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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if specific lower body muscle movements can improve blood pressure and heart function in children who faint. The trial will test maneuvers such as leg crossing, crouching, and muscle tensing to assess their impact on blood flow and heart performance. English-speaking children aged 6-18 with a history of fainting due to conditions like postural orthostatic tachycardia syndrome (POTS) may be suitable for this study. Participants will perform a baseline standing test and various counterpressure maneuvers to compare results. As an unphased trial, this study provides a unique opportunity to understand how simple maneuvers might assist children with fainting issues.

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 prior data suggests that these counterpressure maneuvers are safe for children who faint?

Research shows that simple exercises like crossing the legs and tensing muscles can safely and effectively prevent fainting. These exercises increase blood pressure, preventing loss of consciousness. Studies confirm that these techniques are safe and cause no harm. They offer an easy and affordable way for individuals who often faint to manage their symptoms. Participants in various studies reported no major side effects, making these exercises well-tolerated and safe. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about counterpressure maneuvers for fainting because they offer a simple, non-pharmaceutical approach to manage symptoms. Unlike standard treatments that might involve medication, these maneuvers involve physical techniques like leg crossing, muscle tensing, or crouching, which can be performed quickly and easily without medical supervision. This method has the potential to empower individuals to actively prevent fainting episodes by using their own body movements, offering a practical solution that's accessible anywhere.

What evidence suggests that these counterpressure maneuvers are effective for fainting?

Research has shown that counterpressure maneuvers (CPM), which participants in this trial will perform, can help prevent fainting, also known as syncope. Studies have found that many people feel better using these maneuvers, with success rates between 60% and 72%. These techniques help stabilize blood pressure, especially in individuals with impaired automatic body functions. Simple actions like crossing the legs, tensing muscles, and crouching can help maintain blood flow. Overall, CPMs show promise for managing fainting by helping the body maintain steady blood pressure. ^{1 4 6 7 8}

Who Is on the Research Team?

Victoria E Claydon, PhD

Principal Investigator

Simon Fraser University

Are You a Good Fit for This Trial?

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 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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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 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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9606335/

Counter pressure maneuvers for syncope prevention: A semi ... Most patients experienced symptom improvement following CPM use (laboratory: 60 ± 4%, community: 72 ± 9%). The most prominent barrier to employing CPM in daily ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S0735109706019504

Effectiveness of Physical Counterpressure Maneuvers in ... Physical counterpressure maneuvers (PCM) have previously proven to be effective in stabilizing blood pressure in patients with autonomic failure (13, 14).

3. clinicaltrials.gov clinicaltrials.gov/study/NCT05633693

Postural Sway and Counterpressure Maneuvers for ... We will record cardiovascular responses to maneuvers of exaggerated sway, leg crossing, crouching, and gluteal muscle tensing in children who faint (N=20), as ...

4. autonomicneuroscience.com autonomicneuroscience.com/article/S1566-0702(25)00033-5/fulltext

Orthostatic cardiovascular responses to postural sway and ... Counterpressure maneuvers (CPM) can delay or prevent syncope (fainting), but may have practical barriers to use. •. Novel practical CPM augmented orthostatic ...

5. ahajournals.org ahajournals.org/doi/10.1161/01.cir.0000074257.16387.40

Management of Vasovagal Syncope: Controlling or ... A randomized trial of applied tension for injection phobia with syncope demonstrated that 80% of patients were clinically improved after just 1 treatment ...

6. cpr.heart.org cpr.heart.org/en/resuscitation-science/first-aid-guidelines/first-aid/description-of-recommended-physical-counterpressure-maneuvers

Description of Recommended Physical Counterpressure ... This page contains a table that provides a description of recommended physical counterpressure maneuvers.

7. ahajournals.org ahajournals.org/doi/10.1161/CIR.0000000000000730

Presyncope: An Update to the American ... Researchers across the studies applied a variety of physical counterpressure maneuvers (PCMs), including handgrip, arm tensing, abdominal muscle ...

8. my.clevelandclinic.org my.clevelandclinic.org/-/scassets/files/org/heart/disease-conditions/syncope/counter-pressure-techniques-1014.ashx

counter-pressure techniques for patients with syncope Cross one leg over the other and squeeze the muscles in your legs, abdomen and buttocks. Hold this position as long as you can or until your ...