Alessandra de Souza Miranda

A single bout of resistance exercise does not modify cardiovascular responses during daily activities in patients with peripheral artery disease.

ObjectiveTo analyze the posteffects of a single bout of resistance exercise on cardiovascular parameters in patients with peripheral artery disease (PAD). DesignRandomized cross-over. Materials and methodsSeventeen PAD patients performed two experimental sessions: control (C) and resistance exercise (R). Both sessions were identical (eight exercises, 3×10 repetitions), except that the R session was performed with an intensity between 5 and 7 in the OMNI-RES scale and the C session was performed without any load. Systolic blood pressure (BP), diastolic BP, heart rate, and rate–pressure product (RPP) were measured for 1 h after the interventions in the laboratory and during 24-h using ambulatory BP monitoring. ResultsAfter the R session, systolic BP (greatest reduction: −6±2 mmHg, P<0.01) and RPP (greatest reduction: −888±286 mmHg×bpm; P<0.01) decreased until 50 min after exercise. From the second hour until 23 h after exercise, BP, heart rate, and RPP product were similar (P>0.05) between R and C sessions. BP load, nocturnal BP fall, and morning surge were also similar between R and C sessions (P>0.05). ConclusionA single bout of resistance exercise decreased BP and cardiac work for 1 h after exercise under clinical conditions, and did not modify ambulatory cardiovascular variables during 24 h in patients with PAD.

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; p<0.05) and in the pattern of the symbolic analysis with no variation (0V) (control: 25.1±3.5 vs. 33.4±4.1%; resistance exercise: 26.1±3.2 vs. 29.7±3.5%; p<0.05) until 50 min after both interventions. The pattern of two variations (2V) decreased similarly (control: 11.2±2.1 vs. 8.3±2.1%; resistance exercise: 9.5±1.7 vs. 7.8±1.7%; p<0.05). In contrast, the pattern of one variation (1V), the low and high frequency bands and sympathovagal balance did not change after the interventions (p>0.05). CONCLUSION: A single bout of resistance exercise did not alter cardiac autonomic modulation in patients with peripheral artery disease.

Sympathetic cardiac modulation and vascular worsening in arteritis: A case report

Increases in sympathetic modulation have been associated with increased risk of acute cardiovascular events in some populations. However, whether altered cardiac autonomic modulation is related to peripheral vascular worsening has not yet been described. In this study, we assessed cardiac autonomic modulation by heart rate variability in two patients with arteritis who were followed up for 5 months. Only the subject who presented high cardiac sympathetic modulation had acute vascular worsening. This case report suggests that cardiac autonomic modulation may be related to vascular worsening in patients with arteritis.

A session of resistance exercise increases vasodilation in intermittent claudication patients

No study has shown the effects of acute resistance exercise on vasodilatory capacity of patients with peripheral artery disease. The aim of this study was to analyse the effects of a single session of resistance exercise on blood flow, reactive hyperemia, plasma nitrite, and plasma malondialdehyde in patients with peripheral artery disease. Fourteen peripheral artery disease patients underwent, in a random order, 2 experimental sessions: control (rest for 30 min) and resistance exercise (8 exercises, 2 sets of 10 repetitions at an intensity of 5-7 in the OMNI Resistance Exercise Scale). Blood flow, reactive hyperemia, plasma nitrite, and malondialdehyde were measured before and 40 min after the interventions in both sessions. Data were compared between sessions by analysis of covariance, using pre-intervention values as covariates. The increases in blood flow, reactive hyperemia, and log plasma nitrite were greater (p ≤ 0.05) after resistance exercise than the control session (3.2 ± 0.1 vs. 2.7 ± 0.1 mL · 100 mL(-1) tissue · min(-1), 8.0 ± 0.1 vs. 5.7 ± 0.1 AU, and 1.36 ± 0.01 vs. 1.26 ± 0.01 μmol ∙ L(-1), respectively). On the other hand, malondialdehyde was similar between sessions (p > 0.05). In peripheral arterial disease patients, a single session of resistance exercise increases blood flow and reactive hyperemia, which seems to be mediated, in part, by increases in nitric oxide release.

Associação de comorbidades e hábitos não saudáveis com a capacidade de caminhada em pacientes com claudicação intermitente

Individuos com claudicacao intermitente (CI) comumente apresentam comorbidades associadas e habitos nao saudaveis, como o tabagismo e a inatividade fisica. Todavia, o quanto esses fatores contribuem para a intolerância a caminhada desses individuos permanece incerto. Assim, o objetivo deste estudo foi analisar a associacao das comorbidades e habitos nao saudaveis com a capacidade de caminhada de individuos com CI. A amostra foi composta por 66 individuos com CI de ambos os generos. Todos os individuos realizaram teste ergometrico maximo em esteira, sendo registrada o tempo de claudicacao (TC) e o tempo total de caminhada (TTC). Os dados referentes as comorbidades e habitos nao saudaveis foram obtidos por meio de entrevista. Para analise estatistica foi empregada analise de regressao simples univariada, com p < 0,05. A comorbidade mais prevalente foi a hipertensao arterial (86,4%), ao passo que a inatividade fisica foi o habito nao saudavel mais prevalente (47%). Alem disso, 90,9% dos pacientes apresentaram duas ou mais comorbidades e/ou habitos nao saudaveis. A inatividade fisica foi associada com menor TC (β = -154 s; p = 0,02; IC95% = -283; -25 s) e TTC (β = -189 s; p = 0,02; IC95% = -384; -29 s). Alem disso, o maior numero de comorbidades e habitos nao saudaveis tambem foram associados com menor TC (β = -55 s; p = 0,02; IC95% = -102; -8 s). Como conclusao, os resultados deste estudo indicam que a inatividade fisica e o numero de comorbidades e/ou habitos nao saudaveis estao associados com a intolerância a caminhada de individuos com CI.

Individual blood pressure responses to walking and resistance exercise in peripheral artery disease patients: Are the mean values describing what is happening?

OBJECTIVE The aim of this study was to analyze the average and individual blood pressure responses to walking and resistance exercise in patients with peripheral artery disease. METHODS Thirteen patients underwent three experimental sessions: walking exercise, resistance exercise, and control. Ambulatory blood pressure, heart rate, and rate pressure product were obtained before and until 24 hours after sessions. RESULTS The mean cardiovascular values during 24 hours, awake, and sleep periods were similar (P > 0.05) after the three experimental sessions. The analysis of individual data revealed that during 24 hours, eight of 13 patients reduced systolic or diastolic blood pressure in ≥4.0 mm Hg in at least one of the exercise session; furthermore, most of these patients presented greater responses after resistance exercise. The clinical characteristics of patients seem to influence the blood pressure responses after exercises. Individual data showed that part of patients presented clinically significant decreases in blood pressure, showing that these patients have acute cardiovascular benefits after performing an acute bout of exercise. CONCLUSIONS Although, in average, a bout of walking or resistance exercise did not decrease ambulatory blood pressure in peripheral artery disease patients, the individual data revealed that most patients presented clinically relevant blood pressure reductions, especially after resistance exercise.

Limitações para caminhar em idosos com claudicação intermitente: a religiosidade como mecanismo de superação da dor

OBJECTIVE: To analyze the perception about pain during walking in elderly with intermittent claudication and how they use religion to overcome the painful symptoms. METHODS: The sample consisted of 10 members of a physical training program with symptoms of intermittent claudication. A profile of the population was drawn, containing sociodemographic and religious data, and an interview based semi-structured interview script was conducted. We used the procedure descriptive statistics for numeric data and statements of the subjects were subjected to Analysis of Qualitative Data (AQUAD) software and analyzed through qualitative analysis. RESULTS: The results showed that the subjects had negative feelings regarding pain when walking, such as anger, sadness and fear. At the same time, they believed that religion and belief in the existence of a Higher Being helped them overcome the pain in the legs. CONCLUSION: The faith and religiosity seem to act as tools to overcome pain during walking of elderly peoples with intermittent claudication.

Effects of walking and strength training on walking capacity in individuals with claudication: meta-analysis

CONTEXT: Over the past few years, several clinical trials have been performed to analyze the effects of exercise training on walking ability in patients with intermittent claudication (IC). However, it remains unclear which type of physical exercise provides the maximum benefits in terms of walking ability. OBJECTIVE: To analyze, by means of a meta-analysis, the effects of walking and strength training on the walking capacity in patients with IC. METHODS: Papers analyzing the effects of walking and strength training programs in patients with IC were browsed on the Medline, Lilacs, and Cochrane databases. Randomized clinical trials scoring >4 on the Physiotherapy Evidence Database (PEDro) scale and assessing claudication distance (CD) and total walking distance (TWD) were included in the review. RESULTS: Walking and strength training yielded increases in CD and TWD (P < 0.05). However, walking training yielded greater increases than strength training (P = 0.02). CONCLUSION: Walking and strength training improve walking capacity in patients with IC. However, greater improvements in TWD are obtained with walking training.

Triagem pré-participação em exercício físico em pacientes com doença arterial periférica

BACKGROUND: Exercise has been recommended as the main treatment for individuals with peripheral artery disease (PAD). However, since these individuals have increased cardiovascular risk, a cardiovascular assessment before onset of exercise program must be performed. OBJECTIVE: The purpose of this study was to compare the efficacy of two screening tools for identifying individuals with PAD. METHODS: Twenty-eight men and women with PAD, who answered the Physical Activity Readiness Questionnaire (PAR-Q) and the stratification of cardiovascular risk questionnaire (SCRQ). RESULTS: The PAR-Q results showed that question six (Has any physician recommended the use of blood pressure or cardiovascular medications?) had higher frequency of positive responses (82.1%). Considering all responses, five individuals had all negative answers (17.9%). The results of the SCRQ showed that the question 11 (Do you have leg cramps or burning sensation cramp when you walk?) and the 2nd (Have you ever been told by a physician you have high blood pressure?) showed higher frequency of positive responses (82.1%). According to the criteria for cardiovascular risk stratification, all individuals were considered to be at high cardiovascular risk. CONCLUSION: The PAR-Q questionnaire was not sensitive enough to identify all subjects with PAD. On the other hand, the SRCQ was more efficient in identifying the subjects with PAD. Therefore, the use of SRCQ for screening PAD patients is suggested.