Counterpressure Maneuvers for Fainting

Overseen By Victoria E Claydon, PhD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Simon Fraser University

Must not be taking: Cardiovascular medications

Disqualifiers: Cardiac arrhythmia, Seizure disorder, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

30 Participants Needed

Trial Summary

What is the purpose of this trial?

The investigators are interested in whether discrete counterpressure maneuvers, or muscle movements in the lower body, will boost blood pressure and cardiovascular control in children who faint. We will record cardiovascular responses to maneuvers of exaggerated sway, leg crossing, crouching, and gluteal muscle tensing in children who faint (N=20), as well as their height, weight, muscularity, and pubertal (Tanner) stage. Autonomic cardiovascular control will be measured using a Valsalva manoeuvre (expiration against a closed airway for 20 seconds) and a supine-stand test. The primary outcomes are noninvasive measures of cardiovascular responses to the maneuvers (blood pressure, cerebral blood flow, and stroke volume (volume of blood pumped per heartbeat). Comparisons will be made across levels of sex, diagnosis, Tanner stage, muscularity, height, and degree of autonomic control.

Do I need to stop my current medications to join the trial?

Yes, if you are taking any cardiovascular acting medications or medications for orthostatic syncope, you will be excluded from the study.

What data supports the idea that Counterpressure Maneuvers for Fainting is an effective treatment?

The available research does not provide any direct data supporting the effectiveness of Counterpressure Maneuvers for Fainting. The studies focus on muscle activation in different contexts, such as gluteus maximus activation during chair-rise in stroke patients or muscle activity during sit-to-stand movements. None of these studies directly address the use of Counterpressure Maneuvers for Fainting or compare it to other treatments for fainting. ^{1 2 3 4 5}

What safety data exists for counterpressure maneuvers for fainting?

The provided research abstracts do not directly address the safety data for counterpressure maneuvers for fainting. They focus on muscle activation and contractility in various contexts, such as gluteal muscle contraction, abdominal muscle strength, and motor strategies for movements like sitting and squatting. None of these studies specifically evaluate the safety of counterpressure maneuvers or related techniques for fainting. ^{1 4 6 7 8}

Is the treatment 'Counterpressure Maneuvers' for fainting promising?

Yes, Counterpressure Maneuvers, which include actions like leg crossing and muscle tensing, are promising because they can help improve muscle performance and balance, which might prevent fainting. ^{1 3 4 9 10}

Research Team

Victoria E Claydon, PhD

Principal Investigator

Simon Fraser University

Eligibility Criteria

This trial is for English-speaking children aged 6-18 with recurrent fainting due to vasovagal syncope or POTS, having fainted at least twice in the last year. It excludes those not fully vaccinated against COVID-19, with seizure disorders, cardiovascular diseases, pregnancy, disabilities affecting test completion, on certain medications for syncope or heart issues.

Inclusion Criteria

I am a child aged 6-18 and speak English.

I have fainted or almost fainted at least twice in the past year.

I have been diagnosed with recurrent fainting or POTS by a pediatric cardiologist.

Exclusion Criteria

I have been diagnosed with fainting spells due to a heart rhythm problem.

I have had fainting spells due to low blood sugar.

I have heart disease and experience frequent fainting.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Testing Session

Participants attend a single testing session to perform various counterpressure maneuvers and cardiovascular tests.

1 day

1 visit (in-person)

Follow-up

Participants are monitored for any adverse effects or changes in cardiovascular responses post-testing.

2 weeks

Treatment Details

Interventions

• Baseline Stand
• Counterpressure Maneuvers

Trial Overview The study tests if counterpressure maneuvers like exaggerated sway and muscle tensing can prevent fainting by improving blood pressure and heart function in kids who faint. Researchers will measure how these movements affect blood flow and heartbeat during a stand test and Valsalva maneuver.

Participant Groups

Group I: Counterpressure Maneuvers Experimental Treatment 2 Interventions

Counterpressure maneuver (CPM) trials will be performed in front of a neutral wall in silence to ensure that visual or auditory stimuli do not affect movement. CPM: * Leg crossing and muscle tensing: Legs are crossed while upright and lower body musculature is isometrically contracted (clinical) * Crouching: Participant crouches down resting weight on the balls of their feet, pressing calves against the back surface of the thighs (clinical) * Exaggerated anterior-posterior sway: Participant sways back and forth with feet planted on ground at a pace/amplitude that is comfortable (discrete) * Gluteal clenching: Participant rhythmically tenses and relaxes the gluteal muscles at a pace/duration that is comfortable (discrete) Participants serve as their own controls and complete both testing arms.

Group II: Baseline Stand Placebo Group 2 Interventions

Participants will perform a sit-stand test, followed by 5-minutes of baseline (quiet) standing trial on a force platform while cardiorespiratory responses are recorded. Sit-stand test: following 5-minutes of supine rest, the participant will be passively moved into the seated position. They will then be asked to actively move into the standing position. Baseline stand: immediately following the sit-stand test, the baseline trial will begin. Participants will stand quietly on the force platform for 5-minutes. This trial will be performed in front of a neutral wall in silence to ensure that visual or auditory stimuli do not affect their movement. Participants serve as their own controls and complete both testing arms.

Who Is Running the Clinical Trial?

Simon Fraser University

Lead Sponsor

Trials

59

Recruited

12,500+

Natural Sciences and Engineering Research Council, Canada

Collaborator

Trials

63

Recruited

3,000+

University of British Columbia

Collaborator

Trials

1,506

Recruited

2,528,000+

Provincial Health Services Authority

Collaborator

Trials

40

Recruited

31,900+

Findings from Research

In a study involving 13 recreationally active females, both the prone bent-leg hip extension and the standing glute squeeze positions produced similar peak electromyography (EMG) readings for the gluteus maximus, indicating no significant difference in muscle activation between the two positions.

The results suggest that there is no single ideal position for testing gluteus maximus strength, and researchers should consider using multiple positions to improve accuracy in future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of two gluteus maximus EMG maximum voluntary isometric contraction positions. Contreras, B., Vigotsky, AD., Schoenfeld, BJ., et al.[2022]

In a study comparing 12 adults post-stroke to 12 healthy controls, significant reductions in gluteus maximus activation were found in both the paretic and nonparetic legs of stroke survivors during chair-rising, indicating impaired muscle function post-stroke.

The study also revealed that the onset of gluteus maximus activation was delayed in the paretic leg of stroke patients compared to their nonparetic leg, suggesting a need for targeted interventions to improve muscle activation and functional independence in post-stroke individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gluteus Maximus Muscle Activation Characteristics During a Chair-Rise in Adults With Chronic Stroke. Sawtelle, M., Roddey, T., Ellison, J., et al.[2023]

A new surgical procedure targeting the anterior fibers of the gluteus medius and minimus was developed to correct internal rotation gait without affecting hip abductor function.

In a study involving 12 hips, this procedure successfully improved gait in all cases while preserving hip abductor strength, suggesting a safer and more effective approach to treating this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of internal rotation gait due to gluteus medius and minimus overactivity in cerebral palsy: anatomical rationale of a new surgical procedure and preliminary results in twelve hips. Joseph, B.[2013]

A series of unique cases revealed that gluteal muscle contracture (GMC) is often associated with congenital heart disease (CHD) in children, suggesting a potential link between these conditions.

The study recommends reducing intramuscular injections in CHD patients, emphasizing the need for thorough cardiac examinations and advanced imaging techniques like 3D-CT to better understand GMC before surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Congenital heart disease in adolescents with gluteal muscle contracture. You, T., Zhang, XT., Zha, ZG., et al.[2022]

In a study involving 30 healthy females (15 young and 15 elderly), the gluteus medius (Gmed) muscle showed significantly increased activation in elderly participants during sit-to-stand movements with hip abduction, suggesting a compensatory mechanism due to weakened rectus femoris (RF) function.

The elderly group demonstrated a significant increase in Gmed activation during natural sit-to-stand compared to the young group, indicating age-related changes in muscle recruitment patterns during functional movements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of the gluteus medius and rectus femoris muscle activities during natural sit-to-stand and sit-to-stand with hip abduction in young and older adults. Jang, EM., Yoo, WG.[2020]

Abdominal muscle contractility can be effectively measured using twitch gastric pressure (Pgat), which showed a significant decrease of 25% and 37% after sit-ups at 1 and 30 minutes, indicating substantial muscle fatigue.

Despite the observed fatigue in abdominal muscles after sit-ups, the maximum voluntary ventilation (MVV) remained unchanged, suggesting that overall breathing capacity is not significantly affected by this type of exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of abdominal muscle contractility, strength, and fatigue. Suzuki, J., Tanaka, R., Yan, S., et al.[2006]

In a study of 16 healthy elderly females, sit-to-stand (STS) movements that included hip abduction led to increased activation of the gluteus medius (Gmed) muscle and decreased reliance on the rectus femoris (RF) muscle during the movement.

The findings suggest that incorporating hip abduction into STS exercises can be beneficial for elderly females by optimizing muscle activation patterns, potentially reducing strain on the RF muscle.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of Hip Stabilization Muscle Use during Neutral Sit to Stand and Sit to Stand Involving Isometric Hip Abduction in Elderly Females. Jang, EM., Yoo, WG.[2020]

The study analyzed the differences in motor strategies between sitting down and squatting in 12 healthy subjects, revealing that sitting down relies on a specific muscle activation pattern that stabilizes the body and prevents falling backward.

In contrast, squatting allows for a variety of motor strategies without a need for forward momentum, indicating that the central nervous system optimizes movements based on the task, particularly by adjusting the initial body position when sitting down.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motor strategies for initiating downward-oriented movements during standing in adults. Hase, K., Sako, M., Ushiba, J., et al.[2018]

Weakness in the gluteal muscles, induced by blocking the superior and inferior gluteal nerves, significantly altered joint reaction forces (JRFs) during deep bilateral squats in healthy young adults, with affected joints showing lower JRFs and contralateral joints compensating with higher forces.

Despite changes in JRFs, hip, knee, and ankle kinematics did not show significant differences, indicating that while muscle weakness affects force distribution, it may not alter the overall movement pattern during squats.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of experimentally induced gluteal muscle weakness on joint kinematics, reaction forces, and dynamic balance performance during deep bilateral squats. Dimitriou, D., Meisterhans, M., Geissmann, M., et al.[2023]

A lower-limb warm-up targeting the gluteal muscles significantly improved countermovement jump height by 7.9% in ten semi-professional rugby players, indicating its efficacy in enhancing muscular performance.

Despite the performance improvements, there were no significant changes in muscle activity measured by electromyography, suggesting that the benefits may not be directly linked to increased muscle activation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The acute effect of lower-limb warm-up on muscle performance. Pinfold, SC., Harnett, MC., Cochrane, DJ.[2018]

References

1. United States pubmed.ncbi.nlm.nih.gov

A comparison of two gluteus maximus EMG maximum voluntary isometric contraction positions. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Gluteus Maximus Muscle Activation Characteristics During a Chair-Rise in Adults With Chronic Stroke. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Treatment of internal rotation gait due to gluteus medius and minimus overactivity in cerebral palsy: anatomical rationale of a new surgical procedure and preliminary results in twelve hips. [2013]

4. United States pubmed.ncbi.nlm.nih.gov

Congenital heart disease in adolescents with gluteal muscle contracture. [2022]

5. Japan pubmed.ncbi.nlm.nih.gov

Comparison of the gluteus medius and rectus femoris muscle activities during natural sit-to-stand and sit-to-stand with hip abduction in young and older adults. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Assessment of abdominal muscle contractility, strength, and fatigue. [2006]

7. Japan pubmed.ncbi.nlm.nih.gov

Comparison of Hip Stabilization Muscle Use during Neutral Sit to Stand and Sit to Stand Involving Isometric Hip Abduction in Elderly Females. [2020]

8. Germany pubmed.ncbi.nlm.nih.gov

Motor strategies for initiating downward-oriented movements during standing in adults. [2018]

9. United States pubmed.ncbi.nlm.nih.gov

The effect of experimentally induced gluteal muscle weakness on joint kinematics, reaction forces, and dynamic balance performance during deep bilateral squats. [2023]

10. England pubmed.ncbi.nlm.nih.gov

The acute effect of lower-limb warm-up on muscle performance. [2018]