Cardiovascular responses to short-term head-down positioning in healthy young and older adults

Physiother Res Int. 2005;10(1):32-47. doi: 10.1002/pri.22.


Background and purpose: Isolated head-down postural drainage is assumed to acutely load the cardiovascular system. Consequently, it is considered a relative contraindication in the presence of severe cardiovascular disease. Evidence demonstrating that the head-down manoeuvre as used by physiotherapists does significantly load the cardiovascular system is lacking. The present study documents the cardiovascular responses t short-term 30 degrees head-down positioning in healthy subjects. The results are a point of reference for respiratory patients with and without cardiovascular disease.

Method: A quasi-experimental research design was used, with multiple measurements obtained at rest (long sitting and in the head-down position. Twenty-one young subjects (mean age 25 years (standard deviation, (SD) 3 years)) and 19 older subjects (mean age 66 years (SD 6 years)) were studied. Applanation tonometry and sphygmocardiography were used to measure temporal and pressure variables, and indices that estimate myocardial work and coronary blood flow.

Results: Absolute differences existed between the two age groups for all variables at rest (p < 0.001). No age-time interaction was observed for any variable in the head-down position (p > 0.05). Serial measures in the head-down position did not vary across time (p > 0.05). Small (<9%) but significant (p < or = 0.02) decreases in heart rate, relative diastolic duration, mean arterial blood pressure and diastolic time indices, and small (<12%) but significant (p < or = 0.002) increases in cardiac cycle time, ejection duration (relative and absolute) and absolute diastolic duration were observed in the head-down position compared with rest. A small (9%) but significant (p < 0.001) fall in the sub-endocardial viability ratio occurred in the head down position.

Conclusion: The findings have little consequence in health, but they suggest that head-down postural drainage may be of concern for chest physiotherapy recipients with reduced cardiac reserve or impaired barorefilex function.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Baroreflex / physiology*
  • Blood Pressure
  • Head-Down Tilt / physiology*
  • Heart Rate
  • Hemodynamics*
  • Humans
  • Male
  • Middle Aged
  • Myocardium / metabolism*
  • Oxygen / metabolism*
  • Oxygen Consumption


  • Oxygen