Effects of compression stockings on sympathetic activity and heart rate variability in individuals with spinal cord injury

Abstract

Objective: To investigate whether wearing graduated compression stockings (GCS) could affect the sympathoadrenergic and heart rate variability (HRV) responses at rest and after a strenuous wheelchair exercise in individuals with spinal cord injury (SCI). Design: Crossover trial. Setting: Department of Physical Medicine and Rehabilitation, Saint Etienne, France. Participants: Nine men with SCI (five with low paraplegia: LP, four with high paraplegia: HP). Interventions: Two maximal wheelchair exercise tests: with and without GCS (21 mmHg). Main outcome measures: HRV measurements: high frequency (HF), low frequency (LF), and LF/HF ratio. Norepinephrine (NOR) and epinephrine (EPI), at rest and post-exercise. Secondary measures were: blood pressure, heart rate, maximal power output, oxygen uptake, stroke volume, cardiac output, at rest, during and after exercise. Results: When wearing GCS: LFnu wavelet-post significantly increased and HFnu wavelet-post significantly decreased (P < 0.05) in SCI subjects, leading to an enhance ratio of LF wavelet /HF wavelet and a significantly increased in NOR rest (P < 0.05). Conclusions: GCS induces an enhanced sympathetic activity in individuals with paraplegia, regardless of the level of the injury. Enhanced post-exercise sympathetic activity with GCS may help prevent orthostatic hypotension or post-exercise hypotension.

Effect of lower limb compression on blood flow and performance in elite wheelchair rugby athletes

“…6 Wearing lower limb compression has been suggested to reduce venous distension 11 and enhance sympathetic activity 5 in paraplegic individuals, regardless of lesion level, leading to the prevention of orthostatic hypotension and post-exercise hypotension. 5 The positive effect of lower limb compression on arm blood flow is likely to be achieved through an enhancement of venous return and, in turn, a positive effect on stroke volume and cardiac efficiency. While the present study did not aim to investigate these central cardiovascular dynamics, a tendency for heart rate to be reduced during the COMP trial (not significant), despite the higher volume of work that was achieved during this trial, was observed.…”

“…3 In addition, vascular atrophy occurs below the level of injury resulting in a reduction in femoral artery diameter, venous capacity, and resting and maximal blood flow. 4,5 Excessive lower limb venous pooling is likely to occur in individuals with tetraplegia due to the culmination of peripheral vascular insufficiency and poor muscle pump function. 6,7 This response may be exacerbated during upper-body exercise such as wheelchair rugby.…”

“…6 There is a reduction in venous pooling 6,11,12 and a decrease in venous capacitance below the lesion level, 11 which potentially contributes to an improved hemodynamic state and enhanced sympathetic activity. 5 Whether the physiological effects of lower limb compression garments are associated with alterations in wheelchair performance in individuals with a highlevel SCI is not clear. Therefore, the purpose of the present study was to examine the effect of compression socks worn during exercise on upper and lower limb blood flow and wheelchair performance in elite wheelchair rugby athletes.…”

Assessing kinematics and kinetics of functional electrical stimulation rowing

“…SCI does not alter this effect, and in fact may make exercise of critical importance to health (Groah et al, 2012; Hooker and Wells, 1989; Nash et al, 2012; West et al, 2014a). However, this population is typically restricted to only upper body exercise, which involves a smaller amount of muscle mass and limits cardiovascular adaptations compared to lower extremity or combined activities (Figoni, 1993; Gates et al, 2002; Pitetti et al, 1994; Rimaud et al, 2012; West et al, 2014b). To overcome both of these limitations, functional electrical stimulation (FES) of the lower body combined with upper body exercise actively engages more muscle mass and demands greater cardiovascular adjustments and hence can lead to broad health benefits (Petrofsky and Phillips, 1984).…”

Postural Hypotension Associated with Nonelastic Pantyhose during Lymphedema Treatment

“…Graduated compression stockings might affect the sympathoadrenergic variability and heart rate variability in response to rest and after strenuous exercise by individuals in wheelchairs with spinal cord injury [7]. …”