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Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review.
de Zwart, AH, Dekker, J, Lems, W, Roorda, LD, van der Esch, M, van der Leeden, M
Journal of rehabilitation medicine. 2018;(2):140-150
Abstract
OBJECTIVE Muscle weakness is common and strongly related to clinical outcome in patients with knee or hip osteoarthritis. To date, there is no clear overview of the information on factors associated with muscle strength in knee and hip osteoarthritis. The aim of this paper is to provide an overview of current knowledge on factors associated with upper leg muscle strength in this population. DESIGN The framework of a scoping review was chosen. MEDLINE database was searched systematically up to 22 April 2017. Studies that described a relationship between a factor and muscle strength in knee or hip osteoarthritis were included. RESULTS A total of 65 studies met the inclusion criteria. In studies of knee osteoarthritis, 4 factors were consistently found to be associated with lower muscle strength. Due to the low number of studies on hip osteoarthritis no conclusions could be drawn on associations. CONCLUSION Lower muscle quality, physical inactivity, more severe joint degeneration, and higher pain are reported to be associated with lower strength in the upper leg muscles in knee osteoarthritis. Future research into knee osteoarthritis should focus on other potential determinants of muscle strength, such as muscle quantity, muscle activation, nutrition and vitamins, and inflammation. In hip osteoarthritis, more research is needed into all potential determinants.
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2.
Prolonged sitting leg vasculopathy: contributing factors and clinical implications.
Padilla, J, Fadel, PJ
American journal of physiology. Heart and circulatory physiology. 2017;(4):H722-H728
Abstract
Atherosclerotic peripheral artery disease primarily manifests in the medium- to large-sized conduit arteries of the lower extremities. However, the factors underlying this increased vulnerability of leg macrovasculature to disease are largely unidentified. On the basis of recent studies, we propose that excessive time spent in the sitting position and the ensuing reduction in leg blood flow-induced shear stress cause endothelial cell dysfunction, a key predisposing factor to peripheral artery disease. In particular, this review summarizes the findings from laboratory-based sitting studies revealing acute leg vascular dysfunction with prolonged sitting in young healthy subjects, discusses the primary physiological mechanisms and the potential long-term implications of such leg vasculopathy with repeated exposure to prolonged sitting, as well as identifies strategies that may be effective at evading it.
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3.
Sleep-Related Leg Cramps: A Review and Suggestions for Future Research.
Brown, TM
Sleep medicine clinics. 2015;(3):385-92, xvi
Abstract
Various medications and behavioral treatments for sleep-related leg cramps have been tried, but the quality of the evidence is low. Quinine seems to be effective, but dangerous. β-Agonists may be one of the more common causes of secondary leg cramps. Statins may not be implicated in leg cramps as much as has been believed. Potassium-sparing diuretics may have a higher incidence of sleep-related leg cramps than potassium-depleting diuretics. Plantar flexion of the feet may elicit most sleep-related leg cramps. More research into behavioral treatments is needed. A standardized sleep-related leg cramp questionnaire would be useful to expand research.
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4.
Creatine Supplementation and Lower Limb Strength Performance: A Systematic Review and Meta-Analyses.
Lanhers, C, Pereira, B, Naughton, G, Trousselard, M, Lesage, FX, Dutheil, F
Sports medicine (Auckland, N.Z.). 2015;(9):1285-1294
Abstract
BACKGROUND Creatine is the most widely used supplementation to increase strength performance. However, the few meta-analyses are more than 10 years old and suffer from inclusion bias such as the absence of randomization and placebo, the diversity of the inclusion criteria (aerobic/endurance, anaerobic/strength), no evaluation on specific muscles or group of muscles, and the considerable amount of conflicting results within the last decade. OBJECTIVE The objective of this systematic review was to evaluate meta-analyzed effects of creatine supplementation on lower limb strength performance. METHODS We conducted a systematic review and meta-analyses of all randomized controlled trials comparing creatine supplementation with a placebo, with strength performance of the lower limbs measured in exercises lasting less than 3 min. The search strategy used the keywords "creatine supplementation" and "performance". Dependent variables were creatine loading, total dose, duration, the time-intervals between baseline (T0) and the end of the supplementation (T1), as well as any training during supplementation. Independent variables were age, sex, and level of physical activity at baseline. We conducted meta-analyses at T1, and on changes between T0 and T1. Each meta-analysis was stratified within lower limb muscle groups and exercise tests. RESULTS We included 60 studies (646 individuals in the creatine supplementation group and 651 controls). At T1, the effect size (ES) among stratification for squat and leg press were, respectively, 0.336 (95 % CI 0.047-0.625, p = 0.023) and 0.297 (95 % CI 0.098-0.496, p = 0.003). Overall quadriceps ES was 0.266 (95 % CI 0.150-0.381, p < 0.001). Global lower limb ES was 0.235 (95 % CI 0.125-0.346, p < 0.001). Meta-analysis on changes between T0 and T1 gave similar results. The meta-regression showed no links with characteristics of population or of supplementation, demonstrating the creatine efficacy effects, independent of all listed conditions. CONCLUSION Creatine supplementation is effective in lower limb strength performance for exercise with a duration of less than 3 min, independent of population characteristic, training protocols, and supplementary doses and duration.
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5.
[Alcohol drinking and peripheral arterial disease of lower extremity].
Wakabayashi, I, Sotoda, Y
Nihon Arukoru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence. 2014;(1):13-27
Abstract
Peripheral arterial disease (PAD) is defined as an atherosclerotic disease in the lower extremities and is characterized by its symptom of intermittent claudication with discomfort and pain at posterior cruris. Various abnormalities of vascular endothelial cells, smooth muscle cells and platelets induced by risk factors of PAD are involved in its pathogenesis. The most important risk factors are ageing, smoking and diabetes mellitus. Dyslipidemia and hypertension are also classical risk factors of PAD. A lesion of PAD in the lower extremity is prone to be more distal in patients with diabetes than in non-diabetics and to be more proximal in smokers than in nonsmokers. In addition, race/ethnicity, increased inflammatory marker levels, homocysteinemia and abdominal obesity are known to be risk factors of PAD. Light-to-moderate alcohol drinking has been demonstrated to reduce the risks of coronary artery disease and ischemic type of stroke, while excessive alcohol drinking increases the risks of hemorrhagic type of stroke (cerebral hemorrhage and subarachnoid hemorrhage), hypertension, cardiac arrhythmia and sudden cardiac death. In most previous epidemiological studies, the risk of PAD has been shown to be lower in light-to-moderate drinkers than in abstainers. Moreover, drinkers with PAD reportedly showed lower mortality than did nondrinkers with PAD. On the other hand, heavy drinking has been reported to be positively associated with the risk of PAD. Increase in HDL cholesterol, decrease in LDL cholesterol, inhibition of platelet aggregation, decrease in blood coagulability, increase in blood fibrinolitic activity, and increase in insulin sensitivity are known as mechanisms for suppression of atherosclerosis by alcohol drinking. These mechanisms are also thought to contribute to reduction of the risk of PAD by alcohol drinking. Further studies are needed to clarify pathophysiological mechanisms for dose-dependent diverse effects of alcohol on the risk of PAD.
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6.
Transcutaneous laser treatment of leg veins.
Meesters, AA, Pitassi, LH, Campos, V, Wolkerstorfer, A, Dierickx, CC
Lasers in medical science. 2014;(2):481-92
Abstract
Leg telangiectasias and reticular veins are a common complaint affecting more than 80% of the population to some extent. To date, the gold standard remains sclerotherapy for most patients. However, there may be some specific situations, where sclerotherapy is contraindicated such as needle phobia, allergy to certain sclerosing agents, and the presence of vessels smaller than the diameter of a 30-gauge needle (including telangiectatic matting). In these cases, transcutaneous laser therapy is a valuable alternative. Currently, different laser modalities have been proposed for the management of leg veins. The aim of this article is to present an overview of the basic principles of transcutaneous laser therapy of leg veins and to review the existing literature on this subject, including the most recent developments. The 532-nm potassium titanyl phosphate (KTP) laser, the 585-600-nm pulsed dye laser, the 755-nm alexandrite laser, various 800-983-nm diode lasers, and the 1,064-nm neodymium yttrium-aluminum-garnet (Nd:YAG) laser and various intense pulsed light sources have been investigated for this indication. The KTP and pulsed dye laser are an effective treatment option for small vessels (<1 mm). The side effect profile is usually favorable to that of longer wavelength modalities. For larger veins, the use of a longer wavelength is required. According to the scarce evidence available, the Nd:YAG laser produces better clinical results than the alexandrite and diode laser. Penetration depth is high, whereas absorption by melanin is low, making the Nd:YAG laser suitable for the treatment of larger and deeply located veins and for the treatment of patients with dark skin types. Clinical outcome of Nd:YAG laser therapy approximates that of sclerotherapy, although the latter is associated with less pain. New developments include (1) the use of a nonuniform pulse sequence or a dual-wavelength modality, inducing methemoglobin formation and enhancing the optical absorption properties of the target structure, (2) pulse stacking and multiple pass laser treatment, (3) combination of laser therapy with sclerotherapy or radiofrequency, and (4) indocyanin green enhanced laser therapy. Future studies will have to confirm the role of these developments in the treatment of leg veins. The literature still lacks double-blind controlled clinical trials comparing the different laser modalities with each other and with sclerotherapy. Such trials should be the focus of future research.
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7.
New insights into the physiologic basis for intermittent pneumatic limb compression as a therapeutic strategy for peripheral artery disease.
Sheldon, RD, Roseguini, BT, Laughlin, MH, Newcomer, SC
Journal of vascular surgery. 2013;(6):1688-96
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Abstract
The capability for externally applied rhythmic limb compressions to improve the outcomes of patients with peripheral artery disease has been recognized for nearly a century. Modern technology has permitted the development of portable and cost-effective intermittent pneumatic compression (IPC) systems to be made readily available for affordable at-home use. Mounting clinical evidence attests to the effectiveness of this strategy, with improvements in claudication distance rivaling those seen with exercise training or pharmacologic interventions, or both. However, owing to a lack of mechanistic knowledge, whether current application protocols are optimized for clinical outcomes is unknown. Traditional thinking has suggested that IPC transiently elevates blood flow, which is purported to relieve ischemia, improve vascular function, and promote vascular remodeling. Surprisingly, much ambiguity exists regarding the physiologic stimuli and adaptations that are responsible for the clinical effectiveness of IPC treatment. This review presents and critically discusses emerging evidence that sheds new light on the physiologic and molecular responses to IPC therapy. These novel findings highlight the importance of characterizing the phasic changes in the hemodynamic profile during IPC application. Further, these studies indicate that factors other than the elevation in blood flow during this therapy should be taken into account when designing an optimal IPC device. Lastly, we advance the hypothesis that manipulation of IPC stimulation characteristics could potentially magnify the documented clinical benefits associated with this therapy. In conclusion, recent evidence challenges the physiologic basis on which current IPC systems were designed, and further research to elucidate the basic and clinical outcomes of alternate stimulation characteristics is necessary.
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[Fall risk and fracture. Diagnosing sarcopenia and sarcopenic leg to prevent fall and fracture: its difficulty and pit falls].
Hida, T, Harada, A
Clinical calcium. 2013;(5):707-12
Abstract
Diagnosis of sarcopenia is based on the combination of physical-performance assessment and muscle-mass measurement. Physical performance was estimated by gait speed and grip strength. Common measuring procedures for skeletal muscle mass were dual energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) . Skeletal muscle mass index (SMI) was calculated from following formula ; [SMI (kg/m(2)) = (arm lean mass + leg lean mass) /height(2)] . Sarcopenia and sarcopenic leg are associated with poor body balance, falls, and subsequent fracture. Treatment of sarcopenia may result in successful prevention of fall and fracture for frail elderly.
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Advances in below-the-knee drug-eluting balloons.
Ferraresi, R, Centola, M, Biondi-Zoccai, G
The Journal of cardiovascular surgery. 2012;(2):205-13
Abstract
The management of critical limb ischemia due to below-the-knee disease remains challenging due to the frequent patient comorbidities, diffuse vascular involvement, and high rates of restenosis and disease progression. The BASIL study has established the substantial equivalence between bypass surgery and percutaneous transluminal angioplasty in this setting, at least at mid-term follow-up, but percutaneous techniques and devices have seen major developments since the publication of this pivotal trial in 2005. A major breakthrough has indeed been the introduction of drug-eluting balloons, which have several theoretical advantages in comparison to standard balloons and metallic stents for infra-popliteal lesions. Two clinical trials have already been reported with favorable results for the In.Pact Amphirion paclitaxel-eluting balloon, when employed for below-the-knee lesions. We hereby discuss the rationale for the use of drug-eluting balloons in this complex setting and the main findings of the study by Schmidt et al. and the DEBATE-BTK trial.
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10.
Pharmacological interventions on critical limb ischemia in diabetic patients.
Parekh, N, Nanjundappa, A, Dieter, RS
The Journal of cardiovascular surgery. 2012;(1):39-43
Abstract
Peripheral arterial disease is highly prevalent in patients with diabetes mellitus. Critical limb ischemia is an important component of this disease entity. Early diagnosis, identification of risk factors, and appropriate therapeutic management strategies are needed to aggresively treat this disease. This paper reviews risk factors for critical limb ischemia and discusses updates on pharmacologic therapies with a specific focus on the diabetic population.