Usefulness of physical maneuvers for prevention of vasovagal syncope
Open accessAbstract
BACKGROUND: It is known that approximately two-thirds of patients with vasovagal syncope have prodromal symptoms and when these start, physical maneuvers that can increase venous return may abort the syncopal attack. The aims of this study were to evaluate the effects of 3 physical maneuvers, squatting, leg-crossing with muscle tensing, and handgrip, on improving hemodynamic status, and to compare the effect of each on aborting or preventing vasovagal syncope. METHODS AND RESULTS: Of 50 patients who underwent the head-up tilt test (HUT) to evaluate syncope, 27 patients with positive HUT were classified as group I (14 men, 13 women; mean age 44.5+/-15.3 years), 23 patients with negative HUT were classified as group II (13 men, 10 women; mean age 41.2 +/-16.7 years), and 21 normal subjects were classified as group III (10 men, 11 women; mean age 28.6+/-6.3 years). The effects of the physical maneuvers were evaluated in 21 patients from group I who underwent a repeat HUT 1 week after the initial test. Leg-crossing significantly increased systolic blood pressure (SBP) in all 3 groups (8.0+/-5.8 mmHg in group I, 7.0+/-8.5 mmHg in group II, 8.7+/-5.7 mmHg in group III; p < 0.05), but not diastolic blood pressure (DBP). Squatting significantly increased SBP and DBP in all 3 groups (7.1 +/-5.1, 4.6+/-5.8 mmHg in group I, 7.8+/-5.9, 4.3+/-4.7 mmHg in group II, 6.5+/-5.0, 3.7+/-3.9 mmHg in group III; p < 0.05). However, handgrip did not exert any significant influence on the hemodynamics in any group nor did heart rate change significantly during the physical maneuvers in any group. During the repeat HUT, prodromal symptoms with hypotension developed in 13 of the 21 patients and of these 5 fainted immediately after and were not able to do the physical maneuvers. Squatting and leg-crossing aborted syncope in 7 of 8 patients, but handgrip aborted syncope in only 1 patient. CONCLUSION: Squatting and leg-crossing with muscle tensing improved the hemodynamics of normal subjects as well as those of patients with vasovagal syncope. Squatting and leg-crossing can be used as a simple and effective preventive maneuver in patients with vasovagal syncope.
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Three clinical studies and one prospective multicentre randomized trial showed that physical counter-pressure manoeuvres of the legs or arms allowed patients to avoid or delay losing consciousness in most cases.
“Three clinical studies 119,120,263 and one prospective multicentre randomized trial 121 assessed the effectiveness of physical counter-pressure manoeuvres (PCM) of the legs or arms and showed that they allowed the patient to avoid or delay losing consciousness in most cases.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [263]
The Methods and Results and Effects of Physical Maneuvers sections report that squatting and leg-crossing aborted syncope in 7 of 8 patients who could perform the maneuvers. But handgrip, an arm maneuver, aborted syncope in only 1 of 8 patients, so this study does not support the claim that leg or arm maneuvers worked in most cases. (LLM, conf=0.90)
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“The usefulness of physical maneuvers such as squatting, leg muscle pumping (tiptoeing), and/or tensing (leg crossing) has been demonstrated in aborting or delaying fainting responses due to orthostatic challenges in patients with autonomic failure or unspecified vasovagal syncope (Krediet et al., 2002; Kim et al., 200…”
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- Authors
- Kim, K. H., Cho, J. G., Lee, K. O., Seo, T. J., Shon, C. Y., Lim, S. Y., Yun, K. H., Sohn, I. S., Hong, Y. J., Park, H. W., Kim, J. H., Kim, W., Ahn, Y. K., Jeong, M. H., Park, J. C., & Kang, J. C.
- Affiliations
- Chonnam National University Hospital (KR)
- ORCID
- Venue
- Circulation Journal
- Publisher
- Japanese Circulation Society
- Published
- 2005
- Volume
- 69
- Issue
- 9
- Pages
- 1084-1088
- ISSN
- 1346-9843 (ISSN-L)
- 1347-4820
- OpenAlex
- W2016585009
- Cited by
- 48
- References
- 22
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 7 · 2018: 4 · 2017: 2 · 2016: 1 · 2014: 3 · 2013: 1 · 2012: 1
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- vasovagal syncope, squatting, leg crossing, grip, head-up tilt, hemodynamics, systolic blood pressure, prodromal symptoms, syncope prevention, venous return, heart rate, hypotension
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Tilt-Table Test, Syncope, Vasovagal, Exercise Movement Techniques
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