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Published in: European Journal of Applied Physiology 3/2014

01-03-2014 | Original Article

Cardiovascular responses in older adults with total knee arthroplasty at rest and with exercise on a positive pressure treadmill

Authors: Sandra C. Webber, Karla J. Horvey, Madison T. Yurach Pikaluk, Scott J. Butcher

Published in: European Journal of Applied Physiology | Issue 3/2014

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Abstract

Purpose

We investigated cardiovascular responses at rest and during submaximal exercise on a lower body positive pressure treadmill in older adults with total knee arthroplasty (TKA).

Methods

Twenty-four adults (mean age 64.6 ± 7.9 SD) with unilateral TKA participated (median time since surgery 8.0 weeks). Heart rate and blood pressure responses were measured at rest standing on the positive pressure treadmill with 0, 10, 20, and 30 mmHg applied. Heart rate, blood pressure, oxygen consumption, minute ventilation, knee pain and perceived exertion were measured during submaximal exercise tests (0 and 40 % body weight support) conducted 1 week apart.

Results

At rest there were no differences in blood pressure across different treadmill pressures, but heart rate was significantly lower when 30 mmHg was applied compared to ambient pressure conditions (P < 0.05). Participants averaged 5.1 exercise test stages with 0 % body weight support (maximum speed 2.5 mph, 0 % incline) and 6.4 stages with 40 % body weight support (maximum speed 3.0 mph, 10 % incline). During exercise, heart rate, systolic blood pressure, oxygen consumption, and minute ventilation were lower when 40 % body weight support was provided for a given test stage (P < 0.01). Diastolic blood pressure, knee pain and perceived exertion did not differ with body weight support but increased with increasing exercise test stages (P < 0.05).

Conclusions

Provision of body weight support allowed TKA patients to walk at faster speeds and/or to tolerate greater incline with relatively lower levels of heart rate, blood pressure, and oxygen consumption.
Literature
go back to reference American College of Sports Medicine (2013) ACSM’s guidelines for exercise testing and prescription, 9th edn. Baltimore American College of Sports Medicine (2013) ACSM’s guidelines for exercise testing and prescription, 9th edn. Baltimore
go back to reference Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, McManus FJ, Hodges PW, Li L, Hinman RS (2010) Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthr Cartil 18:621–628PubMedCrossRef Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, McManus FJ, Hodges PW, Li L, Hinman RS (2010) Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthr Cartil 18:621–628PubMedCrossRef
go back to reference Boonstra MC, De Waal Malefijt MC, Verdonschot N (2008) How to quantify knee function after total knee arthroplasty? Knee 15:390–395PubMedCrossRef Boonstra MC, De Waal Malefijt MC, Verdonschot N (2008) How to quantify knee function after total knee arthroplasty? Knee 15:390–395PubMedCrossRef
go back to reference Borg G (1998) Borg’s perceived exertion and pain scales. Champaign Borg G (1998) Borg’s perceived exertion and pain scales. Champaign
go back to reference Cutuk A, Groppo ER, Quigley EJ, White KW, Pedowitz RA, Hargens AR (2006) Ambulation in simulated fractional gravity using lower body positive pressure: cardiovascular safety and gait analyses. J Appl Physiol 101:771–777PubMedCrossRef Cutuk A, Groppo ER, Quigley EJ, White KW, Pedowitz RA, Hargens AR (2006) Ambulation in simulated fractional gravity using lower body positive pressure: cardiovascular safety and gait analyses. J Appl Physiol 101:771–777PubMedCrossRef
go back to reference Decker LM, Cignetti F, Stergiou N (2012) Wearing a safety harness during treadmill walking influences lower extremity kinematics mainly through changes in ankle regularity and local stability. J Neuroeng Rehabil 9:8PubMedCentralPubMedCrossRef Decker LM, Cignetti F, Stergiou N (2012) Wearing a safety harness during treadmill walking influences lower extremity kinematics mainly through changes in ankle regularity and local stability. J Neuroeng Rehabil 9:8PubMedCentralPubMedCrossRef
go back to reference Di MM, Vallero F, Tappero R, Cavanna A (2009) Rehabilitation after total hip arthroplasty: a systematic review of controlled trials on physical exercise programs. Eur J Phys Rehabil Med 45:303–317 Di MM, Vallero F, Tappero R, Cavanna A (2009) Rehabilitation after total hip arthroplasty: a systematic review of controlled trials on physical exercise programs. Eur J Phys Rehabil Med 45:303–317
go back to reference Eastlack RK, Hargens AR, Groppo ER, Steinbach GC, White KK, Pedowitz RA (2005) Lower body positive-pressure exercise after knee surgery. Clin Orthop Relat Res 431:213–219PubMedCrossRef Eastlack RK, Hargens AR, Groppo ER, Steinbach GC, White KK, Pedowitz RA (2005) Lower body positive-pressure exercise after knee surgery. Clin Orthop Relat Res 431:213–219PubMedCrossRef
go back to reference Gojanovic B, Cutti P, Shultz R, Matheson GO (2012) Maximal physiological parameters during partial body-weight support treadmill testing. Med Sci Sports Exerc 44:1935–1941PubMedCrossRef Gojanovic B, Cutti P, Shultz R, Matheson GO (2012) Maximal physiological parameters during partial body-weight support treadmill testing. Med Sci Sports Exerc 44:1935–1941PubMedCrossRef
go back to reference Grabowski AM (2010) Metabolic and biomechanical effects of velocity and weight support using a lower-body positive pressure device during walking. Arch Phys Med Rehabil 91:951–957PubMedCrossRef Grabowski AM (2010) Metabolic and biomechanical effects of velocity and weight support using a lower-body positive pressure device during walking. Arch Phys Med Rehabil 91:951–957PubMedCrossRef
go back to reference Hoffman MD, Donaghe HE (2011) Physiological responses to body weight-supported treadmill exercise in healthy adults. Arch Phys Med Rehabil 92:960–966PubMedCrossRef Hoffman MD, Donaghe HE (2011) Physiological responses to body weight-supported treadmill exercise in healthy adults. Arch Phys Med Rehabil 92:960–966PubMedCrossRef
go back to reference Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD (1998) Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am 80:1132–1145PubMed Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD (1998) Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am 80:1132–1145PubMed
go back to reference Joffe D, Watkins M, Steiner L, Pfeifer BA (2002) Treadmill ambulation with partial body weight support for the treatment of low back and leg pain. J Orthop Sports Phys Ther 32:202–213PubMedCrossRef Joffe D, Watkins M, Steiner L, Pfeifer BA (2002) Treadmill ambulation with partial body weight support for the treatment of low back and leg pain. J Orthop Sports Phys Ther 32:202–213PubMedCrossRef
go back to reference Johnson JA, McIlroy WE, Roy E, Papaioannou A, Thabane L, Giangregorio L (2013) Feasibility study of walking for exercise in individuals living in assisted living settings. J Geriatr Phys Ther 36:175–181PubMedCrossRef Johnson JA, McIlroy WE, Roy E, Papaioannou A, Thabane L, Giangregorio L (2013) Feasibility study of walking for exercise in individuals living in assisted living settings. J Geriatr Phys Ther 36:175–181PubMedCrossRef
go back to reference Kennedy DM, Stratford PW, Wessel J, Gollish JD, Penney D (2005) Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord 6:3PubMedCentralPubMedCrossRef Kennedy DM, Stratford PW, Wessel J, Gollish JD, Penney D (2005) Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord 6:3PubMedCentralPubMedCrossRef
go back to reference Knikou M (2012) Plasticity of corticospinal neural control after locomotor training in human spinal cord injury. Neural Plast (serial on the internet). doi:10.1155/2012/254948 Knikou M (2012) Plasticity of corticospinal neural control after locomotor training in human spinal cord injury. Neural Plast (serial on the internet). doi:10.​1155/​2012/​254948
go back to reference Kurz MJ, Corr B, Stuberg W, Volkman KG, Smith N (2011) Evaluation of lower body positive pressure supported treadmill training for children with cerebral palsy. Pediatr Phys Ther 23:232–239PubMedCrossRef Kurz MJ, Corr B, Stuberg W, Volkman KG, Smith N (2011) Evaluation of lower body positive pressure supported treadmill training for children with cerebral palsy. Pediatr Phys Ther 23:232–239PubMedCrossRef
go back to reference Lewek MD (2011) The influence of body weight support on ankle mechanics during treadmill walking. J Biomech 44:128–133PubMedCrossRef Lewek MD (2011) The influence of body weight support on ankle mechanics during treadmill walking. J Biomech 44:128–133PubMedCrossRef
go back to reference Mangione KK, Axen K, Haas F (1996) Mechanical unweighting effects on treadmill exercise and pain in elderly people with osteoarthritis of the knee. Phys Ther 76:387–394PubMed Mangione KK, Axen K, Haas F (1996) Mechanical unweighting effects on treadmill exercise and pain in elderly people with osteoarthritis of the knee. Phys Ther 76:387–394PubMed
go back to reference Millslagle D, Levy M, Matack N (2006) Kinematic assessment of treadmill running using different body-weight support harnesses. Percept Mot Skills 103:607–618PubMed Millslagle D, Levy M, Matack N (2006) Kinematic assessment of treadmill running using different body-weight support harnesses. Percept Mot Skills 103:607–618PubMed
go back to reference Miyai I, Fujimoto Y, Ueda Y, Yamamoto H, Nozaki S, Saito T, Kang J (2000) Treadmill training with body weight support: its effect on Parkinson’s disease. Arch Phys Med Rehabil 81:849–852PubMedCrossRef Miyai I, Fujimoto Y, Ueda Y, Yamamoto H, Nozaki S, Saito T, Kang J (2000) Treadmill training with body weight support: its effect on Parkinson’s disease. Arch Phys Med Rehabil 81:849–852PubMedCrossRef
go back to reference Monahan KD (2007) Effect of aging on baroreflex function in humans. Am J Physiol Regul Integr Comp Physiol 293:R3–R12PubMedCrossRef Monahan KD (2007) Effect of aging on baroreflex function in humans. Am J Physiol Regul Integr Comp Physiol 293:R3–R12PubMedCrossRef
go back to reference Moore MN, Vandenakker-Albanese C, Hoffman MD (2010) Use of partial body-weight support for aggressive return to running after lumbar disk herniation: a case report. Arch Phys Med Rehabil 91:803–805PubMedCrossRef Moore MN, Vandenakker-Albanese C, Hoffman MD (2010) Use of partial body-weight support for aggressive return to running after lumbar disk herniation: a case report. Arch Phys Med Rehabil 91:803–805PubMedCrossRef
go back to reference Moseley AM, Stark A, Cameron ID, Pollock A (2005) Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev CD002840 Moseley AM, Stark A, Cameron ID, Pollock A (2005) Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev CD002840
go back to reference Mutlu A, Krosschell K, Spira DG (2009) Treadmill training with partial body-weight support in children with cerebral palsy: a systematic review. Dev Med Child Neurol 51:268–275PubMedCrossRef Mutlu A, Krosschell K, Spira DG (2009) Treadmill training with partial body-weight support in children with cerebral palsy: a systematic review. Dev Med Child Neurol 51:268–275PubMedCrossRef
go back to reference Nishiyasu T, Nagashima K, Nadel ER, Mack GW (1998) Effects of posture on cardiovascular responses to lower body positive pressure at rest and during dynamic exercise. J Appl Physiol 85:160–167PubMed Nishiyasu T, Nagashima K, Nadel ER, Mack GW (1998) Effects of posture on cardiovascular responses to lower body positive pressure at rest and during dynamic exercise. J Appl Physiol 85:160–167PubMed
go back to reference Nishiyasu T, Hayashida S, Kitano A, Nagashima K, Ichinose M (2007) Effects of posture on peripheral vascular responses to lower body positive pressure. Am J Physiol Heart Circ Physiol 293:H670–H676PubMedCrossRef Nishiyasu T, Hayashida S, Kitano A, Nagashima K, Ichinose M (2007) Effects of posture on peripheral vascular responses to lower body positive pressure. Am J Physiol Heart Circ Physiol 293:H670–H676PubMedCrossRef
go back to reference Patil S, Steklov N, Bugbee WD, Goldberg T, Colwell CW Jr, D’Lima DD (2013) Anti-gravity treadmills are effective in reducing knee forces. J Orthop Res 31:672–679PubMedCrossRef Patil S, Steklov N, Bugbee WD, Goldberg T, Colwell CW Jr, D’Lima DD (2013) Anti-gravity treadmills are effective in reducing knee forces. J Orthop Res 31:672–679PubMedCrossRef
go back to reference Phan-Ba R, Pace A, Calay P, Grodent P, Douchamps F, Hyde R, Hotermans C, Delvaux V, Hansen I, Moonen G, Belachew S (2011) Comparison of the timed 25-foot and the 100-meter walk as performance measures in multiple sclerosis. Neurorehabil Neural Repair 25:672–679PubMedCrossRef Phan-Ba R, Pace A, Calay P, Grodent P, Douchamps F, Hyde R, Hotermans C, Delvaux V, Hansen I, Moonen G, Belachew S (2011) Comparison of the timed 25-foot and the 100-meter walk as performance measures in multiple sclerosis. Neurorehabil Neural Repair 25:672–679PubMedCrossRef
go back to reference Raffalt PC, Hovgaard-Hansen L, Jensen BR (2013) Running on a lower-body positive pressure treadmill: VO2max, respiratory response, and vertical ground reaction force. Res Q Exerc Sport 84:213–222PubMedCrossRef Raffalt PC, Hovgaard-Hansen L, Jensen BR (2013) Running on a lower-body positive pressure treadmill: VO2max, respiratory response, and vertical ground reaction force. Res Q Exerc Sport 84:213–222PubMedCrossRef
go back to reference Rose MH, Lokkegaard A, Sonne-Holm S, Jensen BR (2013a) Effects of training and weight support on muscle activation in Parkinson’s disease. J Electromyogr Kinesiol 23:1499–1504PubMedCrossRef Rose MH, Lokkegaard A, Sonne-Holm S, Jensen BR (2013a) Effects of training and weight support on muscle activation in Parkinson’s disease. J Electromyogr Kinesiol 23:1499–1504PubMedCrossRef
go back to reference Rose MH, Lokkegaard A, Sonne-Holm S, Jensen BR (2013b) Improved clinical status, quality of life, and walking capacity in Parkinson’s disease after body weight-supported high-intensity locomotor training. Arch Phys Med Rehabil 94:687–692PubMedCrossRef Rose MH, Lokkegaard A, Sonne-Holm S, Jensen BR (2013b) Improved clinical status, quality of life, and walking capacity in Parkinson’s disease after body weight-supported high-intensity locomotor training. Arch Phys Med Rehabil 94:687–692PubMedCrossRef
go back to reference Ruckstuhl H, Kho J, Weed M, Wilkinson MW, Hargens AR (2009) Comparing two devices of suspended treadmill walking by varying body unloading and Froude number. Gait Posture 30:446–451PubMedCrossRef Ruckstuhl H, Kho J, Weed M, Wilkinson MW, Hargens AR (2009) Comparing two devices of suspended treadmill walking by varying body unloading and Froude number. Gait Posture 30:446–451PubMedCrossRef
go back to reference Ruckstuhl H, Schlabs T, Rosales-Velderrain A, Hargens AR (2010) Oxygen consumption during walking and running under fractional weight bearing conditions. Aviat Space Environ Med 81:550–554PubMedCrossRef Ruckstuhl H, Schlabs T, Rosales-Velderrain A, Hargens AR (2010) Oxygen consumption during walking and running under fractional weight bearing conditions. Aviat Space Environ Med 81:550–554PubMedCrossRef
go back to reference Shi X, Crandall CG, Raven PB (1993) Hemodynamic responses to graded lower body positive pressure. Am J Physiol 265:H69–H73PubMed Shi X, Crandall CG, Raven PB (1993) Hemodynamic responses to graded lower body positive pressure. Am J Physiol 265:H69–H73PubMed
go back to reference Takacs J, Anderson JE, Leiter JR, MacDonald PB, Peeler JD (2013) Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis? Clin Interv Aging 8:983–991PubMedCentralPubMed Takacs J, Anderson JE, Leiter JR, MacDonald PB, Peeler JD (2013) Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis? Clin Interv Aging 8:983–991PubMedCentralPubMed
go back to reference Thomas EE, Stewart D, Mitchell S, Aiken K, Farina D, Macaluso A (2011) Comparison of neural activation and energy cost during treadmill walking with body weight unloading between frail and healthy older women. Gait Posture 33:356–360PubMedCrossRef Thomas EE, Stewart D, Mitchell S, Aiken K, Farina D, Macaluso A (2011) Comparison of neural activation and energy cost during treadmill walking with body weight unloading between frail and healthy older women. Gait Posture 33:356–360PubMedCrossRef
go back to reference Valentin-Gudiol M, Mattern-Baxter K, Girabent-Farres M, Bagur-Calafat C, Hadders-Algra M, Angulo-Barroso RM (2011) Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay. Cochrane Database Syst Rev CD009242 Valentin-Gudiol M, Mattern-Baxter K, Girabent-Farres M, Bagur-Calafat C, Hadders-Algra M, Angulo-Barroso RM (2011) Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay. Cochrane Database Syst Rev CD009242
go back to reference Williamson JW, Crandall CG, Potts JT, Raven PB (1994) Blood pressure responses to dynamic exercise with lower-body positive pressure. Med Sci Sports Exerc 26:701–708PubMedCrossRef Williamson JW, Crandall CG, Potts JT, Raven PB (1994) Blood pressure responses to dynamic exercise with lower-body positive pressure. Med Sci Sports Exerc 26:701–708PubMedCrossRef
go back to reference Williamson JW, Raven PB, Whipp BJ (1996) Unaltered oxygen uptake kinetics at exercise onset with lower-body positive pressure in humans. Exp Physiol 81:695–705PubMed Williamson JW, Raven PB, Whipp BJ (1996) Unaltered oxygen uptake kinetics at exercise onset with lower-body positive pressure in humans. Exp Physiol 81:695–705PubMed
Metadata
Title
Cardiovascular responses in older adults with total knee arthroplasty at rest and with exercise on a positive pressure treadmill
Authors
Sandra C. Webber
Karla J. Horvey
Madison T. Yurach Pikaluk
Scott J. Butcher
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Applied Physiology / Issue 3/2014
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI
https://doi.org/10.1007/s00421-013-2798-1

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