EFEKTIVITAS TERAPI LEG EXERCISE INTRADIALYTIC TERHADAP PENURUNAN MUSCLE CRAMP PADA PASIEN CHRONIC KIDNEY DISEASE YANG MENJALANI HEMODIALISIS

Pendahuluan: Chronic Kidney Disease (CKD) yang terjadi > 3 bulan dan ditunjukan oleh nilai laju filtrasi glomerulus (GFR) < 15 ml/menit/1,73m2 pada tahap stadium akhir (End Stage Renal Disease (ESRD)) diperlukan terapi pengganti ginjal, yaitu salah satunya hemodialisis. Salah satu permasalahan yang sering dikeluhkan pasien hemodialisis rutin adalah muscle cramp, yang biasanya dirasakan satu jam sebelum hemodialisis selesai dilakukan. Untuk mengatasi gejala tersebut dilakukan leg exercise intradialytic. Tujuan penelitian untuk mengidentifikasi pengaruh terapi leg exercise intradialytic terhadap penurunan muscle cramp pada pasien CKD yang menjalani hemodialisis. Metode: Metode penelitian: penelitian bersifat kuantitatif dengan desain quasi eksperimental one group pre-post test design. Sampel ditentukan dengan metode purposive sampling. Hasil: Hasil penelitian menunjukkan bahwa terjadi perubahan yang signifikan muscle cramp sebelum dan sesudah dilakukan terapi leg exercise intradialytic dengan p value = 0,000. Kesimpulan: Terapi leg exercise intradialytic selama hemodialisis dapat menurunkan muscle cramp pada pasien CKD yang menjalani hemodialisis.

Feasibility and Safety of a Novel Leg Exercise Apparatus for Venous Thromboembolism Prophylaxis After Total Joint Arthroplasty of the Lower Extremities

Background: Venous thromboembolism (VTE) is a severe complication of orthopedic surgeries. Although mechanical measures such as graduated compression stockings and intermittent pneumatic compression are widely used for VTE prevention, complications (e.g. lower limb pain or skin disorders) may result from prolonged usage. Early postoperative ambulation and active ankle movements are recommended but have low patient acceptance due to surgical pain and the lack of motivation. To overcome these limitations, we developed a novel leg exercise apparatus (LEX) to encourage limb movement in bedridden patients in the early postoperative period in order to prevent VTE. Here, we aimed to evaluate the feasibility and safety of the LEX in individuals at high risk of deep vein thrombosis (DVT) postoperatively. Methods: Twenty subjects (4 men, 16 women) who underwent total joint arthroplasty in the lower extremity were enrolled in this prospective study. Exercise using LEX was performed for 5 minutes at 30 cycles/min, four times per day from postoperative days 1 to 7. Clinical assessments included the evaluation of vital signs before and after exercise with LEX, venous ultrasonography and blood tests within 7 days postoperatively, and evaluation of adverse events, including pulmonary embolism and cerebral hemorrhage.Results: Overall, 16/20 (80%) patients completed the exercise regimen of 7 days, while 4 dropped out. All four subjects who dropped out had undergone total hip arthroplasty; three of them refused to start exercises with LEX because of leg pain related to surgery. No severe adverse events occurred. There were no severe changes in vital signs. No DVT of the lower extremities was confirmed during postoperative week 1. The average preoperative D-dimer level was 0.85 µg/mL (range, 0.4-2.2), whereas the corresponding value in postoperative week 1 was 7.93 µg/mL (range, 2.0-13.8).Conclusions: In this study, no DVT cases or severe adverse events occurred postoperatively in patients undergoing total joint arthroplasty of the lower extremities who performed exercises with LEX. A study protocol analyzing the efficacy of this tool to prevent VTE after joint arthroplasty of the lower extremities may be safe and feasible.

Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

Category: Ankle; Sports Introduction/Purpose: Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study is to analyze the variability across rehabilitation for patients undergoing lateral ankle ligament repair, reconstruction, or suture tape augmentation. Methods: 26 protocols were found. Inclusion criteria was protocols for ankle ligament surgery. Protocols for nonoperative care were excluded. A rubric was created to analyze weightbearing, range of motion (ROM), immobilization, single leg exercises, return to running, and return to sport (RTS). Results: There was variability especially in recommendations for immobilizing brace, partial and full weigh bearing, specific ROM movements of the ankle, and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement. 100% (12/12) of repair and 86% (12/14) of reconstruction protocols recommended no ROM postoperatively, and 86% (6/7) repair and 78% (11/14) reconstruction recommended no weightbearing postoperatively, making postoperative ROM and weightbearing status the most consistent aspects across protocols. Suture tape augmentation protocols generally allowed rehabilitation on a quicker timeline with full weightbearing by week 4-6 in 100% (3/3) of protocols and full ROM by week 8-10 in 66% (2/3). RTS was consistent in repair protocols (100% at week 12-16). Conclusion: ROM was variable across protocols and did not always match up with supporting literature. Return to sport was likely to correlate between protocols and the literature. Weightbearing was consistent between protocols. The variability between programs demonstrated the need for standardization of rehabilitation.

Salt restriction lowers blood pressure at rest and during exercise without altering peripheral hemodynamics in hypertensive individuals

Dietary salt restriction is a well-established approach to lower blood pressure and reduce cardiovascular disease risk in hypertensive individuals. However, little is currently known regarding the effects of salt restriction on central and peripheral hemodynamic responses to exercise in those with hypertension. Therefore, this study sought to determine the impact of salt restriction on the central and peripheral hemodynamic responses to static-intermittent handgrip (HG) and dynamic single-leg knee extension (KE) exercise in individuals with hypertension. Twenty-two subjects (14 men and 8 women, 51 ± 10 yr, 173 ± 11 cm, 99 ± 23 kg) forewent their antihypertensive medication use for at least 2 wk before embarking on a 5-day liberal salt (LS: 200 mmol/day) diet followed by a 5-day restricted salt (RS: 10 mmol/day) diet. Subjects were studied at rest and during static intermittent HG exercise at 15, 30, and 45% of maximal voluntary contraction and KE exercise at 40, 60, and 80% of maximum KE work rate. Salt restriction lowered resting systolic blood pressure (supine: −12 ± 12 mmHg, seated: −17 ± 12 mmHg) and diastolic blood pressure (supine: −3 ± 9 mmHg, seated: −5 ± 7 mmHg, P < 0.05). Despite an ~8 mmHg lower mean arterial blood pressure during both HG and KE exercise following salt restriction, neither central nor peripheral hemodynamics were altered. Therefore, salt restriction can lower blood pressure during exercise in subjects with hypertension, reducing the risk of cardiovascular events, without impacting central and peripheral hemodynamics during either arm or leg exercise. NEW & NOTEWORTHY This is the first study to examine the potential blood pressure-lowering benefit of a salt-restrictive diet in individuals with hypertension without any deleterious effects of exercising blood flow. While mean arterial pressure decreased by ~8 mmHg following salt restriction, these findings provide evidence for salt restriction to provide protective effects of reducing blood pressure without inhibiting central or peripheral hemodynamics required to sustain arm or leg exercise in subjects with hypertension.

Contralateral fatigue during severe-intensity single-leg exercise: influence of acute acetaminophen ingestion

Exhaustive single-leg exercise has been suggested to reduce time to task failure (Tlim) during subsequent exercise in the contralateral leg by exacerbating central fatigue development. We investigated the influence of acetaminophen (ACT), an analgesic that may blunt central fatigue development, on Tlim during single-leg exercise completed with and without prior fatiguing exercise of the contralateral leg. Fourteen recreationally active men performed single-leg severe-intensity knee-extensor exercise to Tlim on the left (Leg1) and right (Leg2) legs without prior contralateral fatigue and on Leg2 immediately following Leg1 (Leg2-CONTRA). The tests were completed following ingestion of 1-g ACT or maltodextrin [placebo (PL)] capsules. Intramuscular phosphorus-containing metabolites and substrates and muscle activation were assessed using 31P-MRS and electromyography, respectively. Tlim was not different between Leg1ACT and Leg1PL conditions (402 ± 101 vs. 390 ± 106 s, P = 0.11). There was also no difference in Tlim between Leg2ACT-CONTRA and Leg2PL-CONTRA (324 ± 85 vs. 311 ± 92 s, P = 0.10), but Tlim was shorter in Leg2ACT-CONTRA and Leg2PL-CONTRA than in Leg2CON (385 ± 104 s, both P < 0.05). There were no differences in intramuscular phosphorus-containing metabolites and substrates or muscle activation between Leg1ACT and Leg1PL and between Leg2ACT-CONTRA and Leg2PL-CONTRA (all P > 0.05). These findings suggest that levels of metabolic perturbation and muscle activation at Tlim are not different during single-leg severe-intensity knee-extensor exercise completed with or without prior fatiguing exercise of the contralateral leg. Despite contralateral fatigue, ACT ingestion did not alter neuromuscular responses, muscle metabolites, or exercise performance.