Aluísio Henrique Rodrigues de Andrade Lima

Impact of a supervised strength training or walking training over a subsequent unsupervised therapy period on walking capacity in patients with claudication

Previous studies have demonstrated that supervised strength training (ST) or walking training (WT) improve walking capacity in patients with claudication. However, it remains unknown whether these improvements would be sustained over a subsequent unsupervised period. This article reports the findings of a study to analyze whether the improvements in walking capacity, achieved with a supervised ST or WT, would be sustained over a subsequent unsupervised therapy period in patients with claudication. Patients were initially randomized to supervised exercise consisting of ST (n = 15) or WT (n = 15) for 12 weeks. After this period, 12 patients in each group consented to be followed for an additional 12 weeks of unsupervised therapy. Initial claudication distance (ICD) and total walking distance (TWD) were measured at baseline, after the supervised period (Week 12) and after the unsupervised period (Week 24). In comparison with baseline values, both groups similarly increased ICD and TWD at Week 12. From Week 12 to Week 24, both groups similarly decreased ICD (ST: -55 ± 110 m and WT: -82 ± 142 m, P =.04) and TWD (ST: -68 ± 186 m and WT: -128 ± 112 m, P < .01). However, in both groups, ICD (ST: +126 ± 149 m and WT: +50 ± 167 m, P = .01) and TWD (ST: +104 ± 162 m and WT: +45 ± 139 m, P =.01) at Week 24 remained greater than baseline values. The conclusion is that supervised ST or WT followed by an unsupervised therapy period similarly decreased walking capacity in patients with claudication. However, after the unsupervised period, walking capacity remained at a higher level than before the onset of the supervised exercise-training period.

Intra-individuals and inter- and intra-observer reliability of short-term heart rate variability in adolescents

To examine the reliability of heart rate variability (HRV) parameters in adolescents and to analyse the inter‐ and intra‐observer reliability of data analysis.

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.

Effects of rest interval length on rating of perceived exertion during a multiple-set resistance exercise.

This investigation analyzed the effect of rest interval length on the rating of perceived exertion (RPE) during a resistance exercise session. Nineteen males performed two experimental sessions: resistance exercise with 30-sec. rest intervals (E30) and 90-sec. rest intervals (E90). In both sessions, five exercises (bench press, knee extension, seated row, knee curl, and frontal rise) were performed at 50% 1RM in three sets of 12, 9, and 6 repetitions, respectively. In the E30 session, the RPE increased between sets in all exercises, while in the E90 session, the RPE increased from the first set to the second set in three exercises. RPE in the E30 session was higher than that in the E90 session in the third set. The results suggest that RPE increases for shorter rest intervals than for longer rest intervals. Therefore, the RPE could be considered an indicator of muscle recovery during resistance exercise.

Effects of active recovery on autonomic and haemodynamic responses after aerobic exercise

The aim of this study was to examine the effect of active recovery on autonomic and haemodynamic responses after exercise in healthy adults. Nineteen healthy young male individuals underwent two experimental sessions: exercise with active recovery (AR) and exercise with passive recovery (PR). The exercise sessions comprised three phases: warm‐up (5 min), exercise phase (cycle ergometer, 30 min, intensity between 60 and 70% of the heart rate reserve) and recovery (5 min). In the AR, the subjects remained cycling in the recovery phase at intensity between 30% and 35% of heart rate reserve, while in the PR, the subjects stopped the exercise after finishing the exercise phase. Blood pressure and heart rate were measured before and over the 30 min after the interventions. There were no differences for systolic and diastolic blood pressures, heart rate and rate pressure product between active and passive recovery sessions. Also, all heart rate variability parameters changed similarly after exercise with passive or active recovery sessions. In summary, exercise with active recovery does not affect the autonomic and haemodynamic responses after moderate‐intensity aerobic exercise in healthy young male individuals.

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.

Relationship between walking capacity and ambulatory blood pressure in patients with intermittent claudication

Objective Patients with intermittent claudication (IC) often have high blood pressure (BP), which increases their cardiovascular risk. However, whether walking capacity is associated with BP levels in patients with IC remains unknown. Therefore, this study was designed to investigate whether the total walking distance is associated with ambulatory BP in patients with IC. Participants and methods This was a cross-sectional study of 75 patients with IC (58 men; 17 women). A maximal treadmill test (Gardner protocol) was performed to assess total walking distance in these patients. Furthermore, ambulatory BP, heart rate, rate–pressure product, and BP load were obtained over a 24-h period. One-way analysis of variance and multiple linear regression were carried out. Results Walking capacity was correlated negatively with the following: (i) asleep systolic BP, diastolic BP, mean BP and heart rate; (ii) 24-h, awake and asleep RPP; and (iii) awake and asleep systolic BP load (all P<0.05). These associations occurred irrespective of confounders such as age, sex, BMI, smoking status, and number of antihypertensive medications. Conclusion A better walking capacity is associated with lower ambulatory BP parameters in patients with IC.

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.

Post exercise cardiovascular effects of different resistance exercise protocols for trunk and upper limbs

Objective: to analyze the post exercise cardiovascular effects of different resistance exercise protocols for trunk and upper limbs. Methods: Fifteen males (22.3 ± 0.9 years) underwent three experimental sessions randomly: control session (C), resistance exercise session at 50% of one repetition maximum (1-RM) (E50%), and resistance exercise session at 70% of 1-RM (E70%). Three sets of 12, 9 and 6 repetitions were performed for each exercise. Blood pressure (BP), heart rate (HR) and rate pressure product (RPP) were measured before and during 90 minutes after each session. Results: Systolic BP decreased (P<.05) and diastolic BP increased (P<.05) similarly after C, E50% and E70%. However, HR and RPP decreased after C (P<.01), maintained after E50%, and increased after E70% (P<.01). Conclusions: The resistance exercise intensity did not influence post-exercise BP responses, however, cardiac overload was greater after E70%

Inflammation and cardiovascular autonomic dysfunction in rheumatoid arthritis: a bidirectional pathway leading to cardiovascular disease

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that affects the synovial joints, causing pain and loss of function. Interestingly, this inflammatory pattern also causes damage to the heart and vasculature, increasing the deleterious consequences of the disease. Indeed, cardiovascular disease (CVD) represents the primary cause of morbidity/mortality in RA. The increased rates of CVD in RA can be partially explained by the presence of traditional risk factors, such as diabetes, dyslipidaemia, hypertension and physical inactivity. However, recent studies have identified other factors that contribute to the pathophysiology of CVD in RA. Among them, impairment in autonomic cardiovascular regulation, otherwise known as cardiovascular autonomic dysfunction, has received growing attention over recent years (Adlan et al. 2017). Using mostly indirect methods, previous studies have presented equivocal information regarding the presence of autonomic dysfunction in RA patients. In order to address such limitations, Adlan et al. (2017) published a recent study in The Journal of Physiology, whereby they performed a comprehensive assessment of autonomic function in RA, including assessments of heart rate, cardiac and sympathetic baroreflex functions using the modified Oxford technique, and recordings of muscle sympathetic nerve activity using microneurography. In order to avoid the potential confounding effects of hypertension, the main outcomes of the study were compared between RA patients with and without hypertension, as well as between normotensive and hypertensive individuals without RA. Using this elegant design, they observed an increased heart rate, a reduction in cardiac baroreflex sensitivity, increased sympathetic activity and a preserved sympathetic baroreflex sensitivity in RA patients. Interestingly, these responses occurred independently of the presence of hypertension, and were correlated with inflammation and pain, highlighting the link between autonomic dysfunction and the typical symptoms of RA. The cross-sectional design of this study precludes causal inferences between inflammatory status and autonomic dysfunction in RA; however, information from previous studies does provide support for this concept (Tracey, 2002; Suzuki & Nakai, 2016). More specifically, influential reviews have discussed the bidirectional relationship between the immune system/ inflammation and the central nervous system (Tracey, 2002; Suzuki & Nakai, 2016). These authors propose that the central nervous system can regulate immune system function via two plausible mechanisms: receptor-specific proor antiinflammatory effects of noradrenaline (norepinephrine) released