Association between heel-rise test performance and clinical severity of chronic venous insufficiency.

BACKGROUND: Peripheral pump dysfunction is important in identifying manifestations of chronic venous insufficiency. The association with disease severity may define better treatment strategies. OBJECTIVE: To evaluate the association between peripheral muscular pump performance by heel-rise test, age, physical activity, use of compression stockings, and chronic venous insufficiency clinical severity. METHODS: Subjects with chronic venous insufficiency were enrolled in the study (n = 172) and evaluated by clinical-etiology-anatomy-pathophysiology severity and heel-rise test. RESULTS: In model 1 of logistic regression, number of heel-rise test repetitions, age, and physical activity explained 47% of clinical-etiology-anatomy-pathophysiology severity (p = 0.0001), physical activity contributed the most. In model 2, heel-rise test repetition rate, age, and physical activity explained 46.4% of clinical-etiology-anatomy-pathophysiology severity (p = 0.0001), repetition rate contributed the most. Conclusion: There was an inverse association between muscular pump performance and physical activity with clinical-etiology-anatomy-pathophysiology severity, muscular pump repetition rate contributed to a less severe outcome.

Supervised Exercise Therapy for Intermittent Claudication.

Highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions-medication, surgery, education, nutrition, and exercise-and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature. Each article in this Physical Therapy (PTJ) series will summarize a Cochrane review or other scientific evidence resource on a single topic and will present clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on the effectiveness of supervised exercise therapy for intermittent claudication. Can supervised exercise therapy help a person with intermittent claudication?

Effects of modified aerobic training on muscle metabolism in individuals with peripheral arterial disease: a randomized clinical trial.

The primary objective of this study was to compare the effects on muscle metabolism of two types of aerobic training, with and without a load on the lower limbs, in adults with peripheral arterial disease (PAD). A simple blind randomized clinical trial was conducted using two groups: conventional aerobic (CG) and modified aerobic with a load on the lower limbs (MG). Both groups underwent training by walking three times a week over a 12-week period. The ratings of muscle metabolism were determined after a treadmill test with constant velocity and inclination concomitant with the use of near infrared spectroscopy (NIRS). Altogether 40 individuals with PAD (CG = 65.45 ± 10.60 and MG = 63.10 ± 10.54) were included in the study. After the intervention, in both groups, there was a reduction in the relative time to recovery (p = 0.002), an improvement in the re-oxygenation rate (p = 0.017), an increased time of resistance after reaching the lowest muscle oxygen saturation (StO2) (p < 0.001), an increase in the distance walked (p < 0.001), and an improvement of the walking economy relative to StO2 (p < 0.001). After 12 weeks of training, an improvement in the deoxygenation rate was observed in both groups (p = 0.002), but with a greater magnitude in the CG (p = 0.017). Only the CG presented an increase in time to reach the lowest StO2 on the treadmill after the intervention (p = 0.010). The traditional aerobic training was superior to the modified training in relation to the improvement of muscle metabolism in patients with PAD.

Reference values for the bilateral heel-rise test.

BACKGROUND: The bilateral heel-rise test is an instrument that evaluates the performance of the triceps surae. Normative parameters need to be established for the use of the heel-rise test in clinical practice. OBJECTIVE: To determine the reference values for the bilateral heel-rise test. METHODS: This cross-sectional study assessed healthy subjects using the bilateral heel-rise test. We analyzed the number of repetitions, time (in seconds), and repetition rate (repetitions/second) during execution of the heel-rise test, until the point of voluntary fatigue. The estimates were stratified by age and gender. Multiple linear regression was performed to define the reference equation for the bilateral heel-rise test. RESULTS: A total of 147 individuals were included. The median age was 37 years (IQR 28-46). It was observed that the number of repetitions decreases with age, with a higher number of repetitions in male participants compared to female participants. Gender, body mass index, and maximum activity scores predict 14% of the number of plantar flexions performed in the bilateral heel-rise test. Age and adjusted activity scores predict 18% of the repetition rate in the bilateral heel-rise test. CONCLUSION: The bilateral heel-rise test reference values for an adult population were defined as scores above the 25th percentile for number of repetitions, time, and repetition rate. The number of heel-rise test repetitions that corresponds to the 25th percentile, according to age and gender, is as follows: age 20-29, 65 repetitions for men and 45.5 for women; age 30-39, 62.75 men and 41.5 women; age 40-49, 67.25 men and 45 women; and age 50-59, 54 men and 39.25 women.

Does the heel-rise test explain functional capacity in venous insufficiency? / O teste da ponta do pé prediz capacidade funcional na insuficiência venosa?

Introduction Individuals with chronic venous insufficiency (CVI) have muscle pump dysfunction and reduced functionality. However, studies are inconsistent in proving whether a particular test can assess muscle functional capacity. Therefore, the aim of this study was to evaluate whether the heel-rise test (HRT) is able to explain functional capacity in patients with CVI. Materials and methods Subjects with CVI aged between 20 and 59 years old were selected for this study. All participants were classified by means of the Clinical Anatomy Etiology Pathophysiology Classification of Chronic Venous Disease (CEAP). The HRT and the shuttle walk test (SWT) were performed. Descriptive statistics, Spearman correlation, linear models and regression variance analysis (one-way ANOVA) were used for data analysis. Significance was set at alpha ≤ 5%. Results 79 subjects were included in the study (38.79 ± 1.34 years). The HRT was able to explain functional capacity only in individuals aged between 50-59 years (R2 = 0.60, p = 0.0001). The heel-rise test was not sensitive to detect differences between the CEAP classes analyzed (p > 0.05). Conclusion The HRT was able to explain functional capacity in individuals aged between 50-59 years, and it can be applied in clinical practice for the functional evaluation of patients with CVI with mild severity in this age range. .

Introdução Indivíduos com insuficiência venosa crônica (IVC) podem apresentar disfunção da bomba muscular e redução de sua funcionalidade. Porém, estudos são inconsistentes em afirmar se um teste específico muscular pode avaliar a capacidade funcional. Sendo assim, o objetivo do presente estudo é avaliar se o teste da ponta do pé (TPP) é capaz de predizer a capacidade funcional em indivíduos com IVC. Materiais e métodos Foram selecionados para o estudo indivíduos com IVC com idade entre 20 e 59 anos. Os participantes foram classificados por meio da CEAP (Clinical Etiology Anatomy Pathophysiology Classification of Chronic Venous Desease). Foram realizados o TPP e o teste do deslocamento bidirecional progressivo (TDBP). Estatísticas descritivas, correlação de Spearman, modelos de regressão linear e análise de variância (ANOVA one-way) foram utilizados para a análise dos dados. Para significância estatística, foi usado alfa de 5%. Resultados Foram incluídos 79 indivíduos (38,79 ± 1,34 anos) no estudo. O TPP foi capaz de predizer a capacidade funcional somente em indivíduos de 50 a 59 anos (R2 = 0,60; p = 0,0001). O TPP não foi sensível em detectar diferenças entre as classes CEAP analisadas (p > 0,05). Conclusão O TPP foi capaz de explicar a capacidade funcional em indivíduos de 50 a 59 anos, podendo ser aplicado na prática clínica de forma válida para a avaliação funcional de pacientes com IVC de gravidade leve nessa faixa etária. .

Confiabilidade teste-reteste do Heel Rise Test na avaliação de indivíduos com doença arterial obstrutiva periférica / Reliability test-retest of Heel Rise Test on individuals assessment with Peripheral Arterial Oclusive Disease

O Heel Rise Test (HRT) é utilizado para avaliação do tríceps sural de indivíduos com Doença Arterial Obstrutiva Periférica (DAP). Possui baixo custo, é fácil e de rápida aplicação. Analisar a confiabilidade teste-reteste do HRT na avaliação de indivíduos com DAP que apresentam claudicação intermitente (CI). Foram incluídos indivíduos com DAP confirmada pelo índice tornozelo-braço (ITB) 0,05).Todas as variáveis analisadas no HRT são medidas confiáveis, comprovando que o teste pode ser utilizado na prática clínica para avaliação de indivíduos com DAP.

Heel-rise test in the assessment of individuals with peripheral arterial occlusive disease.

INTRODUCTION: The heel-rise test (HRT) is a clinical instrument relevant to vascular rehabilitation that has been proposed to assess the function of the triceps surae muscle. To use HRT in the assessment of individuals with peripheral arterial occlusive disease (PAOD), its ability to detect differences in the functional performance of patients with PAOD must be verified. AIM: To verify whether the test is sensitive in differentiating between individuals with PAOD with distinct functional capacities. MATERIALS AND METHODS: A transversal study in which individuals with PAOD were assessed using the HRT, the Walking Impairment Questionnaire (WIQ), and the Shuttle Walk Test. The following variables were analyzed: number of plantar flexions performed in the HRT (time in seconds) and velocity (plantar flexions per second) when performing plantar flexions up to the point of volunteer fatigue, maximum distance walked in the Shuttle Walk Test, and scores obtained in each WIQ domain. RESULTS: Twenty-five individuals (14 male) were included in the study, with a mean age of 63.36 ± 9.83 years. The variables number of plantar flexions and time to perform the HRT were sensitive enough to differentiate between distinct functional capacities in individuals with PAOD (P = 0.003 and P = 0.009, respectively). However, this result was not found for the variable of velocity in the HRT. The number of plantar flexions in the HRT was sensitive enough to differentiate individuals of extreme classes on the WIQ domain, stairs (P = 0.008). CONCLUSION: The HRT can be applied in clinical practice as a valid assessment of the distinct function capacities of individuals with PAOD.