Predictors of walking capacity in peripheral arterial disease patients

OBJECTIVE: To estimate walking capacity in intermittent claudication patients through a prediction model based on clinical characteristics and the walking impairment questionnaire. METHODS: The sample included 133 intermittent claudication patients of both genders aged between 30 and 80 years. Data regarding clinical characteristics, the walking impairment questionnaire and treadmill walking test performance were obtained. Multiple regression modeling was conducted to predict claudication onset distance and total walking distance using clinical characteristics (age, height, mass, body mass index, ankle brachial index lower, gender, history of smoking and co-morbid conditions) and walking impairment questionnaire responses. Comparisons of claudication onset distance and total walking distance measured during treadmill tests and estimated by a regression equation were performed using paired t-tests. RESULTS: Co-morbid conditions (diabetes and coronary artery disease) and questions related to difficulty in walking short distances (walking indoors - such as around your house and walking 5 blocks) and at low speed (walking 1 block at average speed - usual pace) resulted in the development of new prediction models high significant for claudication onset distance and total walking distance (p0.05) were observed. CONCLUSION: The current study demonstrated that walking capacity can be adequately estimated based on co-morbid conditions and responses to the walking impairment questionnaire

Remote ischemic preconditioning in patients with intermittent claudication

OBJECTIVE: Remote ischemic preconditioning (RIPC) is a phenomenon in which a short period of sub-lethal ischemia in one organ protects against subsequent bouts of ischemia in another organ. We hypothesized that RIPC in patients with intermittent claudication would increase muscle tissue resistance to ischemia, thereby resulting in an increased ability to walk. METHODS: In a claudication clinic, 52 ambulatory patients who presented with complaints of intermittent claudication in the lower limbs associated with an absent or reduced arterial pulse in the symptomatic limb and/or an ankle-brachial index <0.90 were recruited for this study. The patients were randomly divided into three groups (A, B and C). All of the patients underwent two tests on a treadmill according to the Gardener protocol. Group A was tested first without RIPC. Group A was subjected to RIPC prior to the second treadmill test. Group B was subjected to RIPC prior to the first treadmill test and then was subjected to a treadmill test without RIPC. In Group C (control group), both treadmill tests were performed without RIPC. The first and second tests were conducted seven days apart. Brazilian Clinical Trials: RBR-7TF6TM. RESULTS: Group A showed a significant increase in the initial claudication distance in the second test compared to the first test. CONCLUSION: RIPC increased the initial claudication distance in patients with intermittent claudication; however, RIPC did not affect the total walking distance of the patients

Stages of health behavior change and factors associated with physical activity in patients with intermittent claudication

OBJECTIVE: To analyze, in people with intermittent claudication, the frequency of individuals who are in each of stages of health behavior change to practice physical activity, and analyze the association of these stages with the walking capacity. METHODS: We recruited 150 patients with intermittent claudication treated at a tertiary center, being included those > 30-year-old-individuals and who had ankle-arm index < 0.90. We obtained socio-demographic information, presence of comorbidities and cardiovascular risk factors and stages of health behavior change to practice physical activity through a questionnaire, they being pre-contemplation, contemplation, preparation, action and maintenance. Moreover, the walking capacity was measured in a treadmill test (Gardner protocol). RESULTS: Most individuals were in the maintenance stage (42.7%), however, when the stages of health behavior change were categorized into active (action and maintenance) and inactive (pre-contemplation, contemplation and preparation), 51.3% of the individuals were classified as inactive behavior. There was no association between stages of health behavior change, sociodemographic factors and cardiovascular risk factors. However, patients with intermittent claudication who had lower total walking distance were three times more likely to have inactive behavior. CONCLUSION: Most patients with intermittent claudication showed an inactive behavior and, in this population, lower walking capacity was associated with this behavior

Reproducibility of hemodynamic, cardiac autonomic modulation and blood flow assessments in patients with intermittent claudication

Objective: To identify, in patients with peripheral artery disease and intermittent claudication (IC), the reproducibility of heart rate (HR), blood pressure (BP), rate pressure product (RPP), heart rate variability (HRV), and forearm and calf blood flow (BF) and vasodilatory assessments. Methods: Twenty-nine patients with IC underwent test and retest sessions, 8-12 days apart. During each session, HR, BP, HRV, BF and vasodilatory responses were measured by electrocardiogram, auscultation, spectral analysis of HRV (low frequency, LFR-R; high frequency, HFR-R) and strain gauge plethysmography (baseline BF, post-occlusion BF, post-occlusion area under the curve, AUC). Reproducibility was determined by intraclass coefficient correlation (ICC), typical error, coefficient of variation (CV) and limits of agreement. Results: The ICC for HR and BP were > 0.8 with CV 0.9 while CV were 0.9 while CV were < 19%; variable ICC and CV for vasodilatory responses were exhibited for calf (0.653 – 0.770; 35.2 – 37.7%) and forearm (0.169 – 0.265; 46.2 – 55.5%). Conclusions: In male patients with IC, systemic hemodynamic (HR and BP), cardiac autonomic modulation (LFR-R and HFR-R) and forearm and calf baseline BF assessments exhibited excellent reproducibility, whereas the level of reproducibility for vasodilatory responses were moderate to poor. Assessment reproducibility has highlighted appropriate clinical tools for the regular monitoring of disease/intervention progression in patients with IC

Walking training improves systemic and local pathophysiological processes in intermittent claudication

Objective: This study examined the impact of submaximal walking training (WT) on local and systemic nitric oxide (NO) bioavailability, inflammation, and oxidative stress in patients with intermittent claudication (IC). Methods: The study employed a randomised, controlled, parallel group design and was performed in a single centre. Thirty-two men with IC were randomly allocated to two groups: WT (n = 16, two sessions/week, 15 cycles of two minutes walking at an intensity corresponding to the heart rate obtained at the pain threshold interspersed by two minutes of upright rest) and control (CO, n = 16, two sessions/week, 30 minutes of stretching). NO bioavailability (blood NO and muscle nitric oxide synthase [eNOS]), redox homeostasis (catalase [CAT], superoxide dismutase [SOD], lipid peroxidation [LPO] measured in blood and muscle), and inflammation (interleukin-6 [IL-6], C-reactive protein [CRP], tumour necrosis factor α [TNF-α], intercellular adhesion molecules [ICAM], vascular adhesion molecules [VCAM] measured in blood and muscle) were assessed at baseline and after 12 weeks. Results: WT statistically significantly increased blood NO, muscle eNOS, blood SOD and CAT, and muscle SOD and abolished the increase in circulating and muscle LPO observed in the CO group. WT decreased blood CRP, ICAM, and VCAM and muscle IL-6 and CRP and eliminated the increase in blood TNF-α and muscle TNF-α, ICAM and VCAM observed in the CO group. Conclusion: WT at an intensity of pain threshold improved NO bioavailability and decreased systemic and local oxidative stress and inflammation in patients with IC. The proposed WT protocol provides physiological adaptations that may contribute to cardiovascular health in these patients

Strength and power training did not modify cardiovascular responses to aerobic exercise in elderly subjects

Resistance training increases muscle strength in older adults, decreasing the effort necessary for executing physical tasks, and reducing cardiovascular load during exercise. This hypothesis has been confirmed during strength-based activities, but not during aerobic-based activities. This study determined whether different resistance training regimens, strength training (ST, constant movement velocity) or power training (PT, concentric phase performed as fast as possible) can blunt the increase in cardiovascular load during an aerobic stimulus. Older adults (63.9 ± 0.7 years) were randomly allocated to: control (N = 11), ST (N = 13, twice a week, 70-90% 1-RM) and PT (N = 15, twice a week, 30-50% 1-RM) groups. Before and after 16 weeks, oxygen uptake (VO2), systolic blood pressure (SBP), heart rate (HR), and rate pressure product (RPP) were measured during a maximal treadmill test. Resting SBP and RPP were similarly reduced in all groups (combined data = -5.7 ± 1.2 and -5.0 ± 1.7%, respectively, P < 0.05). Maximal SBP, HR and RPP did not change. The increase in measured VO2, HR and RPP for the increment in estimated VO2 (absolute load) decreased similarly in all groups (combined data = -9.1 ± 2.6, -14.1 ± 3.9, -14.2 ± 3.0%, respectively, P < 0.05), while the increments in the cardiovascular variables for the increase in measured VO2 did not change. In elderly subjects, ST and PT did not blunt submaximal or maximal HR, SBP and RPP increases during the maximal exercise test, showing that they did not reduce cardiovascular stress during aerobic tasks.Universidade de São Paulo Escola de Educação Física e Esporte Laboratório de Hemodinâmica da Atividade MotoraUniversidade de São Paulo Escola de Educação Física e Esporte Laboratório de Adaptação Neuromuscular ao Treinamento de ForçaUniversidade Federal de São Paulo (UNIFESP) Centro de Estudos em Psicobiologia e ExercícioUNIFESP, Centro de Estudos em Psicobiologia e ExercícioSciEL

Walking training improves ambulatory blood pressure variability in claudication

Background: Walking training (WT) improves walking capacity and reduces clinic blood pressure (BP) in patients with peripheral artery disease (PAD), but its effects on ambulatory BP remains unknown. Objectives: To investigate the effect of 12 weeks of WT on ambulatory BP and its variability in patients with PAD. Methods: Thirty-five male patients with PAD and claudication symptoms were randomly allocated into two groups: control (n = 16, 30 min of stretching) and WT (n = 19, 15 bouts of 2 min of walking at the heart rate of leg pain threshold interspersed by 2 min of upright rest). Before and after 12 weeks, 24-hour ambulatory BP was assessed. Ambulatory BP variability indices assessed at both time points included the 24-hour standard deviation (SD24), the awake and asleep weighted standard deviation (SDdn), and the 24-hour average real variability (ARV24). Data were analyzed by mixed two-way ANOVAs, considering P<0.05 as significant. Results: After 12 weeks, neither group had significant changes in 24-hour, awake and sleep BPs. The WT decreased systolic and mean BP variabilities (Systolic BP – 13.3±2.8 vs 11.8±2.3, 12.1±2.84 vs 10.7±2.5 and 9.4±2.3 vs 8.8±2.2 mmHg); Mean BP – 11.0±1.7 vs 10.4±1.9, 10.1±1.6 vs 9.1±1.7 and 8.0.±1.7 vs 7.2±1.5 mmHg for SD24, SDdn and ARV24, respectively). Neither group had significant changes in diastolic BP variabilities after 12 weeks. Conclusion: The WT does not change ambulatory BP levels but decreases ambulatory BP variability in patients with PAD. This improvement may have a favorable impact on the cardiovascular risk of patients with symptomatic PAD

Walking Training Increases microRNA-126 Expression and Muscle Capillarization in Patients with Peripheral Artery Disease

Patients with peripheral artery disease (PAD) have reduced muscle capillary density. Walking training (WT) is recommended for PAD patients. The goal of the study was to verify whether WT promotes angiogenesis in PAD-affected muscle and to investigate the possible role of miRNA-126 and the vascular endothelium growth factor (VEGF) angiogenic pathways on this adaptation. Thirty-two men with PAD were randomly allocated to two groups: WT (n = 16, 2 sessions/week) and control (CO, n = 16). Maximal treadmill tests and gastrocnemius biopsies were performed at baseline and after 12 weeks. Histological and molecular analyses were performed by blinded researchers. Maximal walking capacity increased by 65% with WT. WT increased the gastrocnemius capillary-fiber ratio (WT = 109 ± 13 vs. 164 ± 21 and CO = 100 ± 8 vs. 106 ± 6%, p < 0.001). Muscular expression of miRNA-126 and VEGF increased with WT (WT = 101 ± 13 vs. 130 ± 5 and CO = 100 ± 14 vs. 77 ± 20%, p < 0.001; WT = 103 ± 28 vs. 153 ± 59 and CO = 100 ± 36 vs. 84 ± 41%, p = 0.001, respectively), while expression of PI3KR2 decreased (WT = 97 ± 23 vs. 75 ± 21 and CO = 100 ± 29 vs. 105 ± 39%, p = 0.021). WT promoted angiogenesis in the muscle affected by PAD, and miRNA-126 may have a role in this adaptation by inhibiting PI3KR2, enabling the progression of the VEGF signaling pathway

Ética e Publicidade Médica nas Redes Sociais em Dermatologia

The use of social media for professional purposes among physicians as an advertising tool has increased in recent years, raising debates about the norms for medical advertising in the country, with a focus on safeguarding professional ethics. A public consultation carried out in 2020 by the Federal Council of Medicine aimed at updating the Manual of Medical Advertising raised the discussion on the subject in the country and generates expectations for changes in the coming years. This is an original, applied, cross-sectional and descriptive study with quantitative characteristics, conducted with dermatologist physicians working in the municipality of Juiz de Fora. The study aimed to evaluate the profile of social media use by dermatologists in the municipality, their opinion on the current norms of the Manual of Medical Advertising, and their expectations for change. It was found that most professionals use social media for professional purposes and consider that they have adequate knowledge about the current regulation, however, practices prohibited by the Federal Council of Medicine were admitted by a large part of the interviewed dermatologists. All physicians were in favor of changes to the current norms and are against new restrictions.El uso de las redes sociales con fines profesionales entre los médicos como herramienta publicitaria se ha incrementado en los últimos años, suscitando debates sobre las normas para la publicidad médica en el país, con foco en salvaguardar la ética profesional. Una consulta pública realizada en 2020 por el Consejo Federal de Medicina con el objetivo de actualizar el Manual de Publicidad Médica suscitó la discusión sobre el tema en el país y genera expectativas de cambios en los próximos años. Se trata de un estudio original, aplicado, transversal y descriptivo con características cuantitativas, realizado con médicos dermatólogos que actúan en el municipio de Juiz de Fora. El estudio tuvo como objetivo evaluar el perfil de uso de las redes sociales por parte de los dermatólogos del municipio, su opinión sobre las normas vigentes del Manual de Publicidad Médica y sus expectativas de cambio. Se constató que la mayoría de los profesionales utilizan las redes sociales con fines profesionales y consideran que tienen un conocimiento adecuado sobre la normativa vigente, sin embargo, prácticas prohibidas por el Consejo Federal de Medicina fueron admitidas por gran parte de los dermatólogos entrevistados. Todos los médicos se mostraron a favor de cambios en las normas vigentes y en contra de nuevas restricciones.O uso das mídias sociais com fins profissionais entre médicos como ferramenta publicitária tem aumentado nos últimos anos, levantando debates acerca das normas para a publicidade médica no país, com destaque para o resguardo da ética profissional. Uma consulta pública realizada em 2020 pelo Conselho Federal de Medicina com vistas à atualização do Manual de Publicidade Médica levantou a discussão sobre o assunto no país e gera expectativas de mudanças para os próximos anos. Trata-se de pesquisa aplicada, original, de natureza transversal e descritiva, com características quantitativas, realizada com médicos dermatologistas e que atuam no município de Juiz de Fora. O estudo teve como objetivo avaliar o perfil de uso das redes sociais pelos Dermatologistas do município, sua opinião acerca das normas atuais do Manual de Publicidade Médica e prospectar seus anseios de mudança. Constatou-se que a maioria dos profissionais utiliza as redes sociais com fins profissionais e considera que tem conhecimento adequado sobre a regulamentação atual, entretanto, práticas coibidas pelo CFM foram admitidas por grande parte dos entrevistados. Todos os médicos se mostraram a favor de mudanças para as atuais normas e são contra novas restrições

Predictors of walking capacity in peripheral arterial disease patients

OBJECTIVE: To estimate walking capacity in intermittent claudication patients through a prediction model based on clinical characteristics and the walking impairment questionnaire. METHODS: The sample included 133 intermittent claudication patients of both genders aged between 30 and 80 years. Data regarding clinical characteristics, the walking impairment questionnaire and treadmill walking test performance were obtained. Multiple regression modeling was conducted to predict claudication onset distance and total walking distance using clinical characteristics (age, height, mass, body mass index, ankle brachial index lower, gender, history of smoking and co-morbid conditions) and walking impairment questionnaire responses. Comparisons of claudication onset distance and total walking distance measured during treadmill tests and estimated by a regression equation were performed using paired t-tests. RESULTS: Co-morbid conditions (diabetes and coronary artery disease) and questions related to difficulty in walking short distances (walking indoors - such as around your house and walking 5 blocks) and at low speed (walking 1 block at average speed - usual pace) resulted in the development of new prediction models high significant for claudication onset distance and total walking distance (p;0.05) were observed. CONCLUSION: The current study demonstrated that walking capacity can be adequately estimated based on co-morbid conditions and responses to the walking impairment questionnaire