Key result
Lower limb strengthening fails to improve venous ejection fraction or systolic blood pressure drops in OH.
Why the study?
Activation of muscles during standing is recommended to engage the skeletal muscle pump and raise blood pressure in orthostatic hypotension, but whether lower limb strengthening improves venous pump effectiveness and postural blood pressure was unknown.
Does an 8-week lower limb strengthening intervention improve orthostatic blood pressure and venous ejection fraction in older people with orthostatic hypotension?
Does an 8-week lower limb strengthening intervention improve orthostatic blood pressure and venous ejection fraction in older people with orthostatic hypotension?
Effect estimate: percentage change -10% (IQR -16 to 24) for venous EF; 0% (IQR -17 to 16) for systolic BP drop
p-value: p=0.8 for venous EF; 1.0 for systolic BP drop
An 8-week lower limb strengthening intervention successfully increased muscle strength but failed to improve orthostatic blood pressure or venous ejection fraction in older patients with orthostatic hypotension.
Single case suggests no orthostatic benefit from lower limb strengthening; leaves open need for controlled trials in OH.
INTRODUCTION: Activation of muscles during standing is recommended to activate the skeletal muscle pump, increasing venous return and increasing blood pressure (BP) in people with orthostatic hypotension (OH). AIM: The aim of this study is to determine if increasing the strength of the lower limb muscles can improve the effectiveness of the venous pump and postural BP in older people with OH. METHODS: Ten older people with OH underwent an 8-week lower limb strengthening intervention. Repeated measurements of orthostatic BP, calf venous ejection fraction (EF) and muscle strength took place before, during and after intervention. RESULTS: The intervention increased calf muscle strength by 21% (interquartile range: 18-28), p = 0.018, from a median baseline of 38 (34-45) kg. Participants had normal levels of venous EF 64% (51-75) at baseline, with little to no venous reflux. The median ejection volume at baseline was 44 (36-58) mL per calf. Despite increasing muscle strength, venous EF did not increase (percentage change -10% (-16 to 24), p = 0.8) and systolic BP drop did not improve (percentage change 0% (-17 to 16), p = 1.0). Similarly, visual analysis of individual case-series trends revealed increasing muscle strength with no clinically meaningful change in EF or orthostatic BP. CONCLUSIONS: Muscle strengthening exercise does not increase the effectiveness of the skeletal muscle pump and is not an efficacious intervention for OH. As there is little to no venous pooling in the calf during standing in older people with OH, below knee compression is unlikely to be clinically effective.
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Frith et al. (2023) studied orthostatic hypotension (n=10). lower limb strengthening exercise was evaluated on venous ejection fraction (EF) and systolic BP drop (percentage change -10% (IQR -16 to 24) for venous EF; 0% (IQR -17 to 16) for systolic BP drop, p=0.8 for venous EF; 1.0 for systolic BP drop). An 8-week lower limb strengthening exercise increased muscle strength but did not improve venous ejection fraction (P=0.8) or systolic blood pressure drop (P=1.0) in older people with OH.
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