Neuro-Rehabilitation of the Soleus Muscles: Restoring Optimal Diastolic Blood Pressure in Older Adults
Main Article Content
Abstract
Diastolic blood pressure declines after age 50 such that older adults commonly have a diastolic pressure well below the optimal range of 75-90mmHg, resulting in increased risk of all-cause mortality, cognitive impairment, heart disease, and cancer. The cause of the age-related diastolic pressure decline is not well understood. We propose diastolic blood pressure declines with age primarily due to decreased venous return resulting from soleus muscle atrophy. Neuro-rehabilitation of the soleus muscles in older adults has the potential to improve venous return thereby enhancing resting cardiac output, and correspondingly, optimizing diastolic blood pressure. In a repeated measures prospective clinical trial, subjects (N=25, age 75.7±7.2 years) underwent daily, non-invasive, soleus muscle neuro-rehabilitation for six months, initiated through plantar nerve modulation. Average soleus muscle fatigue strength increased more than 2x over the six months resulting in an average 0.4 L/min/m2 increase in resting cardiac index (range 0.1-0.8 L/min/m2; p=0.003). This enhanced cardiac output led to an average rise in resting diastolic blood pressure of 8mmHg, from 63.5mmHg to 71.5mmHg (p=0.001) in subjects not undergoing hypertension therapy. Extrapolation indicated that optimal (>80mmHg) diastolic blood pressure could be achieved, on average, with approximately one year of daily neuro-rehabilitation. These results provide confirmation that decreased venous return resulting from soleus muscle atrophy plays a significant role in the age-related decline in diastolic blood pressure, though overmedication and polypharmacy also play significant roles. These results provide support for neuro-rehabilitation of the soleus muscles as a convenient and non-invasive means to create substantial clinical benefits in older adults by reducing the numerous health complications arising from chronically low cardiac output and diastolic blood pressure.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Boshuizen HC, Izaks GJ, van Buuren S, Ligthart GJ. Blood pressure and mortality in elderly people aged 85 and older: community based study. BMJ. 1998;316(7147):1780-1784. doi:10.1136/bmj.316.7147.1780.
3. Post Hospers G, Smulders YM, Maier AB, Deeg DJ, Muller M. Relation between blood pressure and mortality risk in an older population: role of chronological and biological age. J Intern Med. 2015;277(4):488-497. doi:10.1111/joim.12284.
4. Haring B, McGinn AP, Kamensky V, et al. Low Diastolic Blood Pressure and Mortality in Older Women. Results From the Women's Health Initiative Long Life Study. Am J Hypertens. 2022;35(9):795-802. doi:10.1093/ajh/hpac056.
5. Masoli JAH, Delgado J, Pilling L, Strain D, Melzer D. Blood pressure in frail older adults: associations with cardiovascular outcomes and all-cause mortality. Age Ageing. 2020;49(5):807-813. doi:10.1093/ageing/afaa028.
6. Lian Q, Jafar TH, Allen JC, Ma S, Malhotra R. Association of Systolic and Diastolic Blood Pressure With All-Cause Mortality Among Community-Dwelling Older Adults: A Prospective Observational Study. J Aging Health. 2022;34(4-5):674-683. doi:10.1177/08982643211055245.
7. Filippone EJ, Foy AJ, Naccarelli GV. The diastolic blood pressure J-curve revisited: An update. Am Heart J Plus. 2021;12:100065. Published 2021 Oct 28. doi:10.1016/j.ahjo.2021.100065.
8. Hou W, Zheng B, Gong Y. Association between isolated low or high diastolic blood pressure with all-cause and cardiovascular mortality: evidence from NHANES (1999–2018); Journal of Hypertension 2025; 43(Suppl 1):p e202-e203, May. doi: 10.1097/01.hjh.0001117276.60303.32.
9. Wright JD, Hughes JP, Ostchega Y, Yoon SS, Nwankwo T. Mean systolic and diastolic blood pressure in adults aged 18 and over in the United States, 2001-2008. Natl Health Stat Report. 2011;(35):1-24.
10. Muntner P, Shimbo D, Carey RM, et al. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension. 2019;73(5):e35-e66. doi:10.1161/HYP.0000000000000087.
11. Muntner P, Jaeger BC, Hardy ST, et al. Age-Specific Prevalence and Factors Associated With Normal Blood Pressure Among US Adults. Am J Hypertens. 2022;35(4):319-327. doi:10.1093/ajh/hpab154.
12. Chen FY, Lee CW, Chen YJ, et al. Pathophysiology and blood pressure measurements of hypertension in the elderly. J Formos Med Assoc. 2025;124 Suppl 1:S10-S16. doi:10.1016/j.jfma.2025.03.027.
13. Franklin SS, Gustin W 4th, Wong ND, et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997;96(1):308-315. doi:10.1161/01.cir.96.1.308.
14. Brandfonbrener M, Landowne M, Shock NW. Changes in cardiac output with age. Circulation. 1955;12(4):557-566. doi:10.1161/01.cir.12.4.557.
15. Katori R. Normal cardiac output in relation to age and body size. Tohoku J Exp Med. 1979;128(4):377-387. doi:10.1620/tjem.128.377.
16. Middlemiss JE, Cocks A, Paapstel K, et al. Evaluation of inert gas rebreathing for determination of cardiac output: influence of age, gender and body size. Hypertens Res. 2019;42(6):834-844. doi:10.1038/s41440-018-0179-1.
17. Williams KJ, Ayekoloye O, Moore HM, Davies AH. The calf muscle pump revisited. J Vasc Surg Venous Lymphat Disord. 2014;2(3):329-334. doi:10.1016/j.jvsv.2013.10.053.
18. McLeod KJ. Reversal of Soleus Muscle Atrophy in Older Adults: A Non-Volitional Exercise Intervention for a Changing Climate. Clin Interv Aging. 2024;19:795-806. Published 2024 May 10. doi:10.2147/CIA.S447665.
19. Hainsworth R, Drinkhill MJ. Counterpoint: active venoconstriction is not important in maintaining or raising end-diastolic volume and stroke volume during exercise and orthostasis. J Appl Physiol (1985). 2006;101(4):1264-1270. doi:10.1152/japplphysiol.00561a.2006.
20. Drees JA, Rothe CF. Reflex venoconstriction and capacity vessel pressure-volume relationships in dogs. Circ Res. 1974;34(3):360-373. doi:10.1161/01.res.34.3.360
21. Harvey JA, Chastin SF, Skelton DA. Prevalence of sedentary behavior in older adults: a systematic review. Int J Environ Res Public Health. 2013;10(12):6645-6661. Published 2013 Dec 2. doi:10.3390/ijerph10126645
22. McLeod KJ. Characterizing Soleus Muscle Response to Targeted Plantar Nerve Modulation Using Mechanomyography. Neuromodulation. 2025;28(8):1248-1254. doi:10.1016/j.neurom.2024.11.003.
23. Latham CM, Brightwell CR, Keeble AR, et al. Vitamin D Promotes Skeletal Muscle Regeneration and Mitochondrial Health. Front Physiol. 2021;12:660498. Published 2021 Apr 14. doi:10.3389/fphys.2021.660498.
24. Puga AM, Lopez-Oliva S, Trives C, Partearroyo T, Varela-Moreiras G. Effects of Drugs and Excipients on Hydration Status. Nutrients. 2019;11(3):669. Published 2019 Mar 20. doi:10.3390/nu11030669.
25. Whyte S, Lavender H, Elam, Svantesson U. Tests of muscle function and health related quality of life in healthy older adults in Sweden. Isokinetics and Exercise Science. 2021;29. 1-7. doi:10.3233/IES-202126.
26. Hébert-Losier K, Wessman C, Alricsson M, Svantesson U. Updated reliability and normative values for the standing heel-rise test in healthy adults. Physiotherapy. 2017;103(4):446-452. doi:10.1016/j.physio.2017.03.002.
27. Lu Y, Yu K, Zhai M, Ma P. Age and school-segment difference in daily sedentary behavior and physical activity among student (9-23 years): a cross-sectional accelerometer-based survey. Front Pediatr. 2023;11:1202427. Published 2023 Jul 17. doi:10.3389/fped.2023.1202427.
28. Cioccari L, Luethi N, Glassford NJ, Bellomo R. The normal cardiac index in older healthy individuals: a scoping review. Crit Care Resusc. 2019;21(1):9-17..
29. Bickel A, Shturman A, Sergeiev M, Ivry S, Eitan A, Atar S. Hemodynamic effect and safety of intermittent sequential pneumatic compression leg sleeves in patients with congestive heart failure. J Card Fail. 2014;20(10):739-746. doi:10.1016/j.cardfail.2014.07.004.
30. Bhanu C, Petersen I, Orlu M, et al. Drug-induced orthostatic hypotension: Cluster analysis of co-prescription patterns in older people in UK primary care. Pharmacoepidemiol Drug Saf. 2024;33(1):e5730. doi:10.1002/pds.5730.