Understanding the relationships between the calf muscle pump, ankle range of motion and healing for adults with venous leg ulcers: a review of the literature

Exercise offers the potential to improve circulation, wound healing outcomes, and functional and emotional wellbeing for adults experiencing venous leg ulceration. Individuals with chronic leg ulcers typically have multiple comorbidities such as arthritis, asthma, chronic obstructive airways disease, cardiac disease or neuromuscular disorders, which would also benefit from regular exercise. The aim of this review is to highlight the relationships between the calf muscle pump and venous return and range of ankle motion for adults with venous leg ulcers. The effect of exercise will also be considered in relation to the healing rates for adults experiencing venous leg ulceration. The findings suggest there is evidence that exercises which engage the calf muscle pump improve venous return. Ankle range of motion, which is crucial for complete activation of the calf muscle pump, can also be improved with simple, home-based exercise programs. However, observational studies still report that venous leg ulcer patients are less physically active than age-matched controls. Therefore, the behavioural reasons for not exercising must be considered. Only two studies, both underpowered, have assessed the effect of exercise on the healing rates of venous leg ulcers. In conclusion, exercise is feasible with this patient population. However, future studies with larger sample sizes are needed to provide stronger evidence to support the therapeutic benefit of exercise as an adjunct therapy in wound care.

A home-based progressive resistance exercise programme for patients with venous leg ulcers : a feasibility study

This study aimed to assess the feasibility of a home-based exercise program and examine the effects on the healing rates of venous leg ulcers. A 12 –week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow-up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (p=0.34) than the control group, and a 10% (p=0.74) improvement in the number of participants healed in the intervention group compared to the control group. Significant differences between groups over time were observed in calf muscle pump function parameters; (ejection fraction [p = 0.05]; residual volume fraction [p = 0.04]) and range of ankle motion (p = 0.01). This pilot study is one of the first studies to examine and measure clinical healing rates for participants involved in a home-based progressive resistance exercise program. Further research is warranted with a larger multi-site study.

Scared straight : boot camps for Queensland

The Liberal National Party (‘LNP’) ‘tough on youth crime’ policy mantra was well publicised in the months leading up to the 2012 Queensland state election. 1 Boot camp trials were espoused as a quick-fix panacea — a way of addressing youth offending. The idea was particularly favoured in the far northern regions of the state. In line with the new government’s policy, the Youth Justice (Boot Camp Orders) and Other Legislation Amendment Bill 2012 (Qld) (‘the Bill’) had a speedy passage through the unicameral Queensland parliament. It was introduced on 1 November 2012, scrutinised by the Legal Affairs and Community Safety Committee (‘LACSC’) which sought community feedback, and reported back to Parliament within the given timeframe of three weeks. The Bill received assent early December and the provisions commenced in January 2013. This article examines the legislative changes implemented in Queensland. It analyses the issues prompting the amendments such as the perception that parts of Queensland were in the grip of a ‘soaring juvenile crime rate’, the conservative government’s ‘tough stance’ policy towards youth offending, and the transfer of youth justice ‘solutions’ such as ‘boot camps’ among jurisdictions. The article assesses the evidence base for boot camp orders as an option in sentencing young offenders and concludes by raising serious concerns about pursuing such a narrow hardline approach to youth justice.

Perspectives about exercise from adults with venous leg ulcers : an exploratory study

Objective Exercise has the potential to offer a range of health benefits in addition to improving healing outcomes for people with venous leg ulcers. However despite evidence based recommendations, most of these individuals do not engage in regular exercise. The aim of this study was to gain an understanding of the perspectives of adults with venous leg ulcers, in relation to exercise. Method This was a qualitative design using semi-structured interviews and discussions. Ten participants with venous leg ulceration volunteered to participate. Recruitment was through a specialist wound clinic. Verbatim data were collected by an experienced moderator using a semi-structured guide. Data saturation was reached after three group discussions and two interviews. A random selection of transcripts was sent back to the participants for verification. Thematic content analysis was used to determine major themes and categories. Two transcripts were independently analysed, categories and themes independently developed, cross checked and found comparable. Remaining transcripts were analysed using developed categories and codes. Results Regardless of their current exercise routine, participants reported exercising prior to venous leg ulceration and expressed an interest in either becoming active or maintaining an active lifestyle. Overall four themes emerged from the findings: i) participant understanding of the relationship between chronic venous insufficiency and exercise patterns, ii) fear of harm impacts upon positive beliefs and attitudes to exercise, iii) perceived factors limit exercise and iv) structured management facilitates exercise. Conclusion The value of exercise in improving outcomes in venous leg ulcers lies in its capacity to promote venous return and reduce the risk of secondary conditions in this population. Despite motivation and interest in being exercise active, people with venous leg ulcers report many obstacles. Further exploration of mechanisms that assist this patient population and promote understanding about management of barriers, coupled with promotion of enabling factors is vital for improving their exercise participation.

Design and test of a custom instrumented leg press for injury and recovery intervention

There is an increasing desire and emphasis to integrate assessment tools into the everyday training environment of athletes. These tools are intended to fine-tune athlete development, enhance performance and aid in the development of individualised programmes for athletes. The areas of workload monitoring, skill development and injury assessment are expected to benefit from such tools. This paper describes the development of an instrumented leg press and its application to testing leg dominance with a cohort of athletes. The developed instrumented leg press is a 45° reclining sled-type leg press with dual force plates, a displacement sensor and a CCD camera. A custom software client was developed using C#. The software client enabled near-real-time display of forces beneath each limb together with displacement of the quad track roller system and video feedback of the exercise. In recording mode, the collection of athlete particulars is prompted at the start of the exercise, and pre-set thresholds are used subsequently to separate the data into epochs from each exercise repetition. The leg press was evaluated in a controlled study of a cohort of physically active adults who performed a series of leg press exercises. The leg press exercises were undertaken at a set cadence with nominal applied loads of 50%, 100% and 150% of body weight without feedback. A significant asymmetry in loading of the limbs was observed in healthy adults during both the eccentric and concentric phases of the leg press exercise (P < .05). Mean forces were significantly higher beneath the non-dominant limb (4–10%) and during the concentric phase of the muscle action (5%). Given that symmetrical loading is often emphasized during strength training and remains a common goal in sports rehabilitation, these findings highlight the clinical potential for this instrumented leg press system to monitor symmetry in lower-limb loading during progressive strength training and sports rehabilitation protocols.

An experimental and numerical study of piezoceramic actuator hysteresis in helicopter active vibration control

An aeroelastic analysis is used to investigate the rate dependent hysteresis in piezoceramic actuators and its effect on helicopter vibration control with trailing edge flaps. Hysteresis in piezoceramic materials can cause considerable complications in the use of smart actuators as prime movers in applications such as helicopter active vibration control. Dynamic hysteresis of the piezoelectric stack actuator is investigated for a range of frequencies (5 Hz (1/rev) to 30 Hz (6/rev)) which are of practical importance for helicopter vibration analysis. Bench top tests are conducted on a commercially available piezoelectric stack actuator. Frequency dependent hysteretic behavior is studied experimentally for helicopter operational frequencies. Material hysteresis in the smart actuator is mathematically modeled using the theory of conic sections. Numerical simulations are also performed at an advance ratio of 0.3 for vibration control analysis using a trailing edge flap with an idealized linear and a hysteretic actuator. The results indicate that dynamic hysteresis has a notable effect on the hub vibration levels. It is found that the theory of conic sections offers a straight forward approach for including hysteresis into aeroelastic analysis.

Active Power Decoupling with Reduced Converter Stress for Single-Phase Power Conversion and Interfacing

Single-phase DC/AC power electronic converters suffer from pulsating power at double the line frequency. The commonest practice to handle the issue is to provide a huge electrolytic capacitor for smoothening out the ripple. But, the electrolytic capacitors having short end of lifetimes limit the overall lifetime of the converter. Another way of handling the ripple power is by active power decoupling (APD) using the storage devices and a set of semiconductor switches. Here, a novel topology has been proposed implementing APD. The topology claims the benefit of 1) reduced stress on converter switches 2) using smaller capacitance value thus alleviating use of electrolytic capacitor in turn improving the lifetime of the converter. The circuit consists of a third leg, a storage capacitor and a storage inductor. The analysis and the simulation results are shown to prove the effectiveness of the topology.

Active Power Decoupling with Reduced Converter Stress for Single-Phase Power Conversion and Interfacing

Single-phase DC/AC power electronic converters suffer from pulsating power at double the line frequency. The commonest practice to handle the issue is to provide a huge electrolytic capacitor for smoothening out the ripple. But, the electrolytic capacitors having short end of lifetimes limit the overall lifetime of the converter. Another way of handling the ripple power is by active power decoupling (APD) using the storage devices and a set of semiconductor switches. Here, a novel topology has been proposed implementing APD. The topology claims the benefit of 1) reduced stress on converter switches 2) using smaller capacitance value thus alleviating use of electrolytic capacitor in turn improving the lifetime of the converter. The circuit consists of a third leg, a storage capacitor and a storage inductor. The analysis and the simulation results are shown to prove the effectiveness of the topology.

An experimental semi-active anti-roll system

The use of anti-roll bars to provide additional roll stiffness and therefore to reduce the trade-off between ride and rollover performance has previously been studied. However, little work has been carried out to investigate the benefits of a switchable roll stiffness. Such a semi-active anti-roll system has the ability to have a low roll stiffness during straight-ahead driving for improved ride performance and high roll stiffness during cornering for improved roll performance. Modelling of such a system is conducted and the model is validated against a semi-active anti-roll system fitted to an experimental vehicle. Experimental and theoretical investigations are used to investigate the performance of such a system with several different strategies employed to switch to the high-stiffness state. The use of an air suspension on the vehicle to roll into corners is also investigated, as is the possibility of exploiting the road layout by allowing the vehicle to be in a low-roll-stiffness configuration during a corner, and then to switch to the high-roll-stiffness configuration midcorner, hence 'locking in' a roll angle. The best rollover performance improvement that was achieved was 12.5 per cent. © IMechE 2008.

Active isolated stretching : an investigation of the mechanical mechanisms

The Active Isolated Stretching (AIS) technique proposes that by contracting a muscle (agonist) the opposite muscle (antagonist) will relax through reciprocal inhibition and lengthen without increasing muscle tension (Mattes, 2000). The clinical effectiveness of AIS has been reported but its mechanism of action has not been investigated at the tissue level. Proposed mechanisms for increased range of motion (ROM) include mechanical or neural changes, or an increased stretch tolerance. The purpose of the study was to investigate changes in mechanical properties, i.e. stiffness, of skeletal muscle in response to acute and long-term AIS stretching for the hamstring muscle group. Recreationally active university-aged students (female n=8, male n=2) classified as having tight hamstrings, by a knee extension test, volunteered for the study. All stretch procedures were performed on the right leg, with the left leg serving as a control. Each subject was assessed twice: at an initial session and after completing a 6-week AIS hamstring stretch training program. For both test sessions active knee extension (ROM) to a position of "light irritation", passive resisted torque and stiffness were determined before and after completion of the AIS technique (2x10 reps). Data were collected using a Biodex System 3 Pro (Biodex Medical Systems, NY, USA) isokinetic dynamometer. Surface electromyography (EMG) was used to monitor vastus lateralis (VL) and hamstring muscle activity during the stretching movements. Between test sessions, 2x10 reps of the AIS bent knee hamstring stretch were performed daily for 6-weeks.

Flavonoid supplement improves leg health and reduces fluid retention in pre-menopausal women in a double-blind, placebo-controlled study

Flavonoid extracts derived from plant foods have been shown to benefit certain types of fluid retention. However, no studies have investigated these compounds for use in premenstrual fluid retention, a complaint common among women with otherwise normal menstrual cycles. Therefore, we conducted a double-blind, placebo-controlled, pilot study into the effect of a daily flavonoid extract (Colladeen(R), 320 mg oligomeric procyanidins) on premenstrual fluid retention. Fluid retention was assessed at baseline and throughout 4 menstrual cycles of the intervention using validated questionnaires. Leg girth was also measured at baseline and at the end of the study. Thirty subjects completed the study (n = 18 active treatment; n = 12 placebo). Although no significant changes in leg girth measurements were noted, there was a significant improvement in subjective "leg health" scores after flavonoid treatment compared to placebo (p = 0.013). Furthermore, this was accompanied by an improvement in reported premenstrual fluid retention nearing significance (p = 0.066). We conclude that flavonoids supplements may provide a new therapeutic direction to counter premenstrual fluid retention and improve leg health. A larger study is now warranted.

Deprotection, tethering, and activation of a one-legged metalloporphyrin on a chemically active metal surface: NEXAFS, Synchrotron XPS, and STM study of [SAc]P-Mn(III)Cl on Ag(100)

The structural and reactive properties of the acetyl-protected "one-legged" manganese porphyrin [SAc]P-Mn(III)Cl on Ag(100) have been studied by NEXAFS, synchrotron XPS and STM Spontaneous surface-mediated deprotection occurs at 300 K accompanied by spreading of the resulting thio-tethered porphyrin across the metal surface Loss of the axial chlorine ligand occurs at 498 K, without any demetalation of the macrocycle, leaving the Mn center in a low co-ordination state At low coverages the macrocycle is markedly tilted toward the silver surface, as is the phenyl group that forms part of the tethering "leg". In the monolayer region a striking transition occurs whereby the molecule rolls over, preserving the tilt angle of the phenyl group, strongly increasing that of the macrocycle, decreasing the apparent height of the molecule and decreasing its footprint, thus enabling closer packing These findings are in marked contrast with those previously reported for the corresponding more rigidly bound four-legged porphyrin [Turner, M., Vaughan, O. P. H., Kyriakou, G., Watson, D. J., Scherer, L. J; Davidson, G J. E, Sanders, J. K. M.; Lambert, R. M J. Am. Chem Soc 2009, 131, 1910] suggesting that the physicochemical :)properties and potential applications of these versatile systems should be strongly dependent on the mode of tethering to the surface.

Flavonoid supplement improves leg health and reduces fluid retention in pre-menopausal women in a double-blind, placebo-controlled study

Flavonoid extracts derived from plant foods have been shown to benefit certain types of fluid retention. However, no studies have investigated these compounds for use in premenstrual fluid retention, a complaint common among women with otherwise normal menstrual cycles. Therefore, we conducted a double-blind, placebo-controlled, pilot study into the effect of a daily flavonoid extract (Colladeen(R), 320 mg oligomeric procyanidins) on premenstrual fluid retention. Fluid retention was assessed at baseline and throughout 4 menstrual cycles of the intervention using validated questionnaires. Leg girth was also measured at baseline and at the end of the study. Thirty subjects completed the study (n = 18 active treatment; n = 12 placebo). Although no significant changes in leg girth measurements were noted, there was a significant improvement in subjective "leg health" scores after flavonoid treatment compared to placebo (p = 0.013). Furthermore, this was accompanied by an improvement in reported premenstrual fluid retention nearing significance (p = 0.066). We conclude that flavonoids supplements may provide a new therapeutic direction to counter premenstrual fluid retention and improve leg health. A larger study is now warranted.

Seasonal metabolic changes in a year-round reproductively active subtropical tree-frog (Hypsiboas prasinus)

Although seasonal metabolic variation in ectothermic tetrapods has been investigated primarily in the context of species showing some level of metabolic depression during winter, but several species of anurans maintain their activity patterns throughout the year in tropical and subtropical areas. The tree-frog Hypsiboas prasinus occurs in the subtropical Atlantic Forest and remains reproductively active during winter, at temperatures below 10 degrees C. We compared males calling in summer and winter, and found that males of H. prasinus exhibit seasonal adjustments in metabolic and morphometric variables. Individuals calling during winter were larger and showed higher resting metabolic rates than those calling during summer. Calling rates were not affected by season. Winter animals showed lower liver and heart activity level of citrate synthase (CS), partially compensated by larger liver mass. Winter individuals also showed higher activity Of pyruvate kinase (PK) and lower activity of CS in trunk muscles, and higher activity of CS in leg muscles. Winter metabolic adjustments seem to be achieved by both compensatory mechanisms to the lower environmental temperature and a seasonally oriented aerobic depression of several organs. The impact of seasonal metabolic changes on calling performance and the capacity of subtropical anurans for metabolic thermal acclimatization are also discussed. (C) 2008 Elsevier Inc. All rights reserved.

Seasonal metabolic changes in a year-round reproductively active subtropical tree-frog (Hypsiboas prasinus)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)