title: Managing nocturnal leg cramps--calf-stretching exercises and cessation of quinine treatment: a factorial randomised controlled trial.
abstract: BACKGROUND
  Quinine is a common treatment for nocturnal leg cramps but has potential side effects. An uncontrolled study suggested that calf-stretching exercises could prevent nocturnal leg cramps (night cramps) but these findings have never been confirmed.
  
  
  OBJECTIVE
  To assess the effect of calf-stretching exercises and cessation of quinine treatment for patients with night cramps taking quinine.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Twenty-eight general practices in southern England.
  
  
  METHODS
  One hundred and ninety-one patients prescribed quinine for night cramps were randomised to one of four groups defined by two "advice" factors: undertake exercises and stop quinine. After 6 weeks they were advised that they could take quinine and undertake the exercises freely. Documentation of cramp at 12 weeks was achieved in 181 (95%) patients. Main outcome measures were: symptom burden score, and frequency of night cramps and quinine usage.
  
  
  RESULTS
  At 12 weeks there was no significant difference in number of cramps in the previous 4 weeks (exercise = 1.95, 95% confidence interval [CI] = -3.01 to 6.90; quinine cessation = 3.45, 95% CI = -1.52 to 8.41) nor symptom burden or severity of cramps. However, after 12 weeks 26.5% (95% CI = 13.3% to 39.7%) more patients who had been advised to stop quinine treatment reported taking no quinine tablets in the previous week (odds ratio [OR] = 3.32, 95% CI = 1.37 to 8.06), whereas advice to do stretching exercises had no effect (OR = 0.73, 95% CI = 0.27 to 1.98).
  
  
  CONCLUSIONS
  Calf-stretching exercises are not effective in reducing the frequency or severity of night cramps. Advising those on long-term repeat prescriptions to try stopping quinine temporarily will result in no major problems for patients, and allow a significant number to stop medication.
authors.affiliation: The Surgery, Station Road, Overton, Basingstoke, Hants RG25 3DZ, UK. overtonsurgery@dial.pipex.com
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Coppin
authors.forename: Dorothy M
authors.initials: DM
authors.lastname: Wicke
authors.forename: Paul S
authors.initials: PS
authors.lastname: Little
mesh_terms: D000368:Aged; D003625:Data Collection; D005081:Exercise Therapy; D005194:Family Practice; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009120:Muscle Cramp / Q000517:prevention & control*; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D011803:Quinine / Q000009:adverse effects*; D020922:Sleep-Wake Transition Disorders / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D011803:Quinine