Acute Peripheral Blood Flow Response Induced by Passive Leg Cycle Exercise in People With Spinal Cord Injury

Ballaz, Laurent; Fusco, Nicolas; Crétual, Armel; Langella, B.; Brissot, R.

doi:10.1016/j.apmr.2007.01.011

Cited by 31 publications

(44 citation statements)

References 41 publications

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“…25 Passive leg cycle exercise in the sitting position increased vascular blood flow velocity in the paralyzed legs of patients with paraplegia. 26 On the other hand, passive leg movements and cycling did not affect on the arterial peripheral circulation assessed by echo Doppler measurements in subjects with spinal cord injury. 27 In the present experimental and clinical studies, we demonstrated a clear enhancement of blood flow by WBPA.…”

Section: Discussionmentioning

confidence: 99%

Passive Exercise Using Whole-Body Periodic Acceleration Enhances Blood Supply to Ischemic Hindlimb

Rokutanda

Izumiya²,

Miura³

et al. 2011

ATVB

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Objective-Whole-body periodic acceleration (WBPA) has been developed as a passive exercise technique to improve endothelial function by increasing shear stress through repetitive movements in spinal axis direction. We investigated the effects of WBPA on blood flow recovery in a mouse model of hindlimb ischemia and in patients with peripheral arterial disease. Methods and Results-After unilateral femoral artery excision, mice were assigned to either the WBPA (nϭ15) or the control (nϭ13) group. WBPA was applied at 150 cpm for 45 minutes under anesthesia once a day. WBPA significantly increased blood flow recovery after ischemic surgery, as determined by laser Doppler perfusion imaging. Sections of ischemic adductor muscle stained with anti-CD31 antibody showed a significant increase in capillary density in WBPA mice compared with control mice. WBPA increased the phosphorylation of endothelial nitric oxide synthase (eNOS) in skeletal muscle. The proangiogenic effect of WBPA on ischemic limb was blunted in eNOS-deficient mice, suggesting that the stimulatory effects of WBPA on revascularization are eNOS dependent. Quantitative real-time polymerase chain reaction analysis showed significant increases in angiogenic growth factor expression in ischemic hindlimb by WBPA. Facilitated blood flow recovery was observed in a mouse model of diabetes despite there being no changes in glucose tolerance and insulin sensitivity. Furthermore, both a single session and 7-day repeated sessions of WBPA significantly improved blood flow in the lower extremity of patients with peripheral arterial disease. Conclusion-WBPA increased blood supply to ischemic lower extremities through activation of eNOS signaling and upregulation of proangiogenic growth factor in ischemic skeletal muscle. WBPA is a potentially suitable noninvasive intervention to facilitate therapeutic angiogenesis. (Arterioscler Thromb Vasc Biol. 2011;31:2872-2880.)Key Words: angiogenesis Ⅲ endothelial function Ⅲ exercise Ⅲ peripheral arterial disease Ⅲ vascular biology P atients with peripheral arterial disease (PAD) are at risk of limb loss and impairment of quality of life. 1 Exercise therapy is an effective primary nonpharmacologic treatment for patients with PAD. 2,3 The proposed mechanisms for the beneficial effects of exercise training on PAD include the formation of collateral vessels, improvement in endotheliumdependent vasodilatation and skeletal muscle metabolism, and increased secretion of proangiogenic growth factors. 2,4 -6 Based on this evidence, the current guidelines recommend supervised exercise for patients with PAD. However, it is sometimes difficult to provide appropriate exercise therapy for PAD patients who are incapable of performing active exercise, such as those with neurodegenerative and rheumatologic diseases or age-related skeletal muscle wasting referred to as sarcopenia.Whole-body periodic acceleration (WBPA) is a noninvasive, passive exercise that produces repetitive head-to-footdirection movements of the body. 7,8 Matsumoto et al 9 demon...

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Section: Discussionmentioning

confidence: 99%

Passive Exercise Using Whole-Body Periodic Acceleration Enhances Blood Supply to Ischemic Hindlimb

Rokutanda

Izumiya²,

Miura³

et al. 2011

ATVB

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“…These authors showed no change in femoral blood flow or leg vascular resistance (calculated as mean arterial pressure divided by leg blood flow) for either either of the passive exercise modalities. In contrast, Ballaz et al 57 reported that leg blood flow (measured using Doppler ultrasound) increased in PARA after 10 min of passive cycling. These authors acknowledged the discrepancy and inferred a number of methodological differences between studies to account for marked disparities (such as higher cadence, continuous exercise without 10-s rest periods for flow measurements, larger sample size and optimal force arm length to involve the maximum musculature for a given pedal rotation).…”

Section: Resultsmentioning

confidence: 87%

“…Eight articles were prospective control trials 31,41,[51][52][53][54][55][56] and six were pre-post design. 40,[57][58][59][60][61] Papers investigating acute exercise included: passive leg exercise (n ¼ 3), 53,57,60 FES (n ¼ 3), 54,55,59 single muscle electrical stimulation (n ¼ 1), 56 upper body continuous aerobic exercise (arm cycling or wheeling) (n ¼ 5), 31,40,41,52,58 acute combined arm passive leg exercise (n ¼ 1) 61 and stretchinduced contractions (n ¼ 1). 51 Tables 1 and 2 are a summary of published investigations researching the effect of acute exercise on arterial function in SCI individuals.…”

Section: Resultsmentioning

confidence: 99%

“…These authors acknowledged the discrepancy and inferred a number of methodological differences between studies to account for marked disparities (such as higher cadence, continuous exercise without 10-s rest periods for flow measurements, larger sample size and optimal force arm length to involve the maximum musculature for a given pedal rotation). 57 Conclusions: There is level 4 evidence (indicating available evidence but without comparable groups) that a single bout of passive leg exercise increases leg blood flow, 57 whereas there is level 2 53 (debatable but reliable results) and level 4 evidence 60 suggesting no change in leg blood flow or leg vascular resistance in response to passive leg exercise. As only three papers have published results on leg blood flow changes in response to passive leg exercise, further research, incorporating various exercise intensities and force arm lengths with adequate sample sizes, is warranted.…”

Section: Resultsmentioning

confidence: 99%

“…49,53,57 In a published Letter to the editor, 80 Hopman's group, which had shown no increase in femoral artery blood flow in response to passive leg exercise, questioned the results and methodology of work published by Ballaz et al 57 showing opposite results. Although no definitive conclusion resulted from this discussion, the influence of the muscle pump at increasing femoral artery flow in response to passive exercise was implicated as the potential mechanism.…”

Section: Discussionmentioning

confidence: 98%

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A systematic review of exercise as a therapeutic intervention to improve arterial function in persons living with spinal cord injury

Phillips

Coté

2011

Spinal Cord

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Study design: All randomized controlled trials, prospective cohort, case-controlled, pre-post studies and case reports that assessed exercise interventions, which influence arterial structure and function after spinal cord injury (SCI), were included. Objective: To review systematically the evidence for exercise as a therapy to alter arterial function in persons with SCI. Setting: Literature searches were conducted for appropriate articles using several electronic databases (e.g. MEDLINE, EMBASE). Methods: Three independent reviewers evaluated each investigation's quality, using the Physiotherapy Evidence Database Scale for randomized controlled trials and Downs and Black Scale for all other studies. Results were tabulated and levels of evidence assigned. Results: A total of 283 studies were found through the systematic literature search. Upon review of the articles, 27 were included. The articles were separated into those investigating arterial benefits, resulting from either acute bouts of exercise or long-term exercise interventions. The ability of both acute and long-term exercise interventions to improve arterial structure and function in those with SCI was supported by limited to moderate methodological quality. Upper body wheeling is the most commonly examined exercise therapy for improving arterial function. It appears from the evidence that a variety of exercise interventions, including passive exercise, upper body wheeling, functional electrical stimulation and electrically stimulated resistance exercise, can improve arterial function in those living with SCI. Conclusions: Although the quality and volume of evidence is low, the literature supports exercise as a useful intervention technique for improving arterial function in those with SCI.

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Stimulation Interval Evaluation for Lower‐Limb Cycling Movement Based on Torque Observer

Hsueh

Tsai

Chen

2017

Asian Journal of Control

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A functional electrical stimulation (FES) assisted cycling ergometer incorporating passive or active movement has been proven to be effective in rehabilitation for stroke patients. Although a conventional five-bar linkage model of lower-limb cycling movement was proposed earlier to evaluate the stimulation interval, the accuracy of the obtained anthropometric data of patients still remains uncertain. To properly deliver FES during cycling for restoring the physical strength of patients, this study proposes a method of stimulation interval evaluation by integrating a torque observer into a motor driven cycle ergometer. The torque observer design, which is based on the measured motor current and position information, is employed to evaluate the stimulation interval without measuring the anthropometric data of patients. Simulated and experimental results were compared to verify the effectiveness of the proposed torque observer approach; meanwhile, the results of the study showed that the torque observer indeed provides a proper stimulation interval for FES in comparison to that of the conventional five-bar linkage model.

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Acute Peripheral Blood Flow Response Induced by Passive Leg Cycle Exercise in People With Spinal Cord Injury

Cited by 31 publications

References 41 publications

Passive Exercise Using Whole-Body Periodic Acceleration Enhances Blood Supply to Ischemic Hindlimb

Passive Exercise Using Whole-Body Periodic Acceleration Enhances Blood Supply to Ischemic Hindlimb

A systematic review of exercise as a therapeutic intervention to improve arterial function in persons living with spinal cord injury

Stimulation Interval Evaluation for Lower‐Limb Cycling Movement Based on Torque Observer

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