Annelise Lins Menêses

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.

Isokinetic Strength and Endurance in Proximal and Distal Muscles in Patients With Peripheral Artery Disease

BACKGROUND The objective of this study was to analyze the muscle strength and endurance of the proximal and distal lower-extremity muscles in peripheral artery disease (PAD) patients. METHODS Twenty patients with bilateral PAD with symptoms of intermittent claudication and nine control subjects without PAD were included in the study, comprising 40 and 18 legs, respectively. All subjects performed an isokinetic muscle test to evaluate the muscle strength and endurance of the proximal (knee extension and knee flexion movements) and distal (plantar flexion and dorsiflexion movements) muscle groups in the lower extremity. RESULTS Compared with the control group, the PAD group presented lower muscle strength in knee flexion (-14.0%), dorsiflexion (-26.0%), and plantar flexion (-21.2%) movements (P < 0.05) but similar strength in knee extension movements (P > 0.05). The PAD patients presented a 13.5% lower knee flexion/extension strength ratio compared with the control subjects (P < 0.05), as well as lower muscle endurance in dorsiflexion (-28.1%) and plantar flexion (-17.0%) movements (P < 0.05). The muscle endurance in knee flexion and knee extension movements was similar between PAD patients and the control subjects (P > 0.05). CONCLUSION PAD patients present lower proximal and distal muscle strength and lower distal muscle endurance than control patients. Therefore, interventions to improve muscle strength and endurance should be prescribed for PAD patients.

Cardiovascular Responses to Walking in Patients with Peripheral Artery Disease

PURPOSES The studys purposes were to assess the cardiovascular responses during constant-load walking and to identify predictors of this response in peripheral artery disease (PAD) patients. METHODS Seventy-nine patients with PAD performed a constant-load treadmill test (2 mph, 0% grade). During the test, systolic blood pressure (BP), diastolic BP, and HR were obtained at the fourth minute to the last minute of exercise. Patients were also characterized by demographic measures, cardiovascular risk factors, baseline exercise performance, and vascular measures. RESULTS During constant-load walking, there was a significant increase (P < 0.01) in systolic BP (+12 ± 10 mm Hg), diastolic BP (+6 ± 9 mm Hg), and HR (+5 ± 5 bpm). The HR responses were negatively correlated with the ischemic window (r = -0.23, P < 0.05), expressed as an area under the curve of the resting ankle systolic BP and its recovery from a maximal graded treadmill test, and positively correlated with the HR during the first minute of recovery from the maximal graded treadmill test (r = 0.27, P < 0.05). The increase in cardiovascular variables during constant-load walking was greater in subjects with a higher body mass index and in men (P < 0.05). CONCLUSIONS Patients with PAD had an increased cardiovascular response during constant-load walking, and these responses were greater in obese patients and in men. The clinical implication is that PAD patients engaged in walking training programs, particularly men and those with obesity, require frequent assessment of cardiovascular parameters to avoid exaggerated increases in BP and HR during constant-load walking.

Influence of endurance and resistance exercise order on the postexercise hemodynamic responses in hypertensive women.

Abstract Menêses, AL, Forjaz CL, Lima, PFM, Batista, RMF, Monteiro, MF, and Ritti-Dias, RM. Influence of endurance and resistance exercise order on the postexercise hemodynamic responses in hypertensive women. J Strength Cond Res 29(3): 612–618, 2015—The study aims to evaluate the effects of the order of endurance and resistance exercises on postexercise blood pressure (BP) and hemodynamics in hypertensive women. Nineteen hypertensive women underwent 3 sessions: control (50 minutes rest), endurance (50–60% of heart rate reserve) followed by resistance exercise (50% of 1 repetition maximum) (E + R), and resistance followed by endurance exercise (R + E). Before and 30 minutes after each session, BP, peripheral vascular resistance, cardiac output, stroke volume, and heart rate were measured. Postexercise increases in systolic (E + R: +1 ± 3 mm Hg and R + E: +3 ± 3 mm Hg), diastolic (E + R: +3 ± 1 mm Hg and R + E: +3 ± 2 mm Hg), and mean BP (E + R: +3 ± 1 mm Hg and R + E: +3 ± 2 mm Hg) were significantly lower after the exercise sessions compared with the control session (p ⩽ 0.05). The exercise sessions abolished the increases in peripheral vascular resistance (E + R: +0.00 ± 0.04 mm Hg·min−1·L−1 and R + E: +0.05 ± 0.05 mm Hg·min−1·L−1) and the decreases in cardiac output (E + R: +0.04 ± 0.28 L·min−1 and R + E: −0.26 ± 0.28 L·min−1) observed after the control session (p ⩽ 0.05). After the exercise sessions, stroke volume decreased (E + R: −14 ± 3 ml and R + E: −9 ± 4 ml) and heart rate increased (E + R: +5 ± 1 b·min−1 and R + E: +4 ± 1 b·min−1) in comparison with the control session (p ⩽ 0.05). For all the variables, there were no significant differences between the exercise sessions. Regardless of the order of endurance and resistance exercises, combined exercise sessions abolished increases in BP observed in a control condition due to a reduction in peripheral vascular resistance and increases in cardiac output. Thus, combined exercises should be prescribed to individuals with hypertension to control their BP, regardless of the order they are accomplished.

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%

Clinical predictors of ventilatory threshold achievement in patients with claudication.

PURPOSE Ventilatory threshold (VT) is considered a clinically important marker of cardiovascular function in several populations, including patients with claudication, because it is related to walking capacity and hemodynamics. The purpose of this study was to identify clinical predictors for VT achievement in patients with intermittent claudication. METHODS One hundred and seventy-seven (n = 177) patients with intermittent claudication performed a progressive graded cardiopulmonary treadmill test until maximal claudication pain. Oxygen uptake (V˙O2) was continuously measured during the test, and afterwards, VT was visually detected. Clinical characteristics, demographic data, comorbid conditions, and cardiovascular risk factors were obtained. Patients who achieved and did not achieve VT were compared, as well as the workload that VT occurred in the former group. RESULTS VT was achieved in 134 patients (76%), and the mean V˙O2 at VT for these patients was 10.8 ± 2.4 mL·kg(-1)·min(-1). Patients who did not achieve VT presented lower ankle brachial index (ABI), claudication onset time, peak walking time, and V˙O2peak, and the proportion of women was higher compared with patients who achieved VT (P < 0.05). Multiple linear regression analysis identified that sex (b = 0.25, P = 0.002), body mass index (b = -0.18, P = 0.025), peak walking time (b = 0.17, P = 0.044), and ABI (b = 0.23, P = 0.006) were predictors of V˙O2 at VT. CONCLUSIONS Forty-three patients (24%) with intermittent claudication did not achieve VT, and these patients were mostly women and those with greater severity of disease. Moreover, in those who reached VT, the predictors of poor VT were female sex, high body mass index, low peak walking time, and low ABI.

Motor cortex tDCS does not modulate perceived exertion within multiple-sets of resistance exercises

BACKGROUND: Recent evidences have shown that the motor cortex (MC) may influence the rating of perceived exertion (RPE). Given the potential role of transcranial direct current stimulation (tDCS) in modulate cortical areas related to exercise performance, it is possible that tDCS applied on motor cortex (MC) could also influence the RPE during resistance exercises. OBJECTIVE: This study analyzed the effects of transcranial direct current stimulation on the rating of perceived exertion during multiple sets of resistance exercises. METHODS: Thirteen strength-trained men performed a resistance exercise session after either anodal tDCS or sham stimulation applied over the primary motor cortex. Resistance exercise sessions included 3 sets of 10 repetitions of 6 exercises performed with load of at 85% of 8–12 RM. The RPE was obtained using OMNI-Resistance exercise scale. RESULTS: The RPE assessed at the end of the sessions was similar in tDCS vs. sham condition (6.78 ± 1.48 vs. 6.87 ± 1.49, respectively; p = 0.56). The RPE for each exercise was similar across conditions, except for the second set of bench press (p = 0.04) and first set of seated-row (p = 0.03). CONCLUSION: In conclusion, the RPE during multiple sets of submaximal exercises was not modulated by tDCS applied upon

Hemodynamic and autonomic responses after a single session of resistance exercise following anodal motor cortex tDCS

BACKGROUND: Transcranial direct current stimulation (tDCS) seems to modulate cardiac autonomic function and blood pressure (BP) at rest and during exercise. Therefore, it is possible that anodal tDCS could influence post-exercise hypotension. OBJECTIVE: To investigate whether anodal tDCS applied over the motor cortex would affect cardiac autonomic modulation and BP after resistance exercise. METHODS: Twelve apparently healthy young men performed two experimental sessions: anodal tDCS or sham condition followed by resistance exercise. Blood pressure (BP), heart rate (HR), rate-pressure product (RPP), and HR variability (HRV) were obtained before and during post-exercise recovery (at 20 and 60 minutes). RESULTS: Compared to pre-exercise, systolic BP decreased at 20 and at 60 minutes of post-exercise recovery only in anodal tDCS condition (p = 0.03), with no statistical differences in sham condition (p > 0.05). Diastolic and mean BP reduced after both anodal tDCS and sham conditions with no differences between them (P> 0.05). In comparison with anodal tDCS, there were slower HR recovery (tDCS vs. sham: -2 ± 14 vs. 14 ± 8 bpm) and higher RPP (tDCS vs. sham: -1083 ± 1846 vs. 1672 ± 1275 mmHg × bpm) after exercise following sham condition (P 0.05). CONCLUSION: A single session of primary motor cortex tDCS is capable of decreasing the systolic BP and HR responses, as well as the cardiac work after a resistance exercise session in young normotensive subjects regardless of any changes in cardiac autonomic modulation.