Nelson Wolosker

Effects of walking and strength training on resting and exercise cardiovascular responses in patients with intermittent claudication

BACKGROUNDnExercise training is recommended as the first-line therapy for intermittent claudication patients. However, the effects of exercise therapy on cardiovascular function of these patients have been poorly studied. The aim of this study is to compare the effects of walking and strength training on cardiovascular responses assessed at rest and during exercise in patients with intermittent claudication.nnnPATIENTS AND METHODSnThirty-four patients with stable symptoms of intermittent claudication were randomized into two groups: strength training (ST) consisting of eight exercises, three sets of 10 repetitions, intensity of 11 - 13 on 15-grade Borg scale, 2-min interval between sets; and walking training (WT) consisting of walking on a treadmill, 15 bouts of 2-min, intensity of 11 - 13 on 15-grade Borg scale, with a 2-min interval between bouts. Before and after 12 weeks, blood pressure, heart rate and rate pressure product were measured at rest and during a progressive treadmill test until maximal claudication pain.nnnRESULTSnFifteen patients in each group completed the training program. After the training programs, resting systolic blood pressure (ST:-6 ± 13 mmHg and WT:-3 ± 18 mmHg, P = .04), heart rate (ST: -6 ± 10 bpm and WT:-2 ± 9 bpm, P = .03), and rate pressure product (ST:-1485 ± 1442 mmHg*bpm and WT:- 605 ± 2145 mmHg*bpm, P = .01) decreased significantly and similarly in both groups. Submaximal systolic blood pressure (ST: -14 ± 23 mmHg and WT:-6 ± 23 mmHg, P = .02), and rate pressure product (ST:-1579 ± 3444 mmHg*bpm and WT: -1264 ± 3005 mmHg*bpm, P = .04) decreased significantly and similarly in both groups. There were no changes in submaximal heart rate after ST and WT. Maximal systolic blood pressure, heart rate, and rate pressure product did not change in either group, although maximal exercise time increased similarly in the ST and WT groups (+31 ± 19 %, and +31 ± 32 %, respectively, P < .01).nnnCONCLUSIONSnStrength and walking trainings promoted similar increases in walking capacity and decreases in resting and submaximal exercise cardiovascular load.

Are the Barriers for Physical Activity Practice Equal for All Peripheral Artery Disease Patients

OBJECTIVEnTo investigate barriers to physical activity related to the sociodemographic comorbidities and clinical variables of patients with intermittent claudication.nnnDESIGNnCross-sectional study.nnnSETTINGnAmbulatory care.nnnPARTICIPANTSnThe medical histories of patients (N=145) aged ≥50 years with intermittent claudication were examined.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnSociodemographic data (sex, race, level of education, socioeconomic status, marital status), comorbidities (overweight, hypertension, dyslipidemia, diabetes, currently smoking, heart disease), and clinical variables (initial claudication distance, total walking distance, ankle-brachial index). Information on personal and environmental barriers was obtained by questionnaire.nnnRESULTSnLow economic status was most associated with being afraid of falling (odd ratios [OR]=2.22; 95% confidence interval [CI], 1.08-4.54). Low education level was most associated with lack of street pedestrian crossing (OR=3.34; 95% CI, 1.48-7.52). Diabetes was associated with lack of energy (OR=3.38; 95% CI, 1.68-6.79) and other medical conditions (eg, arthritis, angina) (OR=3.44; 95% CI, 1.65-7.16). Ankle brachial index was associated with some difficulty in getting to a place where physical activity can be performed (OR=2.75; 95% CI, 1.22-6.21). Walking capacity was strongly associated with barriers relating to leg pain (OR=7.39; 95% CI, 1.66-32.88).nnnCONCLUSIONSnOlder patients, those with a low education level, patients with diabetes, low ankle brachial index, and those with a lower walking capacity are more likely to experience barriers to physical activity.

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.

Graduated Compression Stockings Does Not Decrease Walking Capacity and Muscle Oxygen Saturation during 6-Minute Walk Test in Intermittent Claudication Patients

BACKGROUNDnWe analyze the effects of graduated compression stoking (GCS) on walking capacity and oxygen saturation in intermittent claudication (IC) patients.nnnMETHODSnEighteen patients with IC performed the 6-minute walking test in 2 conditions in random order: GCS or placebo sock. Onset claudication distance and total walking distance were obtained. The calf muscle oxygen saturation was continuously monitored before, during, and after 6-minute walk test. Comparisons of the walking capacity and StO2 parameters between GCS and placebo conditions were analyzed by Wilcoxon rank-sum test.nnnRESULTSnThe onset claudication distance (GCS: 120xa0±xa099xa0meters vs. placebo: 150xa0±xa0126xa0meters; Pxa0=xa00.798) and total walking distance (GCS: 330xa0±xa0108xa0meters vs. placebo: 324xa0±xa060xa0meters; Pxa0=xa00.130) were similar between conditions. There were no differences in StO2 parameters between conditions (Pxa0>xa00.05).nnnCONCLUSIONSnGCS does not decrease walking performance and calf muscle oxygenation saturation during 6-minute walk test in patients with IC.

Depression and cancer were independently associated with quality of life in Brazilian older people

To analyse the factors associated with low health‐related quality of life (HRQoL) in older people living in Brazil.