scholarly journals PHYSICAL THERAPY AFFECTS ENDOTHELIAL FUNCTION IN LYMPHEDEMA PATIENTS

Lymphology ◽  
2021 ◽  
Vol 53 (3) ◽  
Author(s):  
B Brix ◽  
G Apich ◽  
C Ure ◽  
A Roessler ◽  
N Goswami
Keyword(s):  
Physical Therapy ◽  
Endothelial Function ◽  
Vascular Function ◽  
Lymphatic Drainage ◽  
Manual Lymphatic Drainage ◽  
Beneficial Effects ◽  
Compression Bandaging ◽  
Complete Decongestive Therapy ◽  
Plasma Adma ◽  
Retinal Microvasculature

Lymphedema arises due to a malfunction of the lymphatic system and can lead to massive tissue swelling. Complete decongestive therapy (CDT), consisting of manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing volume in affected extremities. Lymphatic dysfunction has previously been associated with chronic inflammation processes. We investigated plasma ADMA as an indicator of endothelial function/inflammation before-, during- and after-CDT. Also assessed were vascular function parameters such as carotid-femoral pulse wave velocity (PWVcf), flow-mediated dilatation (FMD) and retinal microvasculature analysis. 13 patients (3 males and 10 females, 57 ± 8 years old (mean ± SD), 167.2 ± 8.3 cm height, 91.0 ± 23.5 kg weight), with lower limb lymphedema were included. Vascular function parameters were assessed on day 1, 2, 7, 14 and 21 of CDT, pre- and post-MLD. ADMA was significantly lower post-MLD (p=0.0064) and tended to reduce over three weeks of therapy (p=0.0506). PWVcf weakly correlated with FMD (r=0.361, p=0.010). PWVcf, FMD and retinal microvasculature analysis did not show changes due to physical therapy. The novel results from this study indicate that lymphedema does not affect endothelial function and lymphedema patients may therefore not have a higher risk of cardiovascular diseases. Our results further suggest that manual lymphatic drainage with or without full CDT could have potentially beneficial effects on endothelial function in lymphedema patients (by reducing ADMA levels), which has not been reported previously.

scholarly journals Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients

2020 ◽  
Vol 9 (11) ◽  
pp. 3678 ◽  
Author(s):  
Bianca Brix ◽  
Gert Apich ◽  
Andreas Roessler ◽  
Christian Ure ◽  
Karin Schmid-Zalaudek ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Plasma Volume ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Lymphatic Drainage ◽  
Whole Body ◽  
Fluid Composition ◽  
Manual Lymphatic Drainage ◽  
Complete Decongestive Therapy ◽  
Fluid Shifts

Complete decongestive therapy (CDT), a physical therapy including manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing limb volume in lymphedema patients. Details of fluid shifts occurring in response to CDT are currently not well studied. Therefore, we investigated fluid shifts before, during and after CDT. Thirteen patients (3 males and 10 females, aged 57 ± 8.0 years, 167.2 ± 8.3 cm height, 91.0 ± 23.4 kg weight) diagnosed with stage II leg lymphedema participated. Leg volume, limb and whole-body fluid composition (total body water (limbTBW/%TBW), extracellular (limbECF/%ECF) and intracellular (limbICF/%ICF fluid), as well as ECF/ICF and limbECF/limbICF ratios were determined using perometry and bioelectrical impedance spectroscopy. Plasma volume, proteins, osmolality, oncotic pressure and electrolytes were assessed. Leg volume (p < 0.001), limbECF (p = 0.041), limbICF (p = 0.005) and limbECF/limbICF decreased over CDT. Total leg volume and limbTBW were correlated (r = 0.635). %TBW (p = 0.001) and %ECF (p = 0.007) decreased over time. The maximum effects were seen within one week of CDT. LimbICF (p = 0.017), %TBW (p = 0.009) and %ICF (p = 0.003) increased post-MLD, whereas ECF/ICF decreased due to MLD. Plasma volume increased by 1.5% post-MLD, as well as albumin and the albumin-to-globulin ratio (p = 0.005 and p = 0.049, respectively). Our results indicate that physical therapy leads to fluid shifts in lymphedema patients, with the greatest effects occurring within one week of therapy. Fluid shifts due to physical therapy were also reflected in increased plasma volume and plasma protein concentrations. Perometry, in contrast to bioelectrical impedance analysis, does not seem to be sensitive enough to detect small fluid changes caused by manual lymphatic drainage.

scholarly journals Effects of physical therapy on hyaluronan clearance and volume regulating hormones in lower limb lymphedema patients: A pilot study

2021 ◽  
Vol 104 (1) ◽  
pp. 003685042199848
Author(s):  
Bianca Brix ◽  
Gert Apich ◽  
Andreas Rössler ◽  
Sebastian Walbrodt ◽  
Nandu Goswami
Keyword(s):  
Pilot Study ◽  
Lower Limb ◽  
Time Course ◽  
Plasma Renin ◽  
Lymphatic Drainage ◽  
Invasive Treatment ◽  
Lymphatic Flow ◽  
Compression Bandaging ◽  
Complete Decongestive Therapy ◽  
Total Plasma Protein

Lymphedema is manifested as a chronic swelling arising due to stasis in the lymphatic flow. No cure is currently available. A non-invasive treatment is a 3 week complete decongestive therapy (CDT), including manual lymphatic drainage and compression bandaging to control swelling. As CDT leads to mobilization of several liters of fluid, effects of CDT on hyaluronan clearance (maker for lymphatic outflow), volume regulating hormones, total plasma protein as well as plasma density, osmolality and selected electrolytes were investigated. In this pilot study, we assessed hyaluronan and volume regulating hormone responses from plasma samples of nine patients (three males, six females, aged 55 ± 13 years) with lower limb lymphedema stage II-III, before - and after - CDT. A paired non-parametric test (Wilcoxon) was used to assess hormonal and plasma volume changes. Correlation was tested using Spearman’s correlation. The main findings of this novel study are that lymphedema patients lost volume and weight after therapy. Hyaluronic acid did not significantly change pre- compared to post-CDT. Aldosterone increased significantly after therapy, while plasma renin activity increased, but not significantly. Plasma total protein, density, osmolality and sodium and chloride did not show differences after CDT. To our knowledge, no study has previously investigated the effects of CDT on volume regulating hormones or electrolytes. To identify the time-course of volume regulating hormones and lymphatic flow changes induced by CDT, future studies should assess these parameters serially over 3 weeks of therapy.

scholarly journals Hemodynamic Responses in Lower Limb Lymphedema Patients Undergoing Physical Therapy

Biology ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 642
Author(s):  
Bianca Brix ◽  
Olivier White ◽  
Christian Ure ◽  
Gert Apich ◽  
Paul Simon ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Lymphatic System ◽  
Orthostatic Intolerance ◽  
Hemodynamic Responses ◽  
Stand Test ◽  
Beneficial Effects ◽  
Sit To Stand ◽  
Complete Decongestive Therapy ◽  
Before And After ◽  
Baseline Values

Background: Lymphedema arises due to a malfunction of the lymphatic system, leading to extensive tissue swelling. Complete decongestive therapy (CDT), which is a physical therapy lasting for 3 weeks and includes manual lymphatic drainages (MLD), leads to fluid mobilization and increases in plasma volume. Here, we investigated hemodynamic responses induced by these fluid shifts due to CDT and MLD. Methods: Hemodynamic parameters were assessed continuously during a sit-to-stand test (5 min baseline, 5 min of standing, and 5 min of recovery). This intervention was repeated on days 1, 2, 7, 14, and 21 of CDT, before and after MLD. Volume regulatory hormones were assessed in plasma samples. Results: A total number of 13 patients took part in this investigation. Resting diastolic blood pressure significantly decreased over three weeks of CDT (p = 0.048). No changes in baseline values were shown due to MLD. However, MLD led to a significant decrease in heart rate during orthostatic loading over all epochs on therapy day 14, as well as day 21. Volume regulatory hormones did not show changes over lymphedema therapy. Conclusion: We did not observe any signs of orthostatic hypotension at rest, as well as during to CDT, indicating that lymphedema patients do not display an elevated risk of orthostatic intolerance. Although baseline hemodynamics were not affected, MLD has shown to have potential beneficial effects on hemodynamic responses to a sit-to-stand test in patients undergoing lymphedema therapy.

Abstract 12555: The Dual PPAR-α/γ Agonist Aleglitazar Enhances Arteriogenesis, Angiogenesis and Endothelial Function

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Christian Werner ◽  
Stephan H Schirmer ◽  
Valerie Pavlickova ◽  
Michael Böhm ◽  
Ulrich Laufs
Keyword(s):  
Endothelial Function ◽  
Vascular Function ◽  
Daily Injection ◽  
Peroxisome Proliferator ◽  
Fluorescent Microspheres ◽  
Artery Ligation ◽  
Peroxisome Proliferator Activated Receptor ◽  
Beneficial Effects ◽  
And Function

Objective: Peroxisome proliferator-activated receptor (PPAR)-α and -γ agonists modify lipid and glucose metabolism. The aim of the study was to characterize the effects of the dual PPAR-α/γ agonist aleglitazar on endothelial function, neoangiogenesis and arteriogenesis in mice and on human endothelial progenitor cells (EPC). Methods and Results: Male C57Bl/6 wild-type (WT, normal chow) and apolipoprotein E-deficient (apoE-/-) mice on Western-type diet (WTD) were treated with aleglitazar (10 mg/kg i.p.) or vehicle by daily injection. Hindlimb ischemia was induced by right femoral artery ligation (FAL). ApoE-/- mice on WTD treated with aleglitazar before FAL were characterized by an improvement of endothelial-dependent laser Doppler perfusion (right/left foot ratio 0.40±0.03) 1 week after FAL compared to controls (R/L foot ratio 0.24±0.01; p<0.001). Collateral-dependent perfusion measured under conditions of maximal vasodilatation 1 week after FAL using fluorescent microspheres was impaired in apoE-/- on WTD compared to WT mice (R/L leg ratio in WT 78±13 vs. apoE-/- 56±6; p<0.001) and was normalized by aleglitazar treatment. Neoangiogenesis was measured in-vivo by subcutaneously implanting discs covered with cell-impermeable filters. The vascularized area of the discs was quantified after 14 days by perfusion of the animals with space-filling fluorescent microspheres. Aleglitazar increased neoangiogenesis in WT mice by 178±18% compared to vehicle (p<0.05). Endothelium-dependent relaxation of aortic rings was impaired in apoE-/- mice on WTD for 6 weeks (relaxation to 52±5% of max. contraction) compared to WT animals (relaxation to 18±5% of max. contraction) (p<0.001). Aleglitazar treatment improved endothelial function (relaxation to 39±5% of max. contraction; p<0.05). In parallel, number and function of EPC were improved in mice. Studies in human EPC showed that 1) aleglitazar’s effects were mediated by both PPAR-α and -γ signalling and Akt and 2) migration and colony forming units were up-regulated by aleglitazar in cultivated EPC from CAD patients. Conclusion: The study provides evidence for beneficial effects of the dual PPAR-α/γ agonist aleglitazar on vascular function in addition to or mediated by its metabolic actions.

scholarly journals Changes in Indocyanine Green Lymphography Patterns after Physical Treatment in Secondary Upper Limb Lymphedema

2020 ◽  
Vol 9 (2) ◽  
pp. 306
Author(s):  
María Elena Medina-Rodríguez ◽  
María de-la-Casa-Almeida ◽  
Jesús González Martín ◽  
María Hermida Anllo ◽  
Esther M. Medrano-Sánchez
Keyword(s):  
Breast Cancer ◽  
Physical Therapy ◽  
Indocyanine Green ◽  
Upper Limb ◽  
Lymphatic Drainage ◽  
Manual Lymphatic Drainage ◽  
Physical Treatment ◽  
Lymphatic Function ◽  
Disease Patterns ◽  
Before And After

Indocyanine green (ICG) lymphography is used to evaluate the lymphatic function before and after pneumatic compression or post-manual lymphatic drainage. The aim of this study was to ascertain the changes in the fluoroscopic pattern produced by the provision of complex physical therapy. This prospective analytic (pretest-posttest) study was conducted in 19 patients with upper lymphedema secondary to breast cancer. Nine patients were excluded due to ICG found after 3 weeks. The ICG patterns were analyzed under basal conditions and after three weeks of treatment. After the treatment, 45% of the patients presented tracer remains in the affected limb, and this finding was significantly related to time of the lymphedema development. In one subject, the patterns remain unchanged or cannot be defined. Three of the ten patients observed present the worsening of at least 1 of the patterns and in the rest of the subjects, six cases, the improvement of the patterns is observed. In 60% of the cases, the most severe pattern reversed towards slight (splash) cases, and moderate cases reversed towards a slight case in 70% of cases. Therefore, after treatment with complex physical therapy, the pathological patterns observed in the pretest, which evolved positively, reverted their severity toward milder disease patterns or towards normality.

scholarly journals Characterisation of Hypertensive Patients with Improved Endothelial Function after Dark Chocolate Consumption

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Jenifer d'El-Rei ◽  
Ana Rosa Cunha ◽  
Adriana Burlá ◽  
Marcelo Burlá ◽  
Wille Oigman ◽  
...  
Keyword(s):  
Endothelial Function ◽  
Vascular Function ◽  
Reactive Hyperemia ◽  
Linear Regression Analysis ◽  
Dark Chocolate ◽  
Peripheral Arterial Tonometry ◽  
Beneficial Effects ◽  
Framingham Risk ◽  
Peripheral Arterial ◽  
A Prospective Study

Recent findings indicate an inverse relationship between cardiovascular disease and consumption of flavonoids. We aimed to identify clinical and vascular parameters of treated hypertensive who present beneficial effects of dark chocolate for one-week period on vascular function. Twenty-one hypertensive subjects, aged 40–65 years, were included in a prospective study with measurement of blood pressure (BP), brachial flow-mediated dilatation (FMD), peripheral arterial tonometry, and central hemodynamic parameters. These tests were repeated after seven days of eating dark chocolate 75 g/day. Patients were divided according to the response in FMD: responders (n=12) and nonresponders (n=9). The responder group presented lower age (54 ± 7 versus 61 ± 6 years,P=0.037), Framingham risk score (FRS) (2.5 ± 1.8 versus 8.1 ± 5.1%,P=0.017), values of peripheral (55 ± 9 versus 63 ± 5 mmHg,P=0.041), and central pulse pressure (PP) (44 ± 10 versus 54 ± 6 mmHg,P=0.021). FMD response showed negative correlation with FRS (r=−0.60,P=0.014), baseline FMD (r=−0.54,P=0.011), baseline reactive hyperemia index (RHI;r=−0.56,P=0.008), and central PP (r=−0.43,P=0.05). However, after linear regression analysis, only FRS and baseline RHI were associated with FMD response. In conclusion, one-week dark chocolate intake significantly improved endothelial function and reduced BP in younger hypertensive with impaired endothelial function in spite of lower cardiovascular risk.

scholarly journals Interactive effects of growth hormone and oestrogen on vascular responses in hypophysectomised female rats

2002 ◽  
pp. 267-274 ◽  
Author(s):  
H Gustafsson ◽  
AW Tordby ◽  
L Brandin ◽  
L Hedin ◽  
IH Jonsdottir
Keyword(s):  
Growth Hormone ◽  
Endothelial Function ◽  
Vascular Function ◽  
Control Level ◽  
Interactive Effects ◽  
Female Rats ◽  
Resistance Arteries ◽  
Beneficial Effects ◽  
Igf I ◽  
Design And Methods

OBJECTIVE: Growth hormone (GH) and oestrogen (E(2)) are associated with beneficial effects on the cardiovascular system and it is therefore of great interest to study their interactive effects on haemodynamics and vascular function. DESIGN AND METHODS: Female hypophysectomised (Hx) rats were treated for seven days with GH, E(2) or a combination of the hormones. Systolic blood pressure (SBP), heart rate (HR) and plasma insulin-like growth factor-I (IGF-I) were measured. Contractile properties and endothelial function were studied in isolated resistance arteries using the wire-myograph technique. RESULTS: Hypophysectomy, per se, caused a fall in SBP and HR, while vascular adrenergic reactivity (sensitivity to applied noradrenaline) was enhanced. Impaired acetylcholine-induced relaxation and basal release of nitric oxide, suggests endothelial dysfunction after Hx. After supplementation with GH, SBP remained low while HR increased towards the control level. GH increased plasma IGF-I, but had no effect on vascular contractility or endothelial responses. E(2) replacement resulted in blunted plasma IGF-I, while the vascular adrenergic and serotonergic responses were reinforced. Endothelial function was not improved after E(2) treatment. When GH and E(2) were given in combination, the GH-induced increase in body weight, plasma IGF-I levels and HR were counteracted by E(2). Moreover, the anticipated reinforcement of the vascular serotonergic response by E(2) was reduced. Neither E(2) nor GH+E(2) affected SBP. CONCLUSIONS: The results suggest that GH and E(2) might have interactive effects on haemodynamic and metabolic parameters, but not on the contractility or endothelial function of resistance arteries, in Hx female rats.

scholarly journals THE EFFICACY OF INTERMITTENT PNEUMATIC COMPRESSION AS A SUBSTITUTE FOR MANUAL LYMPHATIC DRAINAGE IN COMPLETE DECONGESTIVE THERAPY IN THE TREATMENT OF BREAST CANCER RELATED LYMPHEDEMA

Lymphology ◽  
2019 ◽  
Vol 52 (2) ◽  
Author(s):  
C Sanal-Toprak ◽  
T Ozsoy-Unubol ◽  
Y Bahar-Ozdemir ◽  
G Akyuz
Keyword(s):  
Breast Cancer ◽  
Lymphatic Drainage ◽  
Intermittent Pneumatic Compression ◽  
Controlled Study ◽  
Home Exercise ◽  
Manual Lymphatic Drainage ◽  
Complete Decongestive Therapy ◽  
Arm Circumference ◽  
Breast Cancer Related Lymphedema ◽  
Decongestive Therapy

The aim of this study is to evaluate the efficacy of intermittent pneumatic compression (IPC) as a substitute for manual lymphatic drainage (MLD) in complete decongestive therapy (CDT) for treatment of advanced stages of breast cancer-related lymphedema. In this randomized, single-blind, controlled study, 46 patients with breast cancer-related lymphedema were divided into 2 groups. Both MLD with compression bandage (CB) group (n=24) and IPC with CB group (n=22) received treatment 3 days a week for 5 weeks. Home exercise program was also given to all patients. At the end of the 5th week, patients were treated with a daily 23-hour compression garment and home exercise routines. Assessments were taken at baseline, the fifth week, and the third month. Arm circumference was measured at 5 different areas, shoulder range of motion (ROM) was evaluated with a goniometer, pain, and tightness, and heaviness sensations were assessed with visual analog scale. Both groups had similar demographic and clinical characteristics (p &lt; 0.05). There were no significant differences between groups and both groups showed significant improvement (p &lt; 0.05) in the five measurement levels of the arm circumference at the fifth week and third month. Similarly, shoulder ROM, pain, tightness, and heaviness sensations improved in both groups (p &lt; 0.05). Both MLD and IPC as a component of CDT were found successful at 5 weeks and 3 months without superiority to each other.

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