Sérgio Luiz Cahú Rodrigues

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.

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.

Acute and Chronic Effects of Isometric Handgrip Exercise on Cardiovascular Variables in Hypertensive Patients: A Systematic Review

The aim of this study was to describe, through a systematic review, the acute and chronic effects of isometric handgrip exercise on cardiovascular variables in hypertensive individuals. In this systematic review, we included studies that analyzed whether a single bout or a program with isometric exercises affect cardiovascular variables in hypertensive adults. The electronic database PubMed/Medline was searched for relevant studies published until May 2017. Of the 2927 studies initially identified, 2916 were excluded based on title and abstract and five on the basis of full-text assessment, leaving six studies remaining. In addition, one further study cited in the references of the included articles was included in this review, totaling seven studies included (five studies on the chronic effects of isometric handgrip exercise on cardiovascular parameters). None of the acute studies observed post-exercise hypotension. The majority of the chronic studies found decreases in office blood pressure after isometric handgrip training, with training ranging from 6 to 10 weeks, while heart rate variability parameters were improved in one study and did not change in another. Reduction in oxidative stress was observed; however, this variable was only analyzed in one study. In hypertensives, acute responses to isometric handgrip exercise are very limited due to the small number of studies, therefore more research is required. Furthermore, chronic isometric handgrip training reduces blood pressure; however, there is still a gap in the knowledge on the effects of this modality of exercise on other cardiovascular variables—such as endothelial function, oxidative stress, and cardiac autonomic modulation—which should be addressed in future studies.

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.