Handgrip exercise elevates basilic venous hemodynamic parameters in healthy subjects

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1 interntionl journl of nursing sciences 1 (2014) 389e393 Avilble online t ScienceDirect journl homepge: Originl Article Hndgrip exercise elevtes bsilic venous hemodynmic prmeters in helthy subjects Min Zhng b, Xiu-Xin Fng,*, Ming-E. Li b, Chun-Hui Zheng b, Xi-Hun Zhou b, Xio-Qin Lyu b School of Nursing, Binzhou Medicl University, Binzhou, Shndong, Chin b Binzhou Medicl University Hospitl, Binzhou, Shndong, Chin rticle info Article history: Received 26 My 2014 Received in revised form 15 October 2014 Accepted 20 October 2014 Avilble online 7 November 2014 Keywords: Doppler ultrsonogrphy Hndgrip exercise Venous blood velocity Blood vessel dimeter bstrct Purpose: This study exmined the effect of hndgrip exercise on hemodynmic indices to determine the most effective for promoting blood circultion. Methods: Helthy individuls were divided into three tretment groups with ech performing exercises using n electronic hndgrip. Groups performed exercises to determine the most pproprite tp position, frequency, nd durtion. The hemodynmic indices were mesured by Doppler ultrsound. Results: The best hndgrip position ws the wek tp position. Venous blood flow velocity nd blood flow incresed significntly with ech exercise reltive to the resting stte (p < 0.01). Venous blood flow velocity nd blood flow peked with hndgrip exercise frequency of 25 times/min for 2 min (p < 0.01). No significnt differences were observed between sexes. Conclusion: Hndgrip exercise is n effective method for improving blood circultion in the upper extremities. Copyright 2014, Chinese Nursing Assocition. Production nd hosting by Elsevier (Singpore) Pte Ltd. This is n open ccess rticle under the CC BY-NC-ND license ( cretivecommons.org/licenses/by-nc-nd/3.0/). 1. Introduction Venous stsis, vein vsculr injury, nd cogulopthy re the three mjor fctors of venous thrombosis. For ptients prone to venous thrombosis, erly regulr ctivity is n importnt fctor; however, mny ptients re not ble to complete regulr exercise [1]. For lower extremities, some studies hve reported tht foot exercises cn increse venous blood flow velocity nd blood flow, thereby trnsiently reducing the tendency of venous stsis nd potentilly preventing deep venous thrombosis [2e4]. To prevent upper limb vein thrombosis, one study hs reported tht hndgrip exercise enhnced upper rm muscle contrction fter loding nd promoted upper limb blood nd lymphtic circumfluence nd circultion [5]. Although hndgrip exercises re redily vilble to ptients, the most effective pttern of hndgrip exercise hs not been investigted. In this study, vrious hndgrip exercises with electronic hndgrips were tested in 300 helthy volunteers to determine the most effective exercise for promoting blood circultion within the upper extremities. Chnges in venous blood flow * Corresponding uthor. E-mil ddress: xiuxinf@sohu.com (X.-X. Fng). Peer review under responsibility of Chinese Nursing Assocition /Copyright 2014, Chinese Nursing Assocition. Production nd hosting by Elsevier (Singpore) Pte Ltd. This is n open ccess rticle under the CC BY-NC-ND license (

2 390 interntionl journl of nursing sciences 1 (2014) 389e393 velocity nd blood flow fter different frequencies nd durtions were nlyzed. 2. Design nd methods 2.1. Subjects Using the convenience smpling method, we selected 300 helthy volunteers, rnging in ge from 45 to 65 yers, nd who hd no history of thrombosis, upper limb trum, surgery, swelling, lymph edem, hypertension, mentl illness, crdiovsculr diseses, venous reflux, or outflow obstruction. Subjects were divided into three tretment groups: A, B, nd C (n ¼ 100 for ech group). The rtio of men to women in ech group ws 1:1. The verge ge of the men nd women in group A ws ± yers nd ± 7.07 yers, respectively; in group B ws ± 8.94 yers nd ± yers, respectively; nd in group C ± 9.43 yers nd ± 8.74 yers, respectively. The study ws guided by the Declrtion of Helsinki nd pproved by the Reserch Ethics Committee of Binzhou Medicl University Hospitl. Informed consent ws obtined from ll individuls. No sttisticl differences in ge nd sex bseline dt were observed Equipment nd qulity control Equipment A GE LOGIQe portble ultrsound dignostic instrument (LOGIQe GE, USA) nd CAMRY electronic hndgrip (EH101; Gungdong, Chin) were used Qulity control Grip indices were mesured by the sme opertor using the ultrsonic dignostic instrument. All mesurements nd exercises were crried out in drft-free room with constnt temperture of 25 C Doppler ultrsonic recordings The venous blood flow velocity nd vessel dimeter were mesured in ech subject's right upper limb 10 cm bove the elbow joint by single exminer. Pulse-wve Doppler recordings in the bsilic veins were mesured using the LOG- IQe ultrsound system nd L10-5 brodbnd liner rry trnsducer with n extended operting frequency rnge of 5e10 MHz. The gin, contrst, nd rejection settings were optimized fter n initil evlution nd then kept constnt. The smpling site ws guided by color flow mpping tht positioned the smple volume t the center of the color signl to crete the smllest ngle of insontion, rnging from 45 to 60, between the direction of blood flow nd the Doppler bem. Smple volume ws preset nd mintined t 2.0 mm. The venous hemodynmic prmeters evluted were venous blood flow velocity (cm/s), blood vessel dimeter (cm), cross-sectionl re (cm 2 ), nd venous blood flow (ml/s). Venous blood flow ws clculted from the venous blood flow velocity multiplied by the cross-sectionl re (p dimeter 2 / 4) of the bsilic vein Hndgrip exercise s Throughout the reserch process, fixed resercher explined the purpose, frequency nd length of the hndgrip exercise to ensure the subjects' understnding nd smooth study implementtion First stge: group A Ech subject conducted hndgrip exercise to determine the best hndgrip strength, or tp position. Tp positions were ctegorized s wek, intermedite, or strong. An electronic hndgrip mesured the grip strength with ech subject testing their mximum grip strength for totl of three times. Between ttempts, the subjects rested for 15 minutes. If the tp positions of the three mesurements were not consistent for subject, then the following steps were performed. If the tp position mesurements vried by rtio of two to one, then the two consistent tp positions were chosen. If the three tp positions were completely inconsistent, then the intermedite tp position ws chosen. The venous blood flow velocity nd blood vessel dimeter were mesured by the sme exminer before nd fter the hndgrip exercise Second stge: group B The most suitble hndgrip frequency ws chosen from the pproprite tp position. First, the subjects rested for 15 minutes. Using the tp position determined in the first stge, the hndgrip exercise ws performed with vrying frequencies of either 15, 20, 25, or 30 times/min using n electronic hndgrip. After the hndgrip exercise, the subjects rested nother 15 minutes. During the implementtion process, the guidnce personnel plyed recorded sound pttern of hold, loosen, hold, loosen, for ech frequency to ensure n ccurte hndgrip exercise ws performed. The venous blood flow velocity nd blood vessel dimeter were mesured by the sme exminer s in the first stge Third stge: group C The idel durtion for the hndgrip exercise ws chosen bsed on the informtion from the most pproprite tp position determined in the first stge nd the most suitble frequency determined in the second stge. The subjects first rested for 15 minutes nd then performed the hndgrip exercise for 1, 2, or 3 min under the pproprite tp position. The guidnce personnel plyed recorded sound pttern s for Group B. After performing the exercise for vrious lengths of time, the subjects rested for 15 minutes. The venous blood velocity nd blood vessel dimeter were mesured by the sme exminer before nd fter the hndgrip exercise Sttisticl nlysis Dt re expressed s the men ± stndrd error. Anlysis of vrince of rndomized block design using the Friedmn M test ws used to test venous blood flow velocity, vessel dimeter, nd blood flow, nd the lest significnt differences test ws used for multiple comprisons. The Sttisticl Pckge for the Socil Sciences (SPSS), version 13.0 (SPSS Inc., Chicgo, IL, USA) ws used for the sttisticl nlysis with the level of significnce set t p < 0.05.

3 interntionl journl of nursing sciences 1 (2014) 389e Tble 1 e Chnges in blood flow velocity by gender nd frequency (c ± s, cm/s). Resting stte ± ± ± times/min ± ± ± times/min ± ± ± times/min ± ± ± times/min ± ± ± 1.26 F Note: F sttisticl test vlues; P Pvlue. Represents no significnt difference in the blood flow velocities between the hndgrip exercise frequencies of 20 times/min nd 30 times/min p > 0.05, the remining frequencies blood flow velocity compred with ech other ws p < Tble 3 e Chnges in blood flow by gender nd frequency (c ± s, ml/s). Resting stte 2.28 ± ± ± times/min 2.60 ± ± ± times/min 2.96 ± ± ± times/min 3.41 ± 1.23 b 2.69 ± ± times/min 3.13 ± ± ± 1.06 F Represents no significnt difference in blood flow between the hndgrip exercise frequencies of 20 times/min nd 30 times/min (p > 0.05); b Represents no significnt difference in blood flow between the hndgrip exercise frequencies of 25 times/min nd 30 times/min (p > 0.05). The blood flow vlues were significntly different between frequencies ech other (p < 0.01). 3. Results 3.1. Anlysis of hndgrip tp positions in helthy subjects To determine the best hndgrip strength, ech subject conducted hndgrip exercise to determine the idel tp position for the remining tests. Of the totl subjects tested, four mle subjects (4%) nd zero femle subjects (0%) resulted in the strong tp position nd six mle subjects (6%) nd four femle subjects (4%) resulted in the intermedite position. Of the remining 86 subjects, 40 mle subjects (80%) nd 46 femle subjects (92%) resulted in the wek tp position. Given these results, the wek tp position of the electronic hndgrip ws chosen s the best hndgrip strength Chnges in venous blood flow velocity, blood vessel dimeter, nd blood flow using different frequencies Significnt differences in venous blood flow velocity nd venous blood flow were observed between the resting nd hndgrip exercise sttes using four different frequencies (15, 20, 25, nd 30 times/min; p < 0.01). Additionlly, significnt differences were observed in venous blood flow velocity nd venous blood flow between the vrious exercises themselves (p < 0.01). With n increse in exercise frequency, blood vessel dimeter chnges were not obvious. Both genders exhibited similr increse in venous blood flow velocity nd blood flow with incresing exercise frequency. Specificlly, blood flow velocity nd blood flow peked with n exercise frequency of 25 times/min, (p < 0.01), nd then decresed with frequency of 30 times/min (p < 0.01, Tbles 1e3) Chnges in venous blood flow velocity, blood vessel dimeter, nd blood flow with different exercise durtions There were significnt differences in venous blood flow velocity nd venous blood flow mong the different exercise times tested (p < 0.01). With n increse in hndgrip exercise durtion, venous blood flow velocity nd blood flow continully incresed with pek t 2 min (p < 0.01). However, blood flow velocity nd blood flow decresed with 3-min exercise compred to 2-min exercise (p < 0.01) but still remined elevted reltive to the other time periods tested. Significnt differences in blood vessel dimeters were observed only with hndgrip exercise durtion of 2 min reltive to the resting stte (Tbles 4e6). Tble 2 e Chnges in blood vessel dimeter by gender nd frequency (c ± s, cm). Resting stte 0.50 ± ± ± times/min 0.51 ± ± ± times/min 0.53 ± ± ± times/min 0.54 ± ± ± times/min 0.53 ± ± ± 0.09 F P Represents significnt difference in blood vessel dimeter between the hndgrip exercise frequency of 25 times/min nd the resting stte (p < 0.05). The remining blood vessel dimeters were not significntly different t the vrious frequencies (p > 0.05). Tble 4 e Chnges in blood flow velocity by gender nd durtion (c ± s, cm/s). Resting stte ± ± ± min ± ± ± min ± ± ± min ± ± ± 1.33 F Represents no significnt difference in blood flow velocities between the hndgrip exercise durtions of 1 min nd 3 min (p > 0.05). The remining blood flow velocity vlues were significntly different between durtions ech other (p < 0.01).

4 392 interntionl journl of nursing sciences 1 (2014) 389e393 Tble 5 e Chnges in blood vessel dimeter by gender nd durtion (c ± s, cm). 4. Discussion Resting stte 0.51 ± ± ± min 0.54 ± ± ± min 0.56 ± ± ± min 0.55 ± ± ± 0.10 F P Represents significnt difference in blood vessel dimeter between the 2-min hndgrip exercise nd the resting stte (p < 0.05). The remining blood vessel dimeters were not significntly different between durtions ech other (p > 0.05). Peripherlly inserted centrl ctheter (PICC)erelted venous thrombosis, especilly symptomtic thrombosis, is more common thn other complictions in ptients with PICC lines [6]. Studies hve shown tht the incidence of symptomtic PICC-relted upper limb vein thrombosis is s high s 23.3e38.5% [7,8]. PICC-relted thrombosis ccounts for 40% of cses of pulmonry embolism nd crries mortlity rte s high s 25% [9]. The thrombolytic effect of limb vein thrombosis is detrimentl nd will influence ptient prognosis, qulity of life, nd economy. As such, the prevention of upper limb venous thrombosis hs strong clinicl implictions Hndgrip exercise effectively increses upper limb venous blood flow velocity nd blood flow There re severl methods for preventing venous thromboembolism, such s the use of n ir pressure pump or stretch hose, drug prevention, nd exercise therpy [10]. In Chin, hndgrip exercise is the method of choice for preventing limb venous thrombosis. Methodologies, such s ctive nd pssive movements, cn chnge the frequency of venous stsis, nd moderte ctivity, including hnd nd wrist ctivities such s the hndgrip exercise, cn promote blood circultion in the upper extremities [11]. This study hs shown tht venous blood flow velocity nd blood flow were improved Tble 6 e Chnges in blood flow by gender nd durtion (c ± s, ml/s). Resting stte 2.24 ± ± ± min 3.20 ± ± ± min 3.49 ± ± ± min 3.24 ± ± ± 1.22 F Represents no significnt difference in blood flow between the hndgrip exercise durtions of 1 min nd 3 min (p > 0.05). The remining blood flow vlues were significntly different between durtions ech other (p < 0.01). significntly compred to the resting stte using vrious hndgrip exercise frequencies nd durtions in both men nd women. These results re consistent with previous study tht suggested tht clinicl hndgrip exercises t moderte frequency nd durtion cn improve upper limb blood circultion in ptients [12] Different hndgrip exercise ptterns influence upper limb venous blood flow dynmics The wek tp position is dvisble for electronic grip exercises In this study, the electronic grips were divided into three tp positions, nmely strong, intermedite, nd wek. The results indicte tht both men (80%) nd women (92%) utilized the wek tp position the most. Although minority of subjects reched the intermedite or strong tp positions, subjects found those positions to be difficult to use nd not conducive to sustined nd effective exercise The most effective hndgrip exercise for promoting blood circultion is the wek tp position, 25 times/ min for 2 minutes Using the wek tp position nd ech of the four tested frequencies, the venous blood flow velocity nd blood flow incresed significntly compred to the resting stte, indicting tht hndgrip exercise cn effectively promote upper limb blood circultion. In study of 10 subjects with PICC, hndgrip exercises performed with vrious frequencies lso demonstrted blood flow velocity pek nd blood vessel dimeter increse with frequency of 30 times/min [13]. Other reports hve lso shown n increse in blood circultion with exercises consisting of the squeeze nd relese of rubber stress bll three times dy with 30 repetitions t time [5,12e14]. However, stress bll cnnot mesure strength, ffecting the efficcy of the hndgrip exercise. Using n electronic hndgrip to quntify the strength of hndgrip exercises, s in this study, provides more ccurte nlysis of the most effective tretment nd compenstes for the disdvntges of the stress bll. Ptients using hndgrips cn enhnce the lod when the upper rm muscle contrction is reched, therefore promoting blood circultion nd lymphtic circumfluence [5]. In this study, venous blood flow velocity nd blood flow did not continully increse with incresing exercise frequency nd durtion. Rther, venous blood flow velocity decresed with frequency bove 25 times/min. Possible explntions for this observtion my be tht short exercise frequency over long time period mkes the subjects too tired to rech certin level of muscle contrction. As result, the durtion of squeezing from muscle contrctions of blood vessels is too short, preventing blood in the veins from emptying completely nd cusing venous blood velocity to plteu or even decrese Electronic grips strengthen the effect of hndgrip exercises Some studies hve reported tht fibrinolytic ctivity is improved fter exercise by reducing fibrinolytic enzyme ctivtor inhibitor-1 levels, nd thereby incresing the originl tissue fibrinolytic enzyme ctivtor, the fibrinolytic protein

5 interntionl journl of nursing sciences 1 (2014) 389e dissolution, blood flow velocity, nd blood circultion [15]. This study ws in greement with the ltter of those findings nd found tht subjects using the electronic hndgrip with wek tp position t frequency of 25 times/min for 2 min hd the gretest effect on hemodynmic chnges. Using the electronic hndgrip guides ptients through the hndgrip exercise, effectively promoting blood circultion nd decresing the occurrence of upper limb vein thrombosis. Further studies with longer observtion periods re required to confirm the effect of the wek tp position using n electronic hndgrip, s well s the best hndgrip exercise frequency nd durtion. 5. Summry In conclusion, hndgrip exercises using n electronic hndgrip incresed venous blood flow velocity nd venous blood flow, indicting tht these exercises might be useful for preventing stsis-induced venous thrombosis. The best exercise consisted of wek tp position with frequency of 25 times/min nd durtion of 2 minutes. This study suggests tht these exercise my improve thrombosis in clinicl conditions such s long-term PICC, frctures in the upper limb, brest cncer, nd postopertive stroke rehbilittion. This type of exercise my encourge ptients to obtin timely nd effective tretment nd provide theoreticl support for ptient recovery. Conflicts of interest The uthors hve no conflicts of interest to declre. Funding This work ws supported by grnt from the Medicine nd Helth Science Technology Development Progrm of Shndong (No. 2014WS0481). references [1] Geerts WH, Bergqvist D, Pineo GF, Heit JA, Smm CM, Lssen MR, et l. Prevention of venous thromboembolism: Americn College of Chest Physicins Evidence-bsed Clinicl Prctice Guidelines (8th edition). Chest 2008;133:381Se453S. [2] Hitos K, Cnnon M, Cnnon S, Grth S, Fletcher JP. Effect of leg exercises on poplitel venous blood flow during prolonged immobility of seted subjects: implictions for prevention of trvel-relted deep vein thrombosis. J Thromb Hemost 2007;5:1890e5. [3] Stein PD, Yekoub AY, Ahsn ST, Mtt F, Ll MM, Mirz B, et l. Ankle exercise nd venous blood velocity. Thromb Hemost 2009;101(6):1100e3. [4] Ymshit K, Yokoym T, Kitok N, Nishiym T, Mnbe M. Blood flow velocity of the femorl vein with foot exercise compred to pneumtic foot compression. J Clin Anesth 2005;17(2):102e5. [5] Minqing H, Dieqing H, Chunyi H. Hong C.Prevention of PICCinduced mechnicl phlebitis by clenching hnd-muscle developer. J Nurs Sci 2011;11:12e3. [6] Nifong TP, McDevitt TJ. The effect of ctheter to vein rtio on blood flow rtes in simulted model of peripherlly inserted centrl venous ctheters. Chest 2011;140(1):48e53. [7] Allen AW1, Megrgell JL, Brown DB, Lynch FC, Singh H, Singh Y, et l. Venous thrombosis ssocited with the plcement of peripherlly inserted centrl ctheters. J Vsc Interv Rdiol 2000;11:1309e14. [8] Abdullh BJ, Mohmmd N, Sngkr JV, Abd Aziz YF, Gn GG, Goh KY, et l. Incidence of upper limb venous thrombosis ssocited with peripherlly inserted centrl ctheters (PICC). Br J Rdiol 2005;78:596e600. [9] Evns RS, Linford LH, Shrp JH, White G, Lloyd JF, Wever LK. Computer identifiction of symptomtic deep venous thrombosis ssocited with peripherlly inserted centrl ctheters. AMIA Annu Symp Proc 2007;11:226e30. [10] Coppens M, Schreijer AJ, Berger FH, Cnnegieter SC, Rosendl FR, Büller HR. Mechnicl prophylxis for trvelers' thrombosis: comprison of three interventions tht promote venous outflow. J Thromb Hemost 2007;5(7):1556e67. [11] Xing Z. Prevention nd nursing progress of ptients with PICC upper limb vein thrombosis. In: In 2012 the ntionl iv fluids tretment nursing cdemic exchnge meeting, Chngchun; [12] Yingn H. The colostomy surgery effect nlysis of self exercise nursing instruction in ptients with mintennce hemodilysis. Chin J Blood Purif 2009;8(2):110e2. [13] Sijun MJ, Lihu Yu, Yng. Effect of fisting ctivity t different frequencies on hem dynmics of the vein with PICC insertion. J Chin Clin Med Imging 2013;24(11):798e800. [14] Xu W. Observtion on effects of rm swelling ptients fter PICC crrying out rm exercises. Chin Nurs Res 2006;25:2320. [15] Comerot AJ, Chouhn V, Hrd RN, et l. The fibrinolytic effects of intermittent pneumtic compression: mechnism of enhnced fibrinolysis. Ann Surg 1997;226:306e13.

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