Intermittent walking: a potential treatment for older people with postprandial hypotension.

BACKGROUND: Exercise has been proposed as a possible treatment for postprandial hypotension (PPH), yet, its use has not been extensively investigated. This study aimed to determine the effects of intermittent walking on blood pressure (BP) and heart rate (HR) following ingestion of a glucose drink in older people with PPH. METHODS: Thirteen persons with PPH were recruited and studied on 2 randomized days (control, intervention). On both study days, participants ingested 200 mL of water containing 50 g glucose, followed by ambulatory BP and HR monitoring 6 minutely for 60 minutes, then 15 minutely until 120 minutes. On the intervention day, participants walked at their usual pace for 30 m every 30 minutes for 120 minutes. RESULTS: On the control day, significant falls in systolic blood pressure (SBP) (P < .005) and diastolic blood pressure (DBP) (P = .016) were demonstrated between t = 0-120 minutes. On the intervention day, over the same period, there was no significant fall in SBP (P = .520), however, DBP still fell significantly (P = .045). There was a statistically significant difference (P = .005) for the area under the curve for the change in SBP from baseline for the study days but not DBP (P = .716). There was no significant change in HR (control: P = .854; intervention, P = .168) nor between the area under the curve (P = .798) for the change in HR from baseline for the study days. CONCLUSIONS: This study suggests that in older people with PPH, intermittent walking at a usual pace attenuates the fall in SBP after ingestion of a glucose drink.

Role of intestinal peptides and the autonomic nervous system in postprandial hypotension in patients with multiple system atrophy.

Postprandial hypotension (PPH) is a major clinical problem in patients with autonomic failure such as that observed in multiple system atrophy (MSA). The pathophysiology of PPH remains unclear, although autonomic dysfunction and gastrointestinal vasoactive peptides have been suspected to participate in its pathogenesis. We measured blood pressure and plasma levels of glucose, insulin, noradrenaline, neurotensin, glucagon-like peptide (GLP)-1 and GLP-2 before and after meal ingestion in 24 patients with MSA to reveal the roles of the autonomic nervous system and gastrointestinal vasoactive peptides in PPH. We performed a second meal-ingestion test by administering acarbose to evaluate the effects of acarbose (an α-glucosidase inhibitor) on PPH and vasoactive peptides in 14 patients with MSA and PPH. We also evaluated blood pressure responses to the head-up tilt test and heart rate variability in all the patients. Severities of PPH and orthostatic hypotension were significantly correlated. Patients with PPH had significantly worse orthostatic hypotension and lower heart rate variability than those without PPH. Postprandial GLP-1 secretion was higher in patients with PPH than in those without PPH. No significant differences were observed in the postprandial increases in plasma levels of glucose, insulin, noradrenaline, neurotensin or GLP-2. Acarbose significantly attenuated postprandial hypotension and tended to decrease GLP-2 secretion. Our results indicate that autonomic failure is involved in the pathogenesis of PPH and confirm that acarbose has a preventive effect against PPH in patients with MSA. Decreased postprandial secretion of GLP-2, which increases intestinal blood pooling, may attenuate PPH in patients with MSA.

Validación de la clasificación funcional de la bipedestación del Hospital de Sagunto / Validation of the functional ambulation classification of the Hospital of Sagunto

Introducción: La bipedestación es una de las facultades más importantes y características del ser humano, imprescindible para la mayoría de las tareas funcionales. Por eso es una de las funciones habitualmente exploradas en Rehabilitación. Existen varios test de valoración funcional, pero ninguno es rápido y sencillo ni valora exclusivamente la bipedestación; es por ello que se desarrolló la clasificación funcional de la bipedestación del Hospital de Sagunto (BipHS). El objetivo del presente trabajo es demostrar la fiabilidad y la validez de esta escala utilizando para ello, como patrón de referencia, la posturografía. Material y métodos: Utilizando la escala BipHS, que cuenta con 6 niveles de función autoexcluyentes y autoexplicativos (nivel 0: imposible, 1: completamente dependiente, 2: mano dependiente, 3: libre, 4: prolongada, 5: normal), se evaluó la bipedestación en 36 pacientes con ictus y 10 sujetos sanos por parte de dos observadores independientes, efectuando un análisis de la concordancia entre observadores. Registramos diversos parámetros del equilibrio con un equipo de posturografía y efectuamos un análisis de comparación y correlación entre el nivel de bipedestación de nuestra escala y los valores de la posturografía. Resultados: La concordancia entre observadores fue muy buena, con un índice kappa de Cohen de 0,83 (IC: 0,69–0,97). Obtuvimos una asociación significativa entre las medidas del desplazamiento del centro de presiones (cdp) y la escala BipHS, con una buena correlación lineal. A mejor nivel funcional, mejor equilibrio y menores desplazamientos del cdp. Conclusiones: La escala de BipHS es una escala fiable y válida para valorar el equilibrio en bipedestación (AU)

Introduction: Standing is one of the most important and characteristic features of human beings, indispensable for most functional tasks. Therefore, it is one of the functions usually explored in rehabilitation. There are several tests of functional valuation but none of them are quick and easy neither do they evaluate exclusively standing, fact due to which the Standing scale of the "Hospital de Sagunto" (BipHS) was developed. The aim of this work is to demonstrate the reliability and validity of this scale using, as a standard the posturography analysis. Material and methods: Using BipHS Scale, which takes into account 6 levels of function which are self-excluding and self-explanatory (level 0: imposible, 1: completely dependent, 2: hand-dependent, 3: free, 4: prolonged, 5: normal), we evaluated standing in 36 patients which had suffered a vascular stroke and 10 healthy individuals, using two independent observers making a analysis of agreement between both. We then registered different parameters of equilibrium using posturography and made a comparison and correlation analysis between the level of standing of our scale and the values of posturography. Results: The resulting kappa index was 0,83 (CI: 0,69-0,97), proving a good concordance between observers. We achieved a significant association between the measures of movement of the center of pressure (cp) and the BipHS Scale, with a good linear correlation. The better the functional level, the better the balance and smaller displacement of the cp. Conclusion: BipHS is a trustworthy and valid scale to evaluate standing (AU)

Hipotensión permisiva en la reanimación del paciente traumático / Permissive hypotension in resuscitation of trauma patients

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[Acute traumatic spinal cord injury and cardiovascular complications due to neurogenic shock: a possible threat for functional recovery]. / Traumatisch ruggenmergletsel en cardiovasculaire complicaties door neurogene shock: een mogelijke bedreiging voor het functionele herstel.

Three men aged 18, 18 and 24 years, developed hypotension and bradycardia following an acute traumatic cervical or thoracic spinal cord injury. After treatment in intensive care and 1-12 months of rehabilitation they still suffered from considerable neurological disorders. Hypotension and bradycardia are common phenomena following acute traumatic cervical and thoracic spinal cord injury. Awareness of cardiovascular complications as a possible threat for functional recovery and adequate insight in the neurological cause of hypotension and bradycardia are important issues in the acute treatment of patients with spinal cord injury. It seems sensible to admit these patients to a medium-care or intensive-care department where they can be monitored and treated by a specialised team in accordance with an adequate protocol.

[The importance of individualized physical training in the rehabilitation of patients with arterial hypotension]. / Znachenie individualizirovannykh fizicheskikh trenirovok v reabilitatsii bol'nykh arterial'noi gipotenziei.

Essential hypotension patients whose 2-year program of rehabilitation included continuous physical training according to individual multifactorial programs or relevant training combined with drug therapy showed more favourable clinical response. Threshold muscular load and everyday motor activity rose more significantly when compared to those in patients who received chemotherapy alone.

[Conditioning treatment in hypotonia with complications]. / Konditionierungsbehandlung bei Hypotonie mit Beschwerden.

The social-medical significance of hypotension is in general underestimated. For females between the 18th and 35th year of age it has the same significance for the number of patients as the arterial hypertension. The hospital conditioning is the therapy of choice. About half the affected persons needs psychotherapy. Changes of the functional parameters could not be proved after single treatment, but ameliorations of the general condition and improvements in the patients' physical health could be made evident in the region of psychological tests.