Influence of high ambient temperatures on the physiological responses and body sway in healthy young adults after quickly standing

This study was aimed to compare the variations in cerebral oxygenation, blood pressure and center-of-foot pressure after standing from sitting and supine positions at normal (22 degrees C) and high (32 degrees C) room temperatures. Thirty young adults stood up from a resting posture (sitting or supine position) and kept the static standing posture for 90 sec. Meanwhile, their center-of-foot pressure (COP), blood pressure, and cerebral oxygenation kinetics were measured in continuity. The change of the frequency domain low-to-high frequency (LF/HF) ratio of the R-R interval before and after standing from a supine position was significantly higher than that from a sitting position under both temperature conditions. Blood pressure as well as total and oxygenated hemoglobin levels decreased immediately after standing up and the ratio of blood pressure change when moving from a supine position to standing at high room temperature was the largest as compared with the other conditions. Total hemoglobin (Hb) volume was found to temporarily decrease after standing and required 22-24 sec to recover when the subject started from the sitting position and 33-36 sec when the subject started from the supine position. Cerebral oxygenation kinetics tended to be larger under high, rather than normal, temperature conditions. All COP parameters after standing were significantly larger in the high temperature condition than in the normal temperature condition. Body sway after standing was larger in the high temperature condition than in the normal temperature condition and after standing from a supine position than from a sitting position. In conclusion, cerebral oxygenation kinetics and blood pressure measured after the subject moved to the standing position changed dramatically under high temperature conditions, and variations in this parameter may influence body sway.     

Continuous monitoring of blood volume changes in humans

The mass density of antecubital venous blood was measured continuously for 80 min/session with 0.1 g/l precision at a flow rate of 1.5 ml/min in six male subjects. Each person participated in two different sessions with the same protocol. To induce transvascular fluid shifts, the subjects changed from sitting to standing and from standing to supine positions. There was transient blood density shifts immediately after postural changes, followed by an asymptotic approach to a new steady-state blood density level. Additional deviations from a simple time course were regularly observed. Blood density increased by 3.5 +/- 1.4 (SD) g/l when standing after sitting and decreased by 5.0 +/- 1.2 g/l while supine after standing. The corresponding half time of the blood density increase was 5.6 +/- 1.4 min (standing after sitting) and 6.9 +/- 3.1 min (supine after standing) of the blood density decrease. Erythrocyte density was calculated and did not change with body position. Whole-body blood density was calculated from plasma density, hematocrit, and erythrocyte density, assuming an F-cell ratio of 0.91. Volume shifts were computed from the density data; the subject's blood volume density decreased by 6.2 +/- 1.2% from sitting to standing and increased by 8.5 +/- 2.1% from standing to supine. Additional discrete plasma density and hematocrit measurements gave linear relations (P less than 0.001) between all possible combinations of blood density, plasma density, and hematocrit.(ABSTRACT TRUNCATED AT 250 WORDS)     

Calf blood flow and posture: Doppler ultrasound measurements during and after exercise.

To investigate the joint effects of body posture and calf muscle pump, the calf blood flow of eight healthy volunteers was measured with pulsed Doppler equipment during and after 3 min of rhythmic exercise on a calf ergometer in the supine, sitting, and standing postures. Muscle contractions seriously impeded calf blood flow. Consequently, blood flow occurred mainly between contractions and reached a plateau that lasted at least the final 100 s of each exercise series. After exercise the blood flow decreased much faster in the sitting and standing postures than in the supine posture. There was no difference in blood flow between various postures during the same submaximal exercise. However, subjects in the standing posture were able to perform exercise with a higher load than in the supine posture, and blood flow in the standing posture could become twice as high as in the supine posture. We conclude that calf blood flow is regulated according to needs; available perfusion pressure determined maximal blood flow and exercise; and compared with the supine posture, the standing posture and calf muscle pump increase the perfusion pressure.     

Renal sympathetic nerve activity and arterial pressure responses to changes in postural position of conscious dogs

Experiments were conducted in conscious dogs to determine the relationships between postural position, arterial pressure, and renal sympathetic nerve activity. Observations of the changes in arterial pressure and renal nerve activity were made when animals spontaneously changed postural position from lying to sitting, sitting to standing, standing to sitting, and sitting to lying. Rising to sit from lying down increased arterial pressure from 109 +/- 5 to 125 +/- 3 mm Hg and increased renal nerve activity by 96 +/- 58 microV/sec (61% of control). Movement from the sitting to standing position decreased renal nerve activity by 90 +/- 39 microV/sec (48% of control) without changing mean arterial pressure. Sitting down from standing also did not change arterial pressure, whereas renal nerve activity increased by 56 +/- 17 microV/sec (33% of control). Returning to the lying position (from sitting) decreased arterial pressure, and this hypotension was associated with significant reductions in renal nerve activity. These results indicate that nonuniform changes in sympathetic outflow from the central nervous system must occur to various vascular beds during changes in postural position of conscious dogs. Thus, renal sympathetic outflow may or may not reflect changes in nerve traffic which contribute to alterations in arterial pressure.     

Effect of lung volume and positional changes on pulmonary diffusing capacity and its components.

Normal subjects have a larger diffusing capacity normalized per liter alveolar volume (DL/VA) in the supine than in the sitting position. Body position changes total lung diffusing capacity (DL), DL/VA, membrane conductance (Dm), and effective pulmonary capillary blood volume (Qc) as a function of alveolar volume (VA). These functions were studied in 37 healthy volunteers. DL/VA vs. VA yields a linear relationship in sitting as well as in supine position. Both have a negative slope but usually do not run parallel. In normal subjects up to 50 yr old DL/VA and DL increased significantly when subjects moved from a sitting to a supine posture at volumes between 50 and 100% of total lung capacity (TLC). In subjects greater than 50 yr old the responses of DL/VA and DL to change in body position were not significant at TLC. Functional residual capacity (FRC) decreases and DL/VA increases in all normal subjects when they change position from sitting to supine. When DL/VA increases more than predicted from the DL/VA vs. VA relationship in a sitting position, we may infer an increase in effective Qc in the supine position. In 56% of the volunteers, supine DL was smaller than sitting DL despite a higher DL/VA at FRC in the supine position because of the relatively larger decrease in FRC. When the positional response at TLC is studied, an estimation obtained accidentally at a volume lower than TLC may influence results. Above 80% of TLC, Dm decreased significantly from sitting to supine. Below this lung volume the decrease was not significant. The relationship between Qc and VA was best described by a second-order polynomial characterized by a maximum Qc at a VA greater than 60% of TLC. Qc was significantly higher in the supine position than in the sitting position, but the difference became smaller with increasing age. In observing the sitting and supine positions, we saw a decrease in maximum Qc normalized per square meter of body surface area with age.     

G-suit inflation to 50 mmHg alters the cardiovascular transients when entering micro-G in parabolic flight

In the present experiments it was decided to have each test-subject serve as his own control by fitting the test-subjects with a G-suit and comparing the condition of inflated G-suit to the normal situation. G-suit inflation was intended to only displace blood on the venous side of the circulation, not to increase total peripheral resistance. Therefore, a very modest inflation of 50 mmHg was applied. This was considered sufficient to expel most of the blood from the venous pool in abdomen and legs, even under the condition of increased G-loading in the pull-up phase. The parabolas were to be undergone in three body positions: standing upright, sitting and supine. The prediction of the experimental outcome was that we would find no difference between transients with and without G-suit inflation in the supine position, that an initial overshoot in pressure and stroke volume in the upright position would be very much damped by the G-suit, even more in the standing than in the sitting position. Studies were performed in 5 flights of NASA's KC-135, in January 1993. Per flight 40 parabolas were flown in an adapted 'roller coaster profile', i.e. 0-G phases were followed by a 2-G pull-out phase, after a very brief 1-G phase again followed by the next 2-G pull-up phase. This sequence was flown for 10 parabolas, then a 1-G horizontal flight period was inserted. The first 3 parabolas of each set of 10 the subjects were sitting upright, seat belt fastened. The next three they were standing, feet stuck under a load strap on the floor, stabilizing themselves by a grip on the ceiling. Then three parabolas were flown with the test-subject supine, loosely attached to the floor by a load strap and further aided by a grip to another strap on the floor. The last parabola of a set was used as 'spare' to repeat any failed maneuver.     

Quantification of abdominal and pelvic floor muscle synergies in response to voluntary pelvic floor muscle contractions

The relative levels of pelvic floor muscle (PFM) activation and pressure generated by maximum voluntary PFM contractions were investigated in healthy continent women. The normal sequence of abdominal and PFM activation was determined.Fifteen women performed single and repeated maximum voluntary PFM contractions in supine, sitting and standing. PFM electromyographic (EMG) signals and associated intra-vaginal pressure data were recorded simultaneously. Surface EMG data were recorded from rectus abdominus (RA), external obliques (EO), internal obliques (IO) and transversus abdominus (TA).Abdominal and PFM EMG and intra-vaginal pressure amplitudes generated during voluntary PFM contractions were not different among the positions. Muscle activation sequence differed by position. In supine, EO activation preceded all other muscles by 27 ms (p = 0.043). In sitting, all of the muscles were activated simultaneously. In standing, RA and EO were activated 11 and 17 ms, respectively, prior to the PFMs and TA and IO were activated 10 and 12 ms, respectively, after the PFMs (p ≪ 0.001).The results suggest that women are able to perform equally strong PFM contractions in supine, sitting and standing, however the pattern of abdominal and PFM activation varies by position. These differences may be related to position-dependent urine leakage in women with stress incontinence.     

Is Autonomic Modulation Different between European and Chinese Astronauts?

Purpose

The objective was to investigate autonomic control in groups of European and Chinese astronauts and to identify similarities and differences.

Methods

Beat-to-beat heart rate and finger blood pressure, brachial blood pressure, and respiratory frequency were measured from 10 astronauts (five European taking part in three different space missions and five Chinese astronauts taking part in two different space missions). Data recording was performed in the supine and standing positions at least 10 days before launch, and 1, 3, and 10 days after return. Cross-correlation analysis of heart rate and systolic pressure was used to assess cardiac baroreflex modulation. A fixed breathing protocol was performed to measure respiratory sinus arrhythmia and low-frequency power of systolic blood pressure variability.

Results

Although baseline cardiovascular parameters before spaceflight were similar in all astronauts in the supine position, a significant increase in sympathetic activity and a decrease in vagal modulation occurred in the European astronauts when standing; spaceflight resulted in a remarkable vagal decrease in European astronauts only. Similar baseline supine and standing values for heart rate, mean arterial pressure, and respiratory frequency were shown in both groups. Standing autonomic control was based on a balance of higher vagal and sympathetic modulation in European astronauts.

Conclusion

Post-spaceflight orthostatic tachycardia was observed in all European astronauts, whereas post-spaceflight orthostatic tachycardia was significantly reduced in Chinese astronauts. The basis for orthostatic intolerance is not apparent; however, many possibilities can be considered and need to be further investigated, such as genetic diversities between races, astronaut selection, training, and nutrition, etc.     

Sustained microgravity reduces the human ventilatory response to hypoxia but not to hypercapnia.

We measured the isocapnic hypoxic ventilatory response and the hypercapnic ventilatory response by using rebreathing techniques in five normal subjects (ages 37-47 yr) before, during, and after 16 days of exposure to microgravity (microG). Control measurements were performed with the subjects in the standing and supine postures. In both microG and in the supine position, the hypoxic ventilatory response, as measured from the slope of ventilation against arterial O(2) saturation, was greatly reduced, being only 46 +/- 10% (microG) and 52 +/- 11% (supine) of that measured standing (P < 0.01). During the hypercapnic ventilatory response test, the ventilation at a PCO(2) of 60 Torr was not significantly different in microG (101 +/- 5%) and the supine position (89 +/- 3%) from that measured standing. Inspiratory occlusion pressures agreed with these results. The findings can be explained by inhibition of the hypoxic but not hypercapnic drive, possibly as a result of an increase in blood pressure in carotid baroreceptors in microG and the supine position.     

Effects of room temperature on physiological and subjective responses during whole-body bathing,half-body bathing and showering

The effects of bathroom thermal conditions on physiological and subjective responses were evaluated before, during, and after whole-body bath (W-bath), half-body bath (H-bath) and showering. The air temperature of the dressing room and bathroom was controlled at 10 degrees C, 17.5 degrees C, and 25 degrees C. Eight healthy males bathed for 10 min under nine conditions on separate days. The water temperature of the bathtub and shower was controlled at 40 degrees C and 41 degrees C, respectively. Rectal temperature (Tre), mean skin temperature (Tsk), blood pressure (BP), heart rate (HR), body weight loss and blood characteristics (hematocrit: Hct, hemoglobin: Hb) were evaluated. Also, thermal sensation (TS), thermal comfort (TC) and thermal acceptability (TA) were recorded. BP decreased rapidly during W-bath and H-bath compared to showering. HR during W-bath was significantly higher than for H-bath and showering (p < 0.01). The double products due to W-bath during bathing were also greater than for H-bath and showering (p < 0.05). There were no distinct differences in Hct and Hb among the nine conditions. However, significant differences in body weight loss were observed among the bathing methods: W-bath > H-bath > showering (p < 0.001). W-bath showed the largest increase in Tre and Tsk, followed by H-bath, and showering. Significant differences in Tre after bathing among the room temperatures were found only at H-bath. The changes in Tre after bathing for H-bath at 25 degrees C were similar to those for W-bath at 17.5 degrees C and 10 degrees C. TS and TC after bathing significantly differed for the three bathing methods at 17.5 degrees C and 10 degrees C (TS: p < 0.01 TC: p < 0.001). Especially, for showering, the largest number of subjects felt "cold" and "uncomfortable". Even though all of the subjects could accept the 10 degrees C condition after W-bath, such conditions were intolerable to half of them after showering. These results suggested that the physiological strains during H-bath and showering were smaller than during W-bath. However, colder room temperatures made it more difficult to retain body warmth after H-bath and created thermal discomfort after showering. It is particularly important for H-bath and showering to maintain an acceptable temperature in the dressing room and bathroom, in order to bathe comfortably and ensure warmth.     

The effects of posture on blood pressure and heart rate in the three-toed sloth, Bradypus tridactylus

1. In unanesthetized, minimally restrained three-toed sloths, Bradypus tridactylus, the mean arterial pressure was 125/85 mmHg and the heart rate was 83.6 beats/min. There was no significant difference between these parameters whether the animal was erect or supine in the experimental chair. 2. Animals without any restraint had a mean blood pressure of 133/87 mmHg and a heart rate of 78.1 beats/min. There was no significant difference between these parameters whether the animal was seated or suspended from a horizontal bar and there was no significant difference between the minimally restrained and the unrestrained animals. 3. Tilting from the erect to the supine position produced large increases in blood pressure parameters, 37% in systolic and 21% in diastolic, reaching the maximum effect in a mean time of 38 sec. Tilting from the supine to the erect position caused even greater increases in pressure, 43% and 38% respectively, and reaching the maximum also in a mean time of 38 sec. 4. Tilting initially increased the heart rate, in going from erect to supine by 21% in 16 sec and from supine to erect by 23% in 20 sec. 5. In going from erect to supine there was a reflex bradycardia later, 15% below control level with a maximum at 40 sec, and to a lesser degree in going from supine to erect, 9% with maximum at 50 sec.     

Norepinephrine transporter inhibition alters the hemodynamic response to hypergravitation.

Sympathetically mediated tachycardia and vasoconstriction maintain blood pressure during hypergravitational stress, thereby preventing gravitation-induced loss of consciousness. Norepinephrine transporter (NET) inhibition prevents neurally mediated (pre)syncope during gravitational stress imposed by head-up tilt testing. Thus it seems reasonable that NET inhibition could increase tolerance to hypergravitational stress. We performed a double-blind, randomized, placebo-controlled crossover study in 11 healthy men (26 +/- 1 yr, body mass index 24 +/- 1 kg/m2), who ingested the selective NET inhibitor reboxetine (4 mg) or matching placebo 25, 13, and 1 h before testing on separate days. We monitored heart rate, blood pressure, and thoracic impedance in three different body positions (supine, seated, standing) and during a graded centrifuge run (incremental steps of 0.5 g for 3 min each, up to a maximal vertical acceleration load of 3 g). NET inhibition increased supine blood pressure and heart rate. With placebo, blood pressure increased in the seated position and was well maintained during standing. However, with NET inhibition, blood pressure decreased in the seated and standing position. During hypergravitation, blood pressure increased in a graded fashion with placebo. With NET inhibition, the increase in blood pressure during hypergravitation was profoundly diminished. Conversely, the tachycardic responses to sitting, standing, and hypergravitation all were greatly increased with NET inhibition. In contrast to our expectation, short-term NET inhibition did not improve tolerance to hypergravitation. Redistribution of sympathetic activity to the heart or changes in baroreflex responses could explain the excessive tachycardia that we observed.     

Validation of a model for prediction of skin temperatures in footwear

A model for foot skin temperature prediction was evaluated on the basis of 2 experiments on subjects at various environmental temperatures (light seated manual work at -10.7 degrees C (Study 1), and a short walking period in combination with standing and sitting at +2.8 degrees C, -11.8 degrees C and -24.6 degrees C (Study 2), with boots of 3 insulation levels. Insulation of the footwear was measured on a thermal foot model. Predicted and measured data showed a relatively good correlation (r = 0.87) at the 2 colder conditions in Study 2. The environmental temperature of 2.8 degrees C was not low enough at the chosen activity for a considerable foot skin temperature drop. In Study 1 the predicted temperature stayed higher for the whole exposure period and the difference between the predicted and the measured foot skin temperatures grew proportionally with time, while subsequent warm-up curves at room temperature were almost parallel. In Study 1 the correlation was 0.95. However, the paired t-test showed usually significant differences between measured and predicted foot skin temperatures. The insulation values from thermal foot measurements can be used in the model calculations. Lotens' foot model is lacking activity as direct input parameter, however, the blood flow is used instead (effect through Tcore). The Lotens foot model can give reasonable foot skin temperature values if the model limitations are considered. Due to the lack of activity level input, it will be difficult to make any good estimation of foot skin temperature during intermittent exercise. The rate of the foot temperature recovery after cold exposure was somewhat overestimated in the model--the warm-up of the feet of the subjects started later and was slower in the beginning of the warm-up than in the prediction. It could be useful to develop the model further by taking into consideration various wetness and activity levels.     

Studies on heat tolerance at rest and orthostatic heat tolerance in a hot environment

Twelve young male Japanese were exposed to a hot environment in summer, and changes in systolic blood pressure induced by changing the position from recumbent to sitting were observed. Sweating was induced in a climatic chamber at 30 degree C with 70% relative humidity by immersing both legs up to the knees into a water bath of 42 degree C for 90 min after sitting on a chair at rest for 30 min in the chamber. The mean values of rise in rectal temperature, body weight loss and mean sodium concentration in sweat were 0.62 degree C, 0.67 kg and 46 mEq/l, respectively. The mean values of fall in systolic blood pressure associated with changing posture and its recovery time were 13.7 mm Hg and 77.5 sec, respectively. Heat tolerance at rest was assessed by a numerical heat tolerance index involving relative water loss, relative rise in rectal temperature, and relative salt loss. Values of relative water loss, relative rise in rectal temperature, and the numerical heat tolerance index correlated closely to those of fall in systolic blood pressure and its recovery time.     

Supine position decreases the ability of the nose to warm and humidify air.

We tested the hypothesis that decreasing nasal air volume (i.e., increasing nasal turbinate blood volume) improves nasal air conditioning. We performed a randomized, two-way crossover study on the conditioning capacity of the nose in six healthy subjects in the supine and upright position. Cold, dry air (CDA) was delivered to the nose via a nasal mask, and the temperature and humidity of air were measured before it entered and after it exited the nasal cavity. The total water gradient (TWG) across the nose was calculated and represents the nasal conditioning capacity. Nasal volume decreased significantly from baseline without changing the mucosal temperature when subjects were placed in the supine position (P < 0.01). TWG in supine position was significantly lower than that in upright position (P < 0.001). In the supine position, nasal mucosal temperature after CDA exposure was significantly lower than that in upright position (P < 0.01). Our data show that placing subjects in the supine position decreased the ability of the nose to condition CDA compared with the upright position, in contrast to our hypothesis.     

Blood flow to contracting human muscles: influence of increased sympathetic activity

The purpose of this study was to examine the effects of the increased sympathetic activity elicited by the upright posture on blood flow to exercising human forearm muscles. Six subjects performed light and heavy rhythmic forearm exercise. Trials were conducted with the subjects supine and standing. Forearm blood flow (FBF, plethysmography) and skin blood flow (laser Doppler) were measured during brief pauses in the contractions. Arterial blood pressure and heart rate were also measured. During the first 6 min of light exercise, blood flow was similar in the supine and standing positions (approximately 15 ml.min-1.100 ml-1); from minutes 7 to 20 FBF was approximately 3-7 ml.min-1.100 ml-1 less in the standing position (P less than 0.05). When 5 min of heavy exercise immediately followed the light exercise, FBF was approximately 30-35 ml.min-1.100 ml-1 in the supine position. These values were approximately 8-12 ml.min-1.100 ml-1 greater than those observed in the upright position (P less than 0.05). When light exercise did not precede 8 min of heavy exercise, the blood flow at the end of minute 1 was similar in the supine and standing positions but was approximately 6-9 ml.min-1.100 ml-1 lower in the standing position during minutes 2-8. Heart rate was always approximately 10-20 beats higher in the upright position (P less than 0.05). Forearm skin blood flow and mean arterial pressure were similar in the two positions, indicating that the changes in FBF resulted from differences in the caliber of the resistance vessels in the forearm muscles.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fatigue during sustained maximal voluntary contraction of different muscles in humans: dependence on fibre type and body posture

Nine healthy men, aged between 25 and 35 years, performed sustained maximal voluntary contractions (MVC) of foot plantar, foot dorsal, and finger flexor muscles. Contractions lasted 10 min and were followed by short test contractions at 30% MVC during recovery. Two positions of the working extremity high or low were established by different body postures (supine or sitting). Under these conditions, studies of force, integrated electromyogram (iEMG), blood pressure, and heart rate showed firstly that force decreased throughout the first few minutes of maximal contraction but reached a near steady-state value after 5 to 6 min. Secondly, force decay and steady-state level depended on muscle group and body position. When sitting (low leg), muscles with a high incidence of slow twitch fibres (plantar flexors) showed a slower force decay and a higher relative steady-state force than fast dorsal flexor muscles. When supine (high leg), plantar and dorsal flexor muscles reached about the same low level of relative steady-state force. Changes in iEMG, blood pressure, and heart rate did not differ in the two positions. Thirdly, during recovery, plantar flexor muscles showed higher iEMG values as well as higher values of blood pressure and heart rate when supine than when sitting. Recovery of dorsal flexor muscles was little affected by body posture. Fourthly, force development and recovery of predominantly fast finger flexor muscles were almost independent of arm position. It was concluded that muscle fibre composition was the main factor in determining endurance capacity. However, endurance was influenced by changes in the hydrostatic blood pressure component.(ABSTRACT TRUNCATED AT 250 WORDS)     

Circadian variations in plasma renin activity, catecholamines and aldosterone during exercise in women

Four women were studied at 0400 h and 1600 h to determine if their hormonal and hemodynamic responses to exercise varied with the circadian cycle. Esophageal temperature was measured during rest and exercise (60% peak VO2; 30 min) in a warm room (Ta = 35 degrees C; PH2O = 1.7 kPa). Venous blood samples were drawn during rest and exercise and hemoglobin concentration (Hb), hematocrit (Hct), plasma osmolality (Posm), plasma protein concentration (Pp), colloid osmotic pressure (COP), plasma renin activity (PRA), cortisol, aldosterone, norepinephrine (NE) and epinephrine (E) were determined. Changes in plasma volume (PV) were estimated from changes in Hb and Hct. The relative hemoconcentration (-11.2%) was similar at 0400 h and 1600 h, but the absolute PV was smaller at 1600 h than at 0400 h (p = 0.03). The responses of Posm, Pp and COP to exercise were unaffected by time of day. Although PRA was not different at the two times of day, PRA was 244% greater during exercise at 1600 h, but only 103% greater during exercise at 0400 h. The normal circadian rhythms in plasma aldosterone (p = 0.043) and plasma cortisol (p = 0.004) were observed. Plasma aldosterone was 57% greater during exercise, while plasma cortisol did not change. The change in E and NE was greater at 0400 h, but this was due to the lower resting values of the catecholamines at 0400 h. These data indicate that time of day generally did not affect the hormonal or hemodynamic responses to exercise, with the exception that PRA was markedly higher during exercise at 1600 h compared to 0400 h.     

Blood Pressure Associates with Standing Balance in Elderly Outpatients

Objectives

Assessment of the association of blood pressure measurements in supine and standing position after a postural change, as a proxy for blood pressure regulation, with standing balance in a clinically relevant cohort of elderly, is of special interest as blood pressure may be important to identify patients at risk of having impaired standing balance in routine geriatric assessment.

Materials and Methods

In a cross-sectional cohort study, 197 community-dwelling elderly referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Blood pressure was measured intermittently (n = 197) and continuously (subsample, n = 58) before and after a controlled postural change from supine to standing position. The ability to maintain standing balance was assessed during ten seconds of side-by-side, semi-tandem and tandem stance, with both eyes open and eyes closed. Self-reported impaired standing balance and history of falls were recorded by questionnaires. Logistic regression analyses were used to examine the association between blood pressure and 1) the ability to maintain standing balance; 2) self-reported impaired standing balance; and 3) history of falls, adjusted for age and sex.

Results

Blood pressure decrease after postural change, measured continuously, was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed and with increased self-reported impaired standing balance and falls. Presence of orthostatic hypotension was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed for both intermittent and continuous measurements and with increased self-reported impaired standing balance for continuous measurements.

Conclusion

Continuous blood pressure measurements are of additional value to identify patients at risk of having impaired standing balance and may therefore be useful in routine geriatric care.     

Effect of Japanese sitting style (seiza) on the center of foot pressure after standing

Seiza is one of the most commonly used sitting postures in various enrichment lessons of Japanese origin. It is reported that Seiza with large knee flexion produces harmful effects on the cartilage of knee joints and hemodynamics of the lower legs. This study aimed at examining the influence of Seiza on tissue oxygenation kinetics of the lower limbs, plantar somatic and cutaneous sensation, and the center of foot pressure (COP) sway using 10 young adults. COP sway was measured for 1 min just after sitting on a chair for 10 min (pre-test), after 30-min Seiza (post-test 1), and 5 min after Seiza (post-test 2). To evaluate the COP sway, we used 4 body sway factors; unit time sway factor (F1), front-back sway factor (F2), left-right sway factor (F3) and high frequency band power spectrum factor (F4). Physiological parameters (i.e., tissue oxygenation kinetics in the lower legs and sensation on the sole) were measured during 30-min Seiza (continuously on tissue oxygenation, and at 1 min intervals on sensation), and for 1 min just before each COP test (pre-test, post-test 1 and 2).Oxygenated hemoglobin/myoglobin (Hb/Mb) concentration decreased markedly and deoxygenated Hb/Mb concentration increased markedly, resulting in reaching a plateau state at around 7 min. Tissue Hb/Mb index changed little during Seiza. Proprioceptive perception thresholds increased rapidly about 17 min after Starting Seiza. Means of 3 COP sway factors of F1, F2 and F4 were significantly higher in post-test 1 than in pre-test and post-test 2. In conclusion, a marked decrease in tissue oxygen concentration of the lower legs within 4-5 min, and an increase of proprioceptive perception thresholds in the sole at about 17 min are induced by Seiza. Although wiggle and quick body sway in the antero-posterior axis increases markedly in an upright posture just after maintaining Seiza for 30 min, sway recovers after sitting on a chair for 5 min.