Association of Calf Muscle Pump Stimulation With Sleep Quality in Adults.

Prevention of lower extremity fluid pooling (LEFP) is associated with improved sleep quality. Physical activity and compression stockings are non-invasive methods used to manage LEFP, but both are associated with low adherence. Calf muscle pump (CMP) stimulation is an alternative and more convenient approach. Convenience sampling was used to recruit 11 participants between ages 45 and 65 with poor sleep quality. A within-person single-group pre-test-post-test design was used to evaluate changes in sleep quality, daytime sleepiness, and functional outcomes sensitive to impaired sleep as measured by the Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire, and Epworth Sleepiness Scale after 4 weeks of CMP stimulation. Statistical analysis included effect size (ES) calculations. After daily use of CMP stimulation, participants demonstrated improvement in overall sleep quality (ES = -.97) and a large reduction in daily disturbance from poor sleep (ES = -1.25). Moderate improvements were observed in daytime sleepiness (ES = -.53) and functional outcomes sensitive to sleepiness (ES = .49). Although causality could not be determined with this study design, these results support further research to determine whether CMP stimulation can improve sleep quality. © 2016 Wiley Periodicals, Inc.

Calf muscle pump stimulation as a means to reduce symptoms of fibromyalgia syndrome.

Fibromyalgia (FM) is a debilitating chronic condition that often affects women in midlife with widespread pain that interrupts attempts to exercise. The purpose of this pilot study was to test the efficacy of calf muscle pump (CMP) stimulation as an adjuvant therapy for FM by (1) assessing the correlation of the level of symptoms, as measured by the revised Fibromyalgia Impact Questionnaire (FIQR), and blood pressure (BP), (2) measuring change in mean FIQR scores for subjects who use a CMP-stimulation device for 12 weeks, and (3) measuring the correlation of total device usage and the level of symptoms as measured by the FIQR. The 29 male and female participants (mean age = 47.3 years) were screened using the Widespread Pain Index (WPI), Symptom Severity (SS) score, and the FIQR. Participants were contacted weekly, and progress was assessed using the WPI, SS score, and the FIQR as well as general questions regarding responses to CMP stimulation. The attrition rate was high, which is not uncommon in studies of patients with FM. We found that diastolic BP was significantly inversely correlated with baseline FIQR scores during quiet sitting. Further, 12 weeks of CMP stimulation was associated with significant improvement in average FIQR scores at a rate of approximately -1.5 points per week (R (2) = .9; p ≤ .0001). Total device usage was strongly and inversely correlated with baseline FIQR scores (R (2) = .43; p = .02). These findings suggest that CMP stimulation may provide an additional treatment option for individuals with FM who are challenged to perform traditional forms of exercise.

Reversal of lower limb edema by calf muscle pump stimulation.

BACKGROUND: Peripheral edema (PE) is commonly coupled with heart failure, restrictive cardiomyopathy, nephrotic syndrome, renal failure, and hypoproteinemia. Diuretics and/or limb elevation, although commonly prescribed to treat PE, are often insufficient to remove sufficient fluid to prevent complications. We assessed the ability of the calf muscle pump (CMP) stimulation to reverse PE. METHODS: Fluid volume was evaluated by air plethysmography in the right legs of 54 adult women (mean age 46.7 +/- 1.5 years) following venous status assessment. Change in calf volume was assessed during 30 minutes of quiet sitting, followed by 30 minutes of sitting with CMP stimulation via micromechanical stimulation of the plantar surface. RESULTS: Leg volume changes demonstrated a bimodal distribution. Leg volume decreased during quiet sitting in 56% of the study group, whereas in 44% of the group, significant lower leg fluid pooling was evident (increase in calf volume of 14.0 +/- 0.3 mL/h). CMP stimulation reversed the fluid pooling in the edematous group (-2.7 +/- 0.1 mL/h) and was able to accelerate fluid removal in the nonedematous group. CONCLUSIONS: Approximately two fifths of adult women experience substantial pooling when their lower limbs are maintained in a dependent position. Lower-extremity edema exhibited by these women may primarily be due to inadequate calf muscle tone because exogenous stimulation of the CMP was sufficient to halt and reverse fluid pooling. Whether CMP stimulation would provide a means to treat PE in individuals with edema-related health complications, such as congestive heart failure, merits further investigation.

Ultrasonometric profiling of incidence and risk of osteoporosis in rural women.

BACKGROUND: It is estimated that over 200 million people worldwide have osteoporosis. The prevalence of osteoporosis is continuing to escalate with the increasingly aging population. The major complication of osteoporosis is an increase in fragility fractures leading to morbidity, mortality, and decreased quality of life. This investigation profiled the incidence and risk of osteoporosis in adult women from a rural setting using ultrasonic bone scanning technology. METHODS: Between 2001 and 2005, adult female subjects (n = 323) in the age range of 40-87 were drawn from an independent, community dwelling, convenience sample. Bone mineral density T-scores were evaluated using heel ultrasonometry. Demographic and risk factor data, Merck Osteoporosis Evaluation SCORE questionnaire data, and the Osteoporosis Risk Assessment questionnaire data were analyzed. RESULTS: Results of these scans indicate that 25% of the total population had a T-score < or = -1.0, implying a 1.5- to 2.0-fold increase in risk ratio of hip or spinal fracture for each standard deviational decrease. Age at menopause and weight had a positive correlation with T-scores. While the overall scores on the Merck SCORE questionnaire were inversely correlated to T-scores, no significant correlation was found between the Osteoporosis Risk Assessment questionnaire and T-score data. Additionally, women who had taken estrogen had significantly higher T-scores (p = 0.038) than those who had not. CONCLUSION: That approximately 25% of this sample has low bone mass or osteoporosis underscores the importance of early screening in order to develop preventative awareness and provide education on bone health management. This finding has particularly important ramifications, since the sample was rural women, who typically have limited access to diagnostic bone density procedures.

Reversal of lower limb venous and lymphatic pooling by passive non-invasive calf muscle pump stimulation.

Our preliminary data indicate that exogenous plantar micromechanical stimulation at 45 Hz applied at the plantar surface can prevent tachycardia and blood pressure depression associated with immobility, consistent with improvement in venous and lymphatic fluid return delivered by increased calf muscle activity. In this study, instantaneous beat-to-beat systolic blood pressure of thirty four healthy adult women participants (n=34; age range: 35-78 years) were assessed non-invasively using servo-controlled infra-red finger arterial plethysmography, for 30 minutes in the supine position, followed by 30 minutes in the seated position without plantar stimulation, and lastly for 30 minutes in the seated position with the application of a 45 Hz plantar stimulus (50 microm, p-p). Thirty minutes of supine rest resulted in an average increase of 15 mmHg in systolic pressure. During the 30 minutes of upright sitting regimen, two distinct sub-populations were observed. One group (n=18; "hypotensives") experienced a depression of approximately 15 mmHg in systolic pressure, while the other group (n=16; "normotensives and hypertensives") experienced an elevation in the systolic pressure by approximately 8 mmHg. The subsequent 30 minute application of plantar stimulus reversed the pressure drop in hypotensives and elevated the systolic pressure by approximately 20 mmHg in all the subjects. Plantar-based exogenous micromechanical vibration may be an effective approach for reversal of blood pressure depression associated with the physical stress of immobility over a long term, consistent with enhanced venous and lymphatic fluid return delivered via improved calf muscle contractility.

Ultrasonometric profiling of incidence and risk of osteoporosis on rural women.

It is estimated that over 200 million people worldwide have osteoporosis. The prevalence of osteoporosis is continuing to escalate with the increasingly elderly population. The major complication of osteoporosis is an increase in fragility fractures leading to morbidity, mortality, and decreased quality of life. This investigation aimed at profiling the incidence and risk of osteoporosis in adult women from a rural setting using ultrasonic bone scanning technology. Peri- and postmenopausal female subjects (n=234) were drawn from a convenience sample. After a non-radiative dual X-ray absorptiometric scanning, the bone mineral density was measured from the heel of the subjects using bone ultrasonometry, and their T-scores were recorded. Results of these scans indicate that in adult women in the age range of 32 and 87, 23.5% of the population had a heel ultrasonic T-score < or =1.0, implying a 1.5 to 2.0 fold increase in risk ratio of hip or spinal fracture for each standard deviational decrease. Age at menopause was positively correlated with T-scores (p= 0.032); the higher the age at menopause, the higher the T scores. Additionally, women who had taken estrogen had significantly higher T-scores (p=0.038) than those who had not. That approximately 25% of this sample has low bone mass or osteoporosis underscores the importance of early screening in order to develop awareness and provide education on bone health management.