Physical Activity Levels in Peripheral Artery Disease Patients

BACKGROUND: Increases in daily physical activity levels is recommended for patients with peripheral artery disease (PAD). However, despite this recommendation, little is known about the physical activity patterns of PAD patients. OBJECTIVE: To describe the physical activity patterns of patients with symptomatic peripheral artery (PAD) disease. METHODS: This cross-sectional study included 174 PAD patients with intermittent claudication symptoms. Patients were submitted to clinical, hemodynamic and functional evaluations. Physical activity was objectively measured by an accelerometer, and the time spent in sedentary, low-light, high-light and moderate-vigorous physical activities (MVPA) were obtained. Descriptive analysis was performed to summarize patient data and binary logistic regression was used to test the crude and adjusted associations between adherence to physical activity recommendation and sociodemographic and clinical factors. For all the statistical analyses, significance was accepted at p < 0.05. RESULTS: Patients spent in average of 640 ± 121 min/day, 269 ± 94 min/day, 36 ± 27 min/day and 15 ± 16 min/day in sedentary, low-light, high-light and MVPA, respectively. The prevalence of patients who achieved physical activity recommendations was 3.4%. After adjustment for confounders, a significant inverse association was observed between adherence to physical activity recommendation and age (OR = 0.925; p = 0.004), while time of disease, ankle brachial index and total walking distance were not associated with this adherence criteria (p > 0.05). CONCLUSION: The patterns of physical activity of PAD patients are characterized by a large amount of time spent in sedentary behaviors and a low engagement in MVPA. Younger patients, regardless of the clinical and functional factors, were more likely to meet the current physical activity recommendations

Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease

OBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ – Walking Impairment Questionnaire and WELCH – Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (ro0.55, po0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (b=0.001, po0.001), sit-to-stand test score (b=-0.005, p=0.012), and WIQ stairs score (b=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (b=0.002, po0.001), WIQ stairs score (b=0.003, p=0.010), and WELCH total score (b=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients

Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease

OBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ – Walking Impairment Questionnaire and WELCH – Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (ro0.55, po0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (b=0.001, po0.001), sit-to-stand test score (b=-0.005, p=0.012), and WIQ stairs score (b=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (b=0.002, po0.001), WIQ stairs score (b=0.003, p=0.010), and WELCH total score (b=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients

Impact of hypertension on arterial stiffness and cardiac autonomic modulation in patients with peripheral artery disease: a cross-sectional study

To examine the impact of hypertension on cardiovascular health in patients with symptomatic peripheral artery disease and to identify factors associated with uncontrolled hypertension. A cross-sectional study including 251 patients with symptomatic peripheral artery disease (63.9% males, mean age 67±10 years). Following hypertension diagnosis, blood pressure was measured to determine control of hypertension. Arterial stiffness (carotid-femoral pulse wave velocity) and cardiac autonomic modulation (sympathovagal balance) were assessed. Hypertension was associated with higher carotid-femoral pulse wave velocity, regardless of sex, age, ankle-brachial index, body mass index, walking capacity, heart rate, or comorbidities (ß=2.59±0.76m/s, b=0.318, p=0.003). Patients with systolic blood pressure ≥120mmHg had higher carotid-femoral pulse wave velocity values than normotensive individuals, and hypertensive patients with systolic blood pressure of ≤119mmHg (normotensive: 7.6±2.4m/s=≤119mmHg: 8.1±2.2m/s 120-129mmHg:9.8±2.6m/s=≥130mmHg: 9.9±2.9m/s, p0.05). Hypertensive patients with symptomatic peripheral artery disease have increased arterial stiffness. Arterial stiffness is even greater in patients with uncontrolled high blood pressure

Physical activity practice during COVID-19 pandemic in patients with intermittent claudication

OBJECTIVE: To describe physical activity habits and barriers for physical activity practice in patients with peripheral artery disease and claudication symptoms during Coronavirus 2019 (COVID-19) pandemic. METHODS: In this cross-sectional survey study, 127 patients with peripheral artery disease (59.8% men; 68±9 years old; and 81.9% had the peripheral artery disease diagnosis ≥5 years old) were included. The physical activity habits and barriers for physical activity practice were assessed through telephone interview using a questionnaire with questions related to: (a) COVID-19 personal care; (b) overall health; (c) physical activity habits; (d) for those who were inactive, the barriers for physical activity practice. RESULTS: Only 26.8% of patients reported practicing physical activity during the COVID-19 pandemic. Exercise characteristics more common among these patients include walking, performed at least 5 days a week, during 31–60 min at light intensity. In contrast, among physically inactive patients, pain, injury or disability (55%), the COVID-19 pandemic (50%), the need to rest due to leg pain (29%), and lack of energy (27%) were the most frequent barriers to physical activity practice. CONCLUSION: The physical activity level of patients with peripheral artery disease is impacted by the COVID-19 pandemic

URINARY INCONTINENCE IN WOMEN: RISK FACTORS ACCORDING TO TYPE AND SEVERITY

Objetivo: verificar factores asociados con la incontinencia urinaria en mujeres, por tipo y porgravedad.Metodología: estudio transversal realizado entre noviembre de 2018 y abril de 2019 con30 mujeres en un hospital escuela de Pernambuco. Se utilizó el instrumento Gaudenz-Fragebogen para identificar los tipos de incontinencia y el Incontinence Severity Index paraclasificar la gravedad de la pérdida de orina. Se utilizó la prueba exacta de Fisher para analizarlas variables cualitativas, y el t-Student para las variables racionales.Resultados: la incontinencia urinaria por esfuerzo fue el tipo más frecuente (66,7%), en su formamoderada (43,3%) y estuvo asociada a un bajo nivel de escolaridad (p<0,001), a un Índicede Masa Corporal de 28,6 (p=0,043), a una circunferencia abdominal de 103,4 (p<0,001),diabetes (p<0,001), cantidad de partos superior a 4 (p=0,046), cirugía ginecológica (p=0,023)y a la falta de actividad física (p=0,001).Consideraciones finales: identificar el tipo, la gravedad y los principales factores de riesgomodificables podrá ayudar a diseñar intervenciones preventivas y curativas más eficientes yefectivas.Objetivo: verificar fatores associados a incontinência urinária em mulheres por tipo e gravidade.Metodologia: estudo transversal, realizado de novembro de 2018 a abril de 2019, com 30 mulheres em um hospital escola de Pernambuco. Foi utilizado o instrumento Gaudenz-Fragebogen para identificar os tipos de incontinência e o Incontinence Severity Index para classificar a gravidade da perda urinária. Utilizou-se o teste Exato de Fisher para analisar variáveis qualitativas e t-Student para variáveis racionais.Resultados: incontinência urinária de esforço foi o tipo mais frequente (66,7%), na forma moderada (43,3%) e esteve associada a baixa escolaridade (p<0,001), índice de massa corporal de 28,6 (p=0,043), circunferência abdominal de 103,4 (p<0,001), diabetes (p<0,001), número de partos superior a 4 (p=0,046), cirurgia ginecológica (p=0,023) e falta de atividade física (p=0,001).Considerações Finais: a identificação do tipo, da gravidade e dos principais fatores de risco modificáveis poderá subsidiar intervenções preventivas e curativas mais eficientes e efetivas.Objective: To verify factors associated with urinary incontinence in women by type and severity.Methodology: A cross-sectional study conducted from November 2018 to April 2019 with30 women in a teaching hospital of Pernambuco. The Gaudenz-Fragebogen instrument wasused to identify incontinence types, and the Incontinence Severity Index to classify urinaryloss severity. Fisher’s exact test was used to analyze qualitative variables, and the t-Studenttest for rational variables.Results: Stress-induced urinary incontinence was the most frequent type (66.7%), in itsmoderate form (43.3%), and was associated with low schooling (p<0.001), Body Mass Indexof 28.6 (p=0.043), abdominal circumference of 103.4 (p<0.001), diabetes (p<0.001), numberof deliveries above 4 (p=0.046), gynecological surgery (p=0.023), and lack of physical activity(p=0.001).Final Considerations: Identifying the type, severity, and main modifiable risk factors maysupport more effective and efficient preventive and curative interventions

Impact of the COVID-19 pandemic stay at home order and social isolation on physical activity levels and sedentary behavior in Brazilian adults

Objective: To investigate the impact of the coronavirus 2019 pandemic on physical activity levels and sedentary behavior among Brazilians residents aged ≥18 years. Methods: An online survey was distributed through a social media platform between May 5 and 17, 2020. Participants completed a structured questionnaire in Google Forms, which assessed the physical activity level and sedentary behavior of adults in Brazil during the pandemic. Results: Age (OR: 0.98; 95%CI: 0.97-0.99), chronic disease (OR: 1.29; 95%CI: 1.03-1.63), physical inactivity before the coronavirus 2019 pandemic (OR: 2.20; 95%CI: 1.78-2.72) and overweight (OR: 1.34; 95%CI: 1.09-1.65) showed higher risk of impact on physical activity levels. Increased sitting time was associated with older individuals (OR: 0.97; 95%CI: 0.96-0.98), inactivity (OR: 1.51; 95%CI: 1.16-1.96), chronic disease (OR: 1.65; 95%CI: 1.23-2.22), higher number of days in social isolation (OR: 1.01; 95%CI: 1.00-1.02) and higher schooling levels (OR: 1.87; 95%CI: 1.26-2.78). Conclusion: Our results demonstrated that advanced age, chronic disease and physical inactivity before social isolation had a greater risk of impact on reduced physical activity levels and increased sitting time during the coronavirus 2019 disease pandemic

Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial

BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317