Effects of Isometric Handgrip Training in Patients With Peripheral Artery Disease: A Randomized Controlled Trial

BackgroundMeta‐analyses have shown that isometric handgrip training (IHT) can reduce brachial systolic and diastolic blood pressure (BP) by >6/4 mm Hg, respectively. However, whether IHT promotes these effects among patients with peripheral artery disease, who exhibit severe impairment in cardiovascular function, is currently unknown. This study aimed to evaluate the effects of IHT on the cardiovascular function of patients with peripheral artery disease. Methods and ResultsA randomized controlled trial with peripheral artery disease patients assigned to either the IHT or control group was conducted. The IHT group performed 3 sessions per week, for 8 weeks, of unilateral handgrip exercises, consisting of 4 sets of isometric contractions for 2 minutes at 30% of maximum voluntary contraction and a 4‐minute interval between sets. The control group received a compression ball in order to minimize the placebo effects, representing sham training. The primary outcome was brachial BP. The secondary outcomes were central BP, arterial stiffness parameters, cardiac autonomic modulation, and vascular function. The IHT program reduced diastolic BP (75 [10] mm Hg preintervention versus 72 [11] mm Hg postintervention), with no change in the control group (74 [11] mm Hg preintervention versus 74 [11] mm Hg postintervention), with this between‐group difference being significant (P=0.04). Flow‐mediated dilation improved in the IHT group (6.0% [5.7] preintervention versus 9.7% [5.5] postintervention), with no change in the control group (7.6% [5.5] preintervention versus 7.4% [5.1] postintervention), with this between‐group difference being significant (P=0.04). There was no change in other measured variables over the intervention period. ConclusionsIHT reduced brachial diastolic BP and improved local vascular function in patients with peripheral artery disease

Barriers and Levels of Physical Activity in Patients With Symptomatic Peripheral Artery Disease: Comparison Between Women and Men

This cross-sectional study compared physical activity levels and barriers between 212 men and women with symptomatic peripheral artery disease. Physical activity was objectively measured by an accelerometer. Barriers to physical activity were obtained using a validated questionnaire. Women reported higher amounts of light physical activity (p < .001) and lower moderate–vigorous physical activity (p < .001) than men. Women more often reported barriers such as “not having anyone to accompany” (p = .006), “lack of money” (p = .018), “fear of falling or worsening the disease” (p = .010), “lack of security” (p = .015), “not having places to sit when feeling leg pain” (p = .021), and “difficulty in getting to a place to practice physical activity” (p = .015). In conclusion, women with symptomatic peripheral artery disease presented with lower amounts of moderate–vigorous activity and more barriers to activity than men. Strategies to minimize the barriers, including group actives and nonpainful exercises, are recommended for women with peripheral artery disease

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

Effect of 16 Weeks of Resistance Training on Fatigue Resistance in Men and Women

The purpose of this study was to investigate the effect of hypertrophy-type resistance training (RT) on upper limb fatigue resistance in young adult men and women. Fifty-eight men (22.7±3.7 years, 70.6±9.3 kg, and 176.8±6.4 cm) and 65 women (21.6±3.7 years, 58.8±11.9 kg, and 162.6±6.2 cm) underwent RT for 16 weeks. Training consisted of 10–12 whole body exercises with 3 sets of 8–12 repetitions maximum performed 3 times per week. Before and after the RT intervention participants were submitted to 1RM testing, as well as a fatigue protocol consisting of 4 sets at 80% 1RM on bench press (BP) and arm curl (AC). The sum of the number of repetitions accomplished in the 4 sets in each exercise was used to indicate fatigue resistance. There was a significant (p\u3c0.05) time-by-group interaction in 1RM BP (men=+16%, women=+26%), however in 1RM AC no significant time-by-group interaction was observed (men=+14%, women=+23%). For the total number of repetitions, men and women showed a significant increase in BP (men=+16.3%, women=+10.5%) with no time-by-group interaction. The results suggest that the adaptation in maximal strength is influenced by sex in BP. On the other hand, for fatigue resistance, the individual’s sex does not seem to influence outcomes either in BP or AC

Isometric exercise training for hypertension

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: We will aim to conduct a systematic review and meta-analysis quantifying the effects of IRT on systolic, diastolic, mean arterial and 24-hour ambulatory blood pressure. We will also quantify changes in heartrate and heartrate variability, and will attempt to determine which patient demographics and exercise program characteristics are associated with the largest blood pressure changes

Symptoms of anxiety and depression and their relationship with barriers to physical activity in patients with intermittent claudication

OBJECTIVES: Although the practice of physical exercise in patients with intermittent claudication (IC) is often encouraged, adherence is low. The difficulty in performing physical training may be related to the psychological characteristics of patients with claudication. To verify the association between anxiety and depression symptoms and barriers to physical exercise and walking capacity in patients with IC. METHODS: One-hundred and thirteen patients with a clinical diagnosis of IC were included in the study. Patients underwent clinical evaluation by a vascular surgeon, answered the Beck Depression Inventory, and Beck Anxiety Inventory tests were applied by the psychologist. The patients performed the 6-minute test and reported their barriers to physical activity practice in a questionnaire. RESULTS: Patients with signs of depression had a shorter pain-free walking distance (p=0.015) and total walking distance (p=0.035) compared to patients with no signs of depression. Pain-free walking distance (p=0.29) and total walking distance (p=0.07) were similar between patients with and without signs of anxiety. Patients with symptoms of moderate to severe depression reported more barriers to physical activity practice compared to patients without signs of depression. CONCLUSION: Symptoms of anxiety and depression are prevalent among patients with peripheral arterial occlusive disease (PAD). Depression symptoms are associated with personal barriers to exercise, while anxiety symptoms are not. The main barriers to physical activity among patients with IC are exercise-induced pain and the presence of other diseases

Low-intensity resistance exercise does not affect cardiac autonomic modulation in patients with peripheral artery disease

OBJECTIVE: To analyze the effect of a single bout of resistance exercise on cardiac autonomic modulation in patients with peripheral artery disease. METHODS: Fifteen patients with peripheral artery disease (age: 58.3±4.0 years) underwent the following sessions in a random order: resistance exercise (three sets of 10 repetitions of the six resistance exercises with a workload of 5-7 in the OMNI-RES scale) and control (similar to the resistance session; however, the resistance exercises were performed with no load). The frequency domain (low frequency, high frequency and sympathovagal balance) and symbolic analysis (0V, 1V and 2V patterns) of heart rate variability were obtained before and until one hour after the interventions. RESULTS: After the resistance exercise and control sessions, similar increases were observed in the consecutive heartbeat intervals (control: 720.8±28.6 vs. 790.9±34.4 ms; resistance exercise: 712.9±30.1 vs. 756.8±37.9 ms;

Validation of the Modified Shuttle Test to Predict Peak Oxygen Uptake in Youth Asthma Patients Under Regular Treatment

Background: Oxygen uptake (VO2) evaluations by cardiopulmonary exercise test is expensive and time-consuming. Estimating VO2 based on a field test would be an alternative.Objective: To develop and validate an equation to predict VO2peak based on the modified shuttle test (MST).Methods: Cross sectional study, with 97 children and adolescents with asthma. Participants were divided in two groups: the equation group (EG), to construct the equation model of VO2peak, and the cross-validation group (VG). Each subject performed the MST twice using a portable gas analyzer. The peak VO2peak during MST was used in the equation model. The patients’ height, weight, gender, and distance walked (DW) during MST were tested as independent variables.Results: The final model [-0.457 + (gender × 0.139) + (weight × 0.025) + (DW × 0.002)] explained 87% of VO2peak variation. The VO2peak predicted was similar to VO2peak measured by gas analyzer (1.9 ± 0.5 L/min and 2.0 ± 0.5 L/min, respectively) (p = 0.67), and presented significant ICC 0.91 (IC95% 0.77 to 0.96); p &lt; 0.001. The Bland–Altman analysis showed low bias (-0.15 L/min) and limits of agreement (-0.65 to 0.35 L/min). There was no difference in DW between EG (760 ± 209 m) and VG (731 ± 180 m), p = 0.51.Conclusion: The developed equation adequately predicts VO2peak in pediatric patients with asthma