In this trial, we investigated the effect of several common hand exercise on the comfort of the surgical side limbs. Considering the safety of those three training methods on surgical limbs by comparing the degree of bleeding at the puncture site, there was no significant difference in the three groups of patients.
We found that handgrip exercise is more effective in reducing the edema of the limbs, in comparison of hand exercise and acupoint massage. The handgrip changes significantly reduced the palm circumference and middle finger circumference when it works form the fourth hour and the second hour respectively. From the second hour, the gap of middle finger circumference before and after intervention is gradually widened from 2[0.50, 3.00] mm to 4[2.00, 5.00] mm. As expected, the edema of middle finger even other fingers in handgrip exercise group are obviously relieved compared with other groups. Naturally, the palm circumference is decreased by 5 mm even 6.5 mm from the fourth hour. This may be due to the peripheral blood circulation starting from the fingers and gradually extending to the palm.
Straining compression on the puncture site to accelerate hemostasis is a common method for CAD patients after the transradial access. On the basis of regularly releasing the pressure of the puncture site, coordinated with physical activities can help to better relieve the edema of the limbs. Studies have shown that two main factors are recognized as the peripheral venous returning to heart: the muscle pump and the respiratory pump. Hand exercise, such as grasping empty fists and gripping hand muscle developer, can increase venous return without influence of systemic circulation. As a way of the venous return, simply performing finger movements or acupoint massage may not have a significant intervention effect due to the small degree of muscle contraction. Instead, handgrip exercise is conducted to utilize the promoting effect of muscle pump on peripheral venous flow velocity. For more deeply investigation, handgrip exercise using dynamometer for resistance training can help stretch the forearm muscles, contract the flexor muscles of the hand, and effectively promote the return of blood and lymph. As Masashi et al asserted, increasing isometric exercise intensity shifted the threshold of the muscle metaboreflex to higher blood flow levels. Additionally, grasping the dynamometer at a frequency of 25times/min is favorable to improve hemodynamics to the greatest extent. Comerota et al explored the mechanism of physical exercise on peripheral blood flow that exercise can help to increase fibrinolytic activity and reduce plasminogen activator-1, thereby increasing tissue-type plasminogen activator(t-RA) and enhancing plasmin dissolution which increases blood flow velocity and promotes blood circulation. Handgrip exercise, different from other resistance training such as gripping bouncy ball, can exhibit the strength of gripping to avoid excessive grip strength or insufficient grip strength, which will affect the effect of handgrip exercise. In terms of operability, gripping dynamometer gives patients a sense of grasping an object to improve their compliance, which will distract patients’ attention and relieve pain perception.
This study has some limitations. First, the circumference of palm and middle finger were significantly recovered in 6 hours which lacks of long-term observation of limb. This also makes it difficult to further judge when the swollen limbs can return to their original circumference. Second, to be safe, we set the gripping strength of the intervention group at 10%-15% MCV according to the preliminary experiment, and do not further explore how much MCV are most suitable for CAD patients after the transradial approach. Therefore, more intensive studies are needed to investigate the effect of handgrip exercise on postoperative function of limbs and what range of MCV is the most conducive to limb recovery, thereby adapting to life.