Are Compression Stockings an Effective Treatment for Orthostatic Presyncope?

Syncope, or fainting, affects approximately 6.2% of the population, and is associated with significant comorbidity. Many syncopal events occur secondary to excessive venous pooling and capillary filtration in the lower limbs when upright. As such, a common approach to the management of syncope is the use of compression stockings. However, research confirming their efficacy is lacking. We aimed to investigate the effect of graded calf compression stockings on orthostatic tolerance

Exploring perceptions of barriers, facilitators and motivators to physical activity among female bariatric patients

Canadian women are twice as likely to be severely obese compared to men, are more likely to be physically inactive, and comprise the majority of patients undergoing bariatric treatment for severe obesity. Physical activity (PA) is one of the strongest predictors of successful long-term weight management and is a recommended adjunct to bariatric surgery. However, patients often do not increase levels of PA following surgery and physical inactivity among severely obese women remains poorly understood. Twelve women (mean age 47±9 years), who had undergone bariatric surgery in the last two years, were interviewed to explore perceptions of barriers and facilitators to PA. Thematic analysis resulted in development of three key, interrelated themes: the physical body, appraisal of the physical and social self, and the exercise environment. Barriers to PA included weight-restricted mobility, side effects of surgery, body dissatisfaction, compromised psychological health, competing responsibilities, a lack of exercise self-efficacy and social support, reduced access to accommodating facilities, lack of exercise knowledge, as well as northern climate. Participants reported post-surgical weight loss, weight and health maintenance, enjoyment, body image, supportive active relationships, as well as access to accommodating facilities and exercise knowledge as facilitators and motivators for adoption and maintenance of PA. Suggested appropriate PA counselling strategies and programming for healthcare providers and exercise professionals working with this unique population are discussed. Keywords: physical inactivity; women; severe obesity; weight loss surgeryLes femmes canadiennes ont deux fois plus de chance de souffrir d'obésité morbide en comparaison aux hommes et elles constituent la majorité des patients devant subir une chirurgie bariatrique. L'activité physique (AP) est un des indices les plus important pour une gestion adéquate et long terme du poids et devrait être employée comme complément à la chirurgie bariatrique. Toutefois, les femmes n'augmentent souvent pas leur niveau d'AP suite à une chirurgie bariatrique. L'inaction physique parmi les femmes obèses est un phénomène mal compris. Douze femmes (âge moyen de 47±9 ans) qui ont subi une chirurgie bariatrique dans les deux dernières années ont été interviewées pour étudier leur perception à propos des obstacles et des facilitateurs de l'activité physique. Une analyse thématique a résulté dans le développement de trois thèmes : physique, psychosocial et structurel, s'informant et se renforçant mutuellement. Les femmes ont discuté du fait que les barrières physiques de l'activité physique sont le poids restreignant la mobilité, la réduction d'énergie et les effets secondaires de la chirurgie. Les participantes ont également parlé des obstacles psychosociaux suivants : l'insatisfaction au niveau corporel, le manque d'auto-efficacité, le manque de soutien social, le manque de motivation ainsi que la fragilité du bien-être psychologique. Les barrières structurelles comprenaient quant à elles un manque d'installation et d'équipement adapté pour les obèses, un manque de soutien au niveau de l'information et le climat nordique. Nos résultats aident les professionnels de la santé à comprendre quelques défis des femmes souffrant d'obésité morbide qui veulent un traitement de chirurgie bariatrique en adoptant et maintenant simultanément un style de vie physiquement actif. Des stratégies efficaces d'AP et de mise en place de programmes pour ce type spécifique de patients doivent toucher simultanément les trois thèmes clés d'obstacles compte tenu de leur interaction complexe et de leur impact sur le comportement de l'individu par rapport à l'AP. Mots clés : exercice, femme, problèmes de santé, obésité, perte de poids opératio

An Integrative Review of Barriers to Pain Management: Implications for Future Improvement Initiatives

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OT in the three test conditions.

<p>There were no significant differences in OT between conditions (A). Kaplan-Meier plots also revealed similar times to presyncope in all test conditions (B). When the two placebo conditions were combined, OT remained similar in placebo compared to compression stocking conditions (C). Dashed lines denote those in whom OT improved with compression stockings compared to placebo conditions, and solid lines denote those in whom OT was worse with compression stockings. Filled circles denote mean data.</p

Relationship between the change in OT with compression stockings and anthropometric variables.

<p>There was a significant positive correlation between the change in OT and the height∶calf circumference ratio (A). There was a significant negative correlation between the change in OT and the calf circumference: shoe size ratio (B). The efficacy of the compression stockings could be predicted from the subject's shoe size and calf circumference (C).</p

Cerebral autoregulatory responses in the three test conditions.

<p>There were no significant differences in either the correlation coefficient (A) or the gradient (B) describing the efficiency of cerebral autoregulation between the three conditions.</p

CMAP and CBFV in the three test conditions.

<p>There were no significant differences in CMAP or CBFV between conditions at any time point. Significant differences from supine in all conditions are indicated by the * (p<0.05).</p

HR, SV and CO responses in the three test conditions.

<p>There were no significant differences in HR, SV or CO between test conditions at any time point. Significant differences from supine in all conditions are indicated by the * (p<0.05).</p

Blood pressure responses in the three test conditions.

<p>Solid lines, systolic arterial pressures; dotted lines, diastolic arterial pressures. There were no significant differences in systolic or diastolic arterial pressures between test conditions at any time point. Values at presyncope were significantly reduced compared to supine in all conditions (* denotes p<0.01).</p

Compression levels for the compression and calf placebo stockings.

<p>Compression pressures applied over a range of distending circumferences can be seen at each region of interest for the calf placebo (A) and compression stockings (B). The compression pressures applied by the two stockings were compared at physiological distending circumferences for each region of interest (C).</p