Effects of arm-crank exercise on cardiovascular function, functional capacity, cognition and quality of life in patients with peripheral artery disease: Study protocol for a randomized controlled trial

Background: Arm-crank exercise training (ACT) is an alternative exercise strategy for patients with symptomatic peripheral artery disease (PAD) due to the attenuation of pain symptoms during the exercise, as well as the benefits to functional capacity. Purpose: The aim of this study is to describe the study protocol to analyze the effects of ACT exercise on cardiovascular function, functional capacity, cognition and quality of life in patients with symptomatic PAD. Methods: This is a three-armed randomized, prospective, single-blind data collection, single-center, controlled study enrolling 45 patients with symptomatic PAD who will be randomized into 3 intervention groups: walking training (WT), ACT and control group. The WT and ACT will perform 2 sessions/week, 15 to 10 sets of 2 to 5 minutes at values of 13 to 15 on the Borg scale. Before and after 12 weeks of intervention, cardiovascular function (ambulatory blood pressure, office blood pressure, central blood pressure, heart rate variability, arterial stiffness and vascular function), functional capacity (six-minute walk test, 2 minute step test, handgrip test, Walking impairment questionnaire, Walking estimated limitation calculated by history, Baltimore activity scale for intermittent claudication, and short physical performance battery), cognition (executive function and memory), and quality of life (vascular quality of life questionnaire and World Health Organization Quality of Life) will be assessed. Results: This is the first trial to evaluate the effects of ACT on regulatory mechanisms of the cardiovascular system in PAD patients. If the results are as expected, they will provide evidence the ability of ACT to promote cardiovascular benefits in the symptomatic PAD population

Physical aptitude classification tables for users of public parks

INTRODUÇÃO: Devido à difusão dos benefícios da atividade física, muitas pessoas passaram a se exercitar em parques públicos, o que incentivou o surgimento de projetos que orientam a prática nestes locais. Estes projetos precisam avaliar a aptidão física de seus clientes com testes fáceis, cujos resultados são comparados a padrões de estadiamento. Porém, os padrões existentes não se adequam à população em questão. OBJETIVO: Construir tabelas de estadiamento para a avaliação da aptidão física de adultos e idosos. MÉTODOS: Foram utilizados os dados de 713 avaliações feitas em indivíduos de ambos os sexos e com mais de 20 anos. Foram avaliadas a aptidão cardiorrespiratória (marcha estacionária e Cooper), a capacidade muscular (flexão de cotovelo, impulsão vertical e resistência abdominal) e a flexibilidade (sentar e alcançar e flexibilidade de ombros). RESULTADOS: Foi avaliado o percentil 50 de cada teste: marcha estacionária = 105 passadas; Cooper = 1.200m; flexão de cotovelo = 20 rep; resistência abdominal = 18 rep; força de membros inferiores: 18cm; flexibilidade de ombros = 1cm e flexibilidade lombar = 23cm. Estes resultados foram maiores que os verificados nas tabelas originais, o que confirmou a necessidade da criação das tabelas específicas. CONCLUSÃO: Foram construídas sete tabelas separadas por gênero e faixa etária e com o desempenho classificado em: fraco - < que percentil 20; regular - entre 20 e 40; médio - entre 40 e 60; bom - entre 60 e 80; e ótimo - &gt; que o percentil 80.INTRODUCTION: Due to the spread of the health benefits of physical activity, many subjects began to exercise in public parks. This behavior promoted the creation of projects which stimulate and guide on physical activity practice. Nevertheless, for being considered effective, these projects need to evaluate the subjects' physical aptitude by applying easy tests, whose results are compared to classification tables. However, these tables are not adequate to the target population. OBJECTIVE: To design fitness classification tables based on simple fitness tests applied to adults and elderly subjects. METHODS: Data from 713 evaluations conducted with subjects of both genders older than 20 years were analyzed. Cardiorespiratory fitness (stationary gait and Cooper tests), muscle fitness (elbow flexion, vertical jump and abdominal resistance), and flexibility (sit and reach and shoulder flexibility) were evaluated. RESULTS: The 50 percentile for the tests were stationary gait = 105 steps; Cooper = 1200m; elbow flexion = 20 repetitions; abdominal resistance = 18 repetitions; legs strength =18 cm; shoulder flexibility = 1 cm; and lumbar flexibility = 23 cm. These results were higher than the original ones described for each test, which confirmed the need for specific classifications tables. CONCLUSION: Seven tables were designed with the results separated by gender and age group (20 to 80 year-olds divided in 10-year stages). Results were classified as: weak = < than 20 percentile; average= from 20 to 40 percentile; medium = from 40 to 60 percentile; good = from 60 to 80 percentile; and excellent = &gt; than 80 percentile.CNPqUniversidade de São Paulo (USP) - Pró-Reitoria de Cultura e Extensã

Association between the risk of malnutrition and functional capacity in patients with peripheral arterial disease: A cross-sectional study

Introduction The risk of malnutrition is an important predictor of functional capacity in the elderly population. However, whether malnutrition is associated with functional capacity in patients with peripheral artery disease (PAD) is poorly known. Purpose To analyse the association between the risk of malnutrition and functional capacity in patients with PAD. Methods This cross-sectional study included 135 patients with PAD of both genders, ≥50 years old, with symptomatic PAD (Rutherford stage I to III) in one or both limbs and with ankle-brachial index ≤0.90. The risk of malnutrition was assessed by the short form of the Mini Nutritional Assessment-Short Form and patients were classified as having normal nutritional status (n = 92) and at risk of malnutrition (n = 43). Functional capacity was objectively assessed using the six-minute walking test (6MWT, absolute maximal distance and relativized and expressed as a percentage of health subjects), short-physical performance battery (SPPB, balance, gait speed and the sit and stand test) and the handgrip test, and subjectively, using the Walking Impairment Questionnaire and Walking Estimated-Limitation Calculated by History. The association between the risk of malnutrition and functional capacity was analysed using bivariate and multivariate logistic regression adjustments for gender, age, ankle-brachial index, body mass index, use of statins, coronary arterial disease and stroke. For all statistical analyses, significance was accepted at p<0.05. Results Thirty-two per cent of our patients were classified with a risk of malnutrition. The risk of malnutrition was associated with the absolute 6MWT total distance (OR = 0.994, P = 0.031) relative 6MWT total distance (OR = 0.971, P = 0.038), lowest SPPB total score (OR = 0.682, P = 0.011), sit and stand (OR = 1.173, P = 0.003) and usual 4-meter walk test (OR = 1.757, P = 0.034). Conclusion In patients with PAD, the risk of malnutrition was associated with objective measurements of functional capacity

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

Impacto da pandemia da COVID-19 sobre o tratamento medicamentoso dos pacientes com doença arterial periférica: um estudo observacional transversal

Contexto: A pandemia do Coronavírus 2019 (COVID-19) tem afetado negativamente o comportamento dapopulação. Nesse contexto, o impacto da pandemia da COVID-19 no tratamento medicamentoso dos pacientes comdoença arterial periférica (DAP) e claudicação intermitente (CI) permanece obscuro. Objetivos: Analisar o impactoda pandemia da COVID-19 no tratamento medicamentoso dos pacientes com DAP e CI. Métodos: Neste estudoobservacional transversal, 136 pacientes com DAP e CI, recrutados do nosso banco de dados, responderam por telefoneum questionário envolvendo as seguintes questões: a) cuidados com a COVID-19; b) saúde global; c) tratamento dasdoenças. Posteriormente, os pacientes foram divididos em dois grupos, de acordo com a dificuldade para a aquisiçãodos medicamentos (DAM: dificuldade e SDAM: sem dificuldade), para a comparação da saúde global entre os doisgrupos. Resultados: Dezessete porcento dos pacientes reportaram dificuldades para a aquisição dos medicamentosdurante a pandemia. Uma maior prevalência desses pacientes reportou estar mais triste (56,5% versus 24,8%, p 0,05). Conclusões: Uma maior prevalência de pacientes do grupo DAM reportou estar mais triste e com maisdificuldade para dormir em comparação ao grupo SDAM durante a pandemia da COVID-19. = Background: The Coronavirus 2019 (COVID-19) pandemic has had a negative impact on the population’s behavior. In this context, the effect of the COVID-19 pandemic on drug treatment of patients with peripheral arterial disease (PAD) and intermittent claudication (IC) remains unclear. Objectives: To analyze the impact of the COVID-19 pandemic on drug treatment of patients with PAD and IC. Methods: In this cross-sectional, observational study, 136 patients with PAD and IC were recruited from our database and answered a questionnaire by telephone involving the following questions: a) precautions related to COVID-19; b) general health status; and c) treatment of diseases. Subsequently, patients were divided into two groups according to difficulty in obtaining their drugs (DOD: difficulty obtaining drugs, or NDOD: no difficulty obtaining drugs) and overall health was compared between groups. Results: Seventeen percent of patients reported difficulties with obtaining drugs during the pandemic. A higher proportion of these patients reported being sadder (56.5% vs. 24.8%, P < 0.01) and having more difficulty sleeping (56.5% vs. 24.8%, P < 0.01) than of the patients in the NDOD group (P <0.01). The groups did not differ in terms of impairment of walking capability, anxiety, stress, or depression (P> 0.05). Conclusions: A higher proportion of patients in the DOD group reported being sadder and having greater difficulty sleeping compared to the NDOD group during the COVID-19 pandemic

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

Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease

Progressive high-intensity resistance training on blood pressure and its hemodynamic and neural mechanisms in elderly subjects

O treinamento resistido progressivo de alta intensidade tem sido empregado para aumentar a massa e força musculares de indivíduos idosos. Entretanto, existe na área clínica alguma preocupação de que esse treinamento possa promover efeitos adversos sobre o sistema cardiovascular envelhecido. Assim, o objetivo do presente estudo foi avaliar os efeitos do treinamento resistido progressivo de alta intensidade sobre a pressão arterial clínica e ambulatorial e seus mecanismos hemodinâmicos e neurais de idosos. Para tanto, 25 indivíduos com idade entre 60 e 80 anos foram divididos aleatoriamente em dois grupos: Grupo Treinamento Resistido (N=12, 7 mulheres, 64±1 anos - 2 sessões/semana, 7 exercícios, 2-4 séries, 10-4 RM) e Grupo Controle (N=13, 11 mulheres, 63±1 anos - nenhum treinamento). Antes e após 4 meses, a força dinâmica máxima, a área de secção transversa do músculo quadríceps, a pressão arterial clínica (posição deitada e sentada) e ambulatorial, os determinantes hemodinâmicos e a modulação autonômica cardiovascular (posição deitada com respiração livre e controlada e posição sentada com respiração livre) foram avaliados nos dois grupos. Comparando-se os valores medidos no início e no final do estudo, a força dinâmica máxima de membros superiores e inferiores e a área de secção transversa do músculo quadríceps aumentaram no Grupo Treinamento Resistido (+32, +46 e +5%, respectivamente, P0,05) e nem no Grupo Controle (posição deitada, 121±11 vs. 119±10 e 73±5 vs. 72±4 mmHg; posição sentada, 125±11 vs. 124±9 e 75±8 vs. 74±5 mmHg, respectivamente, P>0,05). Da mesma forma, a resistência vascular periférica, o débito cardíaco, o volume sistólico e a frequência cardíaca não se alteraram em nenhum dos grupos (Treinamento Resistido = 26±5 vs. 30±5 mmHg/L.min-1; 3,8±0,9 vs. 3,2±0,4 L/min; 54±11 vs. 43±10 ml e 70±9 vs. 75±12 bpm; Controle = 29±8 vs. 31±10 mmHg/L.min-1; 3,5±1,0 vs. 3,1±0,7 L/min; 54±16 vs. 50±14 ml e 66±11 vs. 65±10 bpm, respectivamente, P>0,05). Com relação aos mecanismos neurais, o balanço simpatovagal (BF/AFR-R) não se modificou em nenhuma das três situações (posição deitada com respiração livre e controlada e posição sentada com respiração livre) no Grupo Treinamento Resistido (4,1±5,4 vs. 1,9±1,3; 0,7±0,6 vs. 0,9±0,9 e 3,5±5,7 vs. 5,0±8,1, respectivamente, P>0,05) nem no Grupo Controle (2,3±2,8 vs. 2,0±1,6; 0,4±0,4 vs. 0,4±0,4 e 3,0±3,7 vs. 2,8±2,8, respectivamente, P>0,05). A sensibilidade barorreflexa espontânea e a pressão arterial ambulatorial também não se alteraram em nenhum dos grupos. Em conclusão, o treinamento resistido de alta intensidade foi efetivo em aumentar a força dinâmica máxima e a área de secção transversa muscular de indivíduos idosos audáveis, sem modificar a pressão arterial clínica e ambulatorial, nem seus determinantes hemodinâmicos e mecanismos de regulação neuralProgressive high-intensity resistance training has been performed to increase of muscle mass and strength in elderly subjects. However, some clinical concerns exist about the possible adverse cardiovascular effects of this training on cardiovascular function and regulation in elderly. Thus, the aim of this study was to evaluate the effects of progressive high-intensity resistance training on blood pressure and its hemodynamic and neural mechanisms in elderly subjects. To investigate this issue, 25 subjects aged between 60 and 80 years were randomly divided into two groups: Resistance Training Group (N=12, 7 females, 64±1 years 2 sessions/week, 7 exercises, 2-4 sets, 10-4 RM) and Control Group (N=13, 11 females, 63±1 years no training). Before and after 4 months, maximal strength, quadriceps cross-sectional area, clinical (supine and sitting position) and ambulatory blood pressure, hemodynamic determinants, and cardiovascular autonomic modulation (supine position with free and controlled breathing and sitting position with free breathing) were measured. Comparing values measured at the beginning and the end of the study, maximal strength of upper and lower limbs, and quadriceps cross-sectional area increased in the Resistance Training Group (+32, +46 e +5%, respectively, P>0.05). Similarly, peripheral vascular resistance, cardiac output, stroke volume and heart rate also did not change in neither of the groups (Resistance Training = 26±5 vs. 30±5 mmHg/L.min-1; 3.8±0.9 vs. 3.2±0.4 L/min; 54±11 vs. 43±10 ml; and 70±9 vs. 75±12 bpm; Control Group = 29±8 vs. 31±10 mmHg/L.min-1; 3.5±1.0 vs. 3.1±0.7 L/min; 54±16 vs. 50±14 ml; and 66±11 vs. 65±10 bpm, respectively, P>0.05). In regard to the neural mechanisms, cardiac sympathovagal balance (LF/HFR-R) also did not change in any of the situations (supine position with free and controlled breathing, and sitting position with free breathing) in the Resistance Training Group (4.1±5.4 vs. 1.9±1.3; 0.7±0.6 vs. 0.9±0.9; 3.5±5.7 vs. 5.0±8.1, respectively, P>0.05) nor in the Control Group (2.3±2.8 vs. 2.0±1.6; 0.4±0.4 vs. 0.4±0.4; 3.0±3.7 vs. 2.8±2.8, respectively, P>0.05). The spontaneous baroreflex sensitivity and ambulatory blood pressure also did not change in neither of the groups. In conclusion, the progressive high-intensity resistance training was effective in increasing muscle mass and strength in healthy elderly subjects, without changing clinic and ambulatory blood pressure as well as their hemodynamic and neural mechanisms. respectively, P0.05) nor in the Control Group (supine, 121±11 vs. 119±10 and 73±5 vs. 72±4 mmHg; sitting, 125±11 vs. 124±9 and 75±8 vs. 74±5 mmH