Postural Hypotension Associated with Nonelastic Pantyhose during Lymphedema Treatment
OBJECTIVE To investigate whether wearing graduated compression stockings (GCS) could affect the sympatho-adrenergic and heart rate variability (HRV) responses at rest and after a strenuous wheelchair exercise in individuals with spinal cord injury (SCI). DESIGN Crossover trial. SETTING Department of Physical Medicine and Rehabilitation, Saint Etienne, France. PARTICIPANTS Nine men with SCI (five with low paraplegia: LP, four with high paraplegia: HP). INTERVENTIONS Two maximal wheelchair exercise tests: with and without GCS (21 mmHg). MAIN OUTCOME MEASURES HRV measurements: high frequency (HF), low frequency (LF), and LF/HF ratio. Norepinephrine (NOR) and epinephrine (EPI), at rest and post-exercise. Secondary measures were: blood pressure, heart rate, maximal power output, oxygen uptake, stroke volume, cardiac output, at rest, during and after exercise. RESULTS When wearing GCS: LFnu(wavelet-post) significantly increased and HFnu(wavelet-post) significantly decreased (P < 0.05) in SCI subjects, leading to an enhance ratio of LF(wavelet)/HF(wavelet) and a significantly increased in NOR(rest) (P < 0.05). CONCLUSIONS GCS induces an enhanced sympathetic activity in individuals with paraplegia, regardless of the level of the injury. Enhanced post-exercise sympathetic activity with GCS may help prevent orthostatic hypotension or post-exercise hypotension.