leg ulcers have a significant impact on individuals' lives. The degree to which this occurs varies between each person. CONCLUSION: Patients need consistent treatment that incorporates benchmarking. A support network to address the needs of those living with a leg ulcer should be considered. This study's findings should be promoted to raise awareness among health-care professionals, enabling them to provide more responsive care.

Activities of Daily Living↗

Management of chronic leg ulcers by nurses working in the community in Sweden and the UK.

OBJECTIVE: This study compared the management of chronic leg ulcers by nurses in community, primary health care and nursing home settings in Kronoberg, Sweden, and East Riding, UK. METHOD: A questionnaire was sent to all nurses in the two areas enquiring about their occupational background, leg ulcer management, resource utilisation and education and training. It also asked about their preferred treatment choices for four types of chronic leg ulcers described in case studies. Response rates of 50% (UK) and 54% (Sweden) were achieved. RESULTS: Nurses in the UK undertook diagnostic investigations of non-healing leg ulcers as part of the initial assessment, whereas in Sweden these were undertaken by physicians. In Sweden daily dressing changes were more frequent and often involved nurse auxiliaries. Patients and relatives almost never participated in dressing changes in the two countries. Sodium chloride was the most commonly used cleansing agent in the UK, as opposed to warm water in Sweden. The use of antibacterial/antiseptic dressings and antibiotics was more frequent in the UK. Nurses there also used scientific and professional literature more frequently. Swedish nurses experienced more problems in obtaining new information. CONCLUSION: Differences exist between the two countries in leg ulcer management. These may be related to differences in the health-care systems, staff training and attitudes to evidence-based practice.

Chronic Disease↗

Treating restless legs syndrome: current pathophysiological concepts and clinical trials.

Restless legs syndrome is a distinctive clinical syndrome with a prevalence of about 5% in the general population. One of the outstanding characteristics of restless legs syndrome is its extreme responsiveness to dopaminergic agents. Together with the latest pathophysiological and genetic findings, recent epidemiological and clinical data give a new insight into the classification of restless legs syndrome, thus building the theoretical foundation for the development of new pharmacological methods in its treatment. Current efforts within this area focus on establishing dopaminergic substances for therapy. The hypothesis of a disturbed iron metabolism in restless legs syndrome has been revived by recent theoretical considerations. The present review attempts to explain current strategies of treatment for restless legs syndrome in relation to aetiological, genetic and pathophysiological findings.

Animals↗

Dopamine agonists for the treatment of restless legs syndrome.

The restless legs syndrome is a neurological disorder characterised by the urge to move the extremities associated with paraesthesias, which are partially or totally relieved by movement, a worsening of symptoms at rest and in the evening or at night and, as a consequence, sleep disturbances. Restless legs syndrome is common and affects 1-10% of the population. The aetiology of restless legs syndrome is unknown, but, beside genetic factors, the dopaminergic system may play a crucial role. Current treatment strategies are not curative, but may nevertheless produce an effective and lasting relief of symptoms. Evidence-based and clinical guidelines identify dopamine agonists as a first-line treatment for daily restless legs symptoms, and such substances are in the process of registration for this indication. In May 2005, the first dopamine agonist, ropinirole, was approved by the FDA. This review discusses treatment studies of dopamine agonists in patients with restless legs syndrome and focuses on long-term treatment with dopamine agonists.

Dopamine Agonists↗

Technical-methodological report: a nomogram for peak leg power output in the vertical jump.

Leg power is an important component in assessing both performance-related and health-related fitness. The Lewis equation and nomogram have been used for years to estimate leg power. A recent evaluation of the Lewis equation and further research led to the development of the Sayers equation. This equation provides an estimate of peak leg power, which has greater relevance than average power. Our purpose was to provide a simple and effective nomogram for calculating peak leg power output. The Sayers equation was transformed to an alignment nomogram and evaluated for facility of use and accuracy. The resultant alignment nomogram is easy to use and generates values for peak leg power in the vertical jump, which are well within the precision of the regression equation (r > 0.9999, CV < 0.2%). Interobserver error was less than 0.3% with a correlation of 0.9999. The Keir nomogram provides a simple and effective representation of the Sayers equation for use in both performance-related and health-related fitness assessments.

Adult↗

Effects of ischemic training on leg exercise endurance.

This study tested whether ischemic exercise training (Tr(IS+EX)) would increase endurance of ischemic (Ex(IS)) and ramp exercise (Ex(RA)) knee-extension tests more than exercise training (Tr(EX)) alone. Ten healthy subjects performed pre- and posttraining tests with each leg. For Ex(RA), after subjects warmed up, a weight was added each minute until they were exhausted. Ex(IS) was similar, but after warm-up, we inflated a thigh cuff to 150 mmHg instead of adding weights. One leg was chosen for Tr(IS+EX) (cuff inflated to 150 mmHg during exercise) and the other for Tr(EX), both with a small weight on each leg, four to six times per daily session for 3 to 5 min each, 5 days per week for 6 weeks. Ex(IS) duration increased 120% more (p = 0.002) in the Tr(IS+EX) leg than in the contralateral Tr(EX) leg, whereas Ex(RA) duration increased only 16% (nonsignificant). Tr(IS+EX )and Tr(EX) significantly attenuated the ventilation increase (ergoreflex) during Ex(IS). TheO(2) debt for Ex(IS )was significantly lower and systolic blood pressure recovery was faster after Tr(IS+EX) than after Tr(EX). Heart rate recovery after Ex(RA )andEx(IS )was faster after Tr(IS+EX). Apparently, Tr(IS+EX) with low-intensity resistance increases exercise endurance and attenuates the ergoreflex and therefore may be a useful tool to increase regional muscle endurance to improve systemic exercise capacity in patients.

Adult↗

Optimal management of chronic leg ulcers in the elderly.

Chronic leg ulceration is a very common clinical problem in the elderly. Good management depends entirely on making an accurate diagnosis, and planning treatment after considering all aspects of patient well-being. All elderly patients with leg ulcers benefit from an assessment of their vascular status, since the effects of gravity influence treatment and healing irrespective of the diagnosis. The most common causes of ulceration are venous and arterial disease. Diabetes mellitus, pressure, vasculitis, metabolic abnormalities and skin cancer are all unusual causes of leg ulceration, but must be considered in the differential diagnosis. Almost all patients with ulcerated legs benefit from the use of compression bandaging at a level appropriate to their vascular status. In patients with venous ulcers, this can be achieved with a number of bandaging techniques; however, multilayer bandaging appears to be the most cost-effective means available, particularly when combined with community-based leg ulcer clinics. The effects of oral drug therapy for venous and arterial disease have been disappointing. Local dressings are important in ulcers that are not suitable for compression therapy. The choice of dressing depends on the nature of the ulcer and the tolerability of the dressing for the patient.

Administration, Oral↗