Counteracting effect of supine leg resistance exercise on systolic orthostatic hypotension in older adults

OBJECTIVES: To assess the efficacy of a leg exercise performed in supine position to prevent orthostatic hypotension (OH) in older adults. DESIGN: Case–control study. SETTING: Division of Physical Medicine and Rehabilitation, Salvatore Maugeri Foundation, Scientific Institute of Veruno, Veruno, Italy. PARTICIPANTS: Individuals aged 65 and older admitted with degenerative joint disease screened (n = 90) and found positive for OH (n = 42). MEASUREMENTS: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded using an automatic oscillometric device in the supine position after 10 minutes of bed rest; immediately upon standing up; and after 1, 3 and 5 minutes standing. In 42 participants, a fall in SBP of 20 mmHg or more within 3 minutes of standing was found. Participants with OH were alternately assigned to the control or exercise group. The following day, both groups were reassessed as above. In the exercise group, before standing up, participants were required to perform 10 full extensions of the lower limbs, starting from 60° flexion of hip and 90° flexion of knee and ankle joints, against the resistance of an elastic band. RESULTS: In both participant groups, SBP, DBP, and HR were similar in the supine position. When standing, the same decrease in SBP and DBP and increase in HR occurred over a similar time-course in both participant groups. The next day, the reduction in SBP was significantly smaller at each time interval after standing up in the exercise than in the control group, but no difference between the exercise and control groups was observed in DBP or HR. CONCLUSION: Supine leg exercise is effective in reducing an initial fall in SBP when passing from a supine to an upright position in older adults. The duration of the effect requires further investigation.