Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease.

Alterações Longitudinais nos Níveis de Atividade Física e Parâmetros de Risco Cardiovascular em Pacientes com Doença Arterial Periférica Sintomática / Longitudinal Changes in Physical Activity Levels and Cardiovascular Risk Parameters in Patients with Symptomatic Peripheral Artery Disease

Resumo Fundamento: Estudos transversais anteriores demonstraram que a atividade física está associada a menor risco cardiovascular em pacientes com doença arterial periférica (DAP). No entanto, não é possível estabelecer causalidade e estudos com desenho longitudinal são necessários. Objetivo: Analisar as alterações nos parâmetros de risco cardiovascular e níveis de atividade física após 2 anos de acompanhamento em pacientes com DAP sintomática. Métodos: O presente estudo teve início em 2015. Na primeira fase, foram incluídos 268 pacientes. Na segunda fase, após 2 anos (mediana = 26 meses), foram reavaliados 72 pacientes. Parâmetros de risco cardiovascular, como pressão arterial, modulação autonômica cardíaca e rigidez arterial, e níveis de atividade física foram medidos na linha de base e após 2 anos de acompanhamento. A associação entre as alterações delta (valores após 2 anos - valores da linha de base) na atividade física e nos parâmetros cardiovasculares foi analisada por meio de regressão linear múltipla. O nível de significância foi estabelecido em p < 0,05 com DAP. Resultados: Pacientes reduziram seus níveis totais de atividade física em comparação com a linha de base (linha de base = 2.257,6 ± 774,5 versus acompanhamento = 2.041 ± 676,2 min/semana, p = 0,001). Após o acompanhamento, o índice tornozelo-braquial (0,62 ± 0,20 versus 0,54 ± 0,20, p = 0,003) e o desvio padrão de todos os intervalos RR (43,4 ± 27,0 versus 25,1 ± 13,4 ms, p < 0,001) foram menores, enquanto a velocidade da onda de pulso carotídeo-femoral foi maior (9,0 ± 3,0 versus 10,7 ± 3,4 m/s, p = 0,002) em relação aos valores basais. Não observamos associação entre os valores delta dos níveis de atividade física e os parâmetros de risco cardiovascular. Conclusão: Pacientes com DAP tiveram níveis reduzidos de atividade física e comprometimento em relação aos parâmetros de risco cardiovascular após 2 anos de acompanhamento.

Background: Previous cross-sectional studies have demonstrated that physical activity is associated with lower cardiovascular risk in patients with peripheral artery disease (PAD). However, it is not possible to establish causality, and longitudinal design studies are required. Objective: To analyze the changes in cardiovascular risk parameters and physical activity levels after a 2-year follow-up in patients with symptomatic PAD. Methods: This study started in 2015. In the first phase, 268 patients were included. In the second phase, after 2 years (median = 26 months), 72 patients were re-evaluated. Cardiovascular risk parameters, such as blood pressure, cardiac autonomic modulation, and arterial stiffness, and physical activity levels were measured at baseline and after 2 years of follow-up. Association among delta changes (values from follow-up - baseline) in physical activity and cardiovascular parameters were analyzed by multiple linear regression. The significance level was set at p < 0.05. Results: Patients reduced their total physical activity levels compared to baseline (baseline = 2257.6 ± 774.5 versus follow-up = 2041 ± 676.2 min/week, p = 0.001). After follow-up, ankle-brachial index (0.62 ± 0.20 versus 0.54 ± 0.20, p = 0.003), and standard deviation of all RR intervals (43.4 ± 27.0 versus 25.1 ± 13.4 ms, p < 0.001) were lower, whereas carotid-femoral pulse wave velocity was higher (9.0 ± 3.0 versus 10.7 ± 3.4 m/s, p = 0.002) compared to baseline values. We did not observe any association among delta values of physical activity levels and cardiovascular risk parameters. Conclusion: Patients with PAD had reduced physical activity levels and impaired cardiovascular risk parameters during 2-year follow-up.

Are physical inactivity, sitting time and screen time associated with obstructive sleep apnea in adults? A cross-sectional study

Abstract BACKGROUND: Sitting time, screen time and low physical activity (PA) levels have been associated with several diseases and all-cause mortality. PA is related to better sleep quality and absence of daytime sleepiness, along with lower risks of obstructive syndrome apnea (OSA). However, studies on the relationship between sitting time, screen time and OSA are scarce in the literature. OBJECTIVE: To analyze associations between PA levels, sitting time, screen time and OSA among adults with suspected sleep disorder. DESIGN AND SETTING: Cross-sectional study conducted at Hospital Israelita Albert Einstein. METHODS: Data were collected from 369 adults with suspected sleep disorders who visited the hospital's neurophysiology clinic between August 2015 and January 2017. RESULTS: Correlations between hypopnea and PA indicators were demonstrated for total sitting time (0.123; P = 0.019) and total screen time (0.108; P = 0.038). There was also a correlation between latency for rapid-eye-movement sleep (REM_LAT) and total sitting time (0.103; P = 0.047) and a negative correlation between mean oxyhemoglobin saturation (SaO_Avg) and total PA time (-0.103; P = 0.048). There were no associations between PA parameters and apnea-hypopnea index. After adjusting for confounding factors (body mass index, age and gender), sitting time and screen time were not associated with OSA. CONCLUSION: After adjusting for anthropometric and clinical factors, excessive sitting time or screen time was not associated with OSA in adults suspected of sleep disorders. Age, gender, hypertension, body mass index and waist circumference were associated with OSA.

The effects of COVID-19 stay-at-home orders on physical activity of people with obesity

ABSTRACT Objective To verify the association of changes on physical activity levels during coronavirus disease 2019 (COVID-19) outbreak of individuals with normal weight and overweight/obesity, and the influence of sex in this relationship. Methods This cross-sectional study (survey research) was conducted in Brazil between May 5 and May 17, 2020. Participants (n=1,828 / 1,062 women >18 years) were invited through social media to answer a structured questionnaire via Google Forms. The online assessment included self-reported responses to questions on physical activity, overall health, weight, and height. Binary logistic regression analyzed the relationship between overweight/obesity (body mass index ≥25kg/m2), the impact of COVID-19 on physical activity level, and the influence of sex. Results Compared to normal weight people, those with overweight/obesity practice less moderate to vigorous physical activity (p<0.001). There were associations between women and men with overweight/obesity and the impact of COVID-19 on the physical activity practice compared to normal weight people, adjusted by age, education level, social isolation, and previous physical activity level (p<0.017). Conclusion The study found an association of weight and changes in physical activity levels. Individuals with overweight/obesity were more likely to have a lower physical activity level during COVID-19 pandemic, regardless of sex.

Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial

ABSTRACT BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P < 0.05; control: 126 ± 4 versus 126 ± 3 mmHg, P > 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317.

Are Vascular Parameters Associated with Walking Impairment in Patients with Claudication?

BACKGROUND: The mechanisms underlying functional impairments in symptomatic PAD patients are controversial and poorly understood. Endothelial dysfunction and arterial stiffness have been proposed as potential mechanisms related to functional impairment in symptomatic PAD patients, however, more studies are needed to confirm these associations. OBJECTIVE: To analyze the association between vascular function and walking impairment in patients with peripheral arterial disease (PAD) and symptoms of claudication. METHODS: This was a cross-sectional study that included 68 patients with symptomatic PAD. All patients underwent an objective (Six-minute walk test [6MWT], 4-meter walk test) and a subjective (Walking Impairment Questionnaire [WIQ]) measurement of walking impairment. Vascular parameters measured were pulse-wave velocity (PWV) and flow-mediated dilation (FMD). Multiple linear regression was performed to investigate the association among walking impairment variables with vascular function parameters. RESULTS: No significant associations between the claudication onset distance (PWV: b=.060, P = 0.842; FMD: b=-.192, P = 0.456), 6MWT (PWV: b=.007, P = 0..975; FMD: b=.090, P = 0.725), WIQ distance (PWV: b=.337, P = 0.117; FMD: b=-.025, P = 0.895) WIQ speed (PWV: b=.320, P = 0.181; FMD: b=-.028, P = 0.497), WIQ stairs (PWV: b=.256, P = 0.204; FMD: b=-.228, P = 0.230), 4-meter usual walk (PWV: b=-.421, P = 0.107; FMD: b=-.338, P = 0.112), 4-meter fast walk (PWV: b=-.496, P = 0.063; FMD: b=-.371, P = 0.086) and vascular function were found. CONCLUSIONS: In symptomatic PAD patients, vascular function is not associated to walking impairment, even when adjusting for comorbid conditions and diabetes.

Expanding the Use of Six-Minute Walking Test in Patients with Intermittent Claudication.

BACKGROUND: Six-min walking test (6MWT) has been widely in patients with symptomatic peripheral artery disease (PAD) to quantify the walking impairment and the efficacy of different therapeutic interventions. Despite the aforementioned usefulness of 6MWT for PAD, the information provided by this test goes beyond the meters walked. The aim of this study was to describe the relative values of 6MWT and body weight-walking distance product (DW) in patients with symptomatic PAD. METHODS: Two hundred twenty-seven patients with symptomatic PAD participated in the study. The 6MWT was performed and absolute and claudication distances were obtained. The results of 6MWT were then relativized and expressed as a percentage of a healthy subject. DW was obtained by the product of 6MWT distance by weight. In both sexes, the relative 6MWT ranged from 57% to 64%. RESULTS: Absolute 6MWT total distance (P < 0.001) was lower in women than in men, whereas the relative 6MWT total distance was similar between sexes (P = 0.398). The absolute and relative 6MWT total distance were similar among age categories (P > 0.072). The DW was higher in men than in women (P < 0.05). In addition, in women, DW was higher in younger group than in other age groups (P < 0.05). CONCLUSIONS: Patients with symptomatic PAD achieve less than 70% of the distance achieved by an age-matched healthy subject. In patients with symptomatic PAD, the relative values of 6MWT total distance are similar between sexes and among different age groups, whereas DW are influenced by age and sex.

Impact of the COVID-19 pandemic stay at home order and social isolation on physical activity levels and sedentary behavior in Brazilian adults / Impacto da permanência em casa e do isolamento social, em função da COVID-19, sobre o nível de atividade física e o comportamento sedentário em adultos brasileiros

ABSTRACT Objective To investigate the impact of the coronavirus 2019 pandemic on physical activity levels and sedentary behavior among Brazilians residents aged ≥18 years. Methods An online survey was distributed through a social media platform between May 5 and 17, 2020. Participants completed a structured questionnaire in Google Forms, which assessed the physical activity level and sedentary behavior of adults in Brazil during the pandemic. Results Age (OR: 0.98; 95%CI: 0.97-0.99), chronic disease (OR: 1.29; 95%CI: 1.03-1.63), physical inactivity before the coronavirus 2019 pandemic (OR: 2.20; 95%CI: 1.78-2.72) and overweight (OR: 1.34; 95%CI: 1.09-1.65) showed higher risk of impact on physical activity levels. Increased sitting time was associated with older individuals (OR: 0.97; 95%CI: 0.96-0.98), inactivity (OR: 1.51; 95%CI: 1.16-1.96), chronic disease (OR: 1.65; 95%CI: 1.23-2.22), higher number of days in social isolation (OR: 1.01; 95%CI: 1.00-1.02) and higher schooling levels (OR: 1.87; 95%CI: 1.26-2.78). Conclusion Our results demonstrated that advanced age, chronic disease and physical inactivity before social isolation had a greater risk of impact on reduced physical activity levels and increased sitting time during the coronavirus 2019 disease pandemic.

RESUMO Objetivo Investigar o impacto da pandemia de coronavírus 2019 sobre o nível de atividade física e comportamento sedentário entre brasileiros com idade ≥18 anos. Métodos Uma pesquisa on-line foi distribuída por meio de mídias sociais entre 5 e 17 de maio de 2020. Os participantes responderam a um questionário estruturado no Google Forms, que avaliou o nível de atividade física e comportamento sedentário de adultos no Brasil durante a pandemia. Resultados Idade (RC: 0,98; IC95%: 0,97-0,99), doença crônica (RC: 1,29; IC95%: 1,03-1,63), inatividade física antes da pandemia de coronavírus 2019 (RC: 2,20; IC95%: 1,78-2,72) e excesso de peso (RC: 1,34; IC95%: 1,09-1,65) apresentaram maior risco de impacto no nível de atividade física. O aumento do tempo sentado foi associado a indivíduos mais velhos (RC: 0,97; IC95%: 0,96-0,98), inatividade (RC: 1,51; IC95%: 1,16-1,96), doença crônica (RC: 1,65; IC95%: 1,23-2,22), maior número de dias no isolamento social (RC: 1,01; IC95%: 1,00-1,02) e níveis de escolaridade mais altos (RC: 1,87; IC95%: 1,26-2,78). Conclusão Nossos resultados demonstraram que a idade, a presença de doenças crônicas e a inatividade física antes do isolamento social tiveram maior risco de impacto na redução do nível de atividade física e maior tempo sentado durante a pandemia de coronavírus 2019.

Symptoms of anxiety and depression and their relationship with barriers to physical activity in patients with intermittent claudication

OBJECTIVES: Although the practice of physical exercise in patients with intermittent claudication (IC) is often encouraged, adherence is low. The difficulty in performing physical training may be related to the psychological characteristics of patients with claudication. To verify the association between anxiety and depression symptoms and barriers to physical exercise and walking capacity in patients with IC. METHODS: One-hundred and thirteen patients with a clinical diagnosis of IC were included in the study. Patients underwent clinical evaluation by a vascular surgeon, answered the Beck Depression Inventory, and Beck Anxiety Inventory tests were applied by the psychologist. The patients performed the 6-minute test and reported their barriers to physical activity practice in a questionnaire. RESULTS: Patients with signs of depression had a shorter pain-free walking distance (p=0.015) and total walking distance (p=0.035) compared to patients with no signs of depression. Pain-free walking distance (p=0.29) and total walking distance (p=0.07) were similar between patients with and without signs of anxiety. Patients with symptoms of moderate to severe depression reported more barriers to physical activity practice compared to patients without signs of depression. CONCLUSION: Symptoms of anxiety and depression are prevalent among patients with peripheral arterial occlusive disease (PAD). Depression symptoms are associated with personal barriers to exercise, while anxiety symptoms are not. The main barriers to physical activity among patients with IC are exercise-induced pain and the presence of other diseases.

Impacto da pandemia da COVID-19 sobre o tratamento medicamentoso dos pacientes com doença arterial periférica: um estudo observacional transversal / Impact of the COVID-19 pandemic on drug treatment of patients with peripheral arterial disease: an observational cross-sectional study

Resumo Contexto A pandemia do Coronavírus 2019 (COVID-19) tem afetado negativamente o comportamento da população. Nesse contexto, o impacto da pandemia da COVID-19 no tratamento medicamentoso dos pacientes com doença arterial periférica (DAP) e claudicação intermitente (CI) permanece obscuro. Objetivos Analisar o impacto da pandemia da COVID-19 no tratamento medicamentoso dos pacientes com DAP e CI. Métodos Neste estudo observacional transversal, 136 pacientes com DAP e CI, recrutados do nosso banco de dados, responderam por telefone um questionário envolvendo as seguintes questões: a) cuidados com a COVID-19; b) saúde global; c) tratamento das doenças. Posteriormente, os pacientes foram divididos em dois grupos, de acordo com a dificuldade para a aquisição dos medicamentos (DAM: dificuldade e SDAM: sem dificuldade), para a comparação da saúde global entre os dois grupos. Resultados Dezessete porcento dos pacientes reportaram dificuldades para a aquisição dos medicamentos durante a pandemia. Uma maior prevalência desses pacientes reportou estar mais triste (56,5% versus 24,8%, p < 0,01) e com mais dificuldades para dormir (56,5% versus 24,8%, p < 0,01) em relação aos pacientes do grupo SDAM. Os grupos não apresentaram diferenças para o declínio na capacidade de caminhada, ansiedade, estresse e depressão (p > 0,05). Conclusões Uma maior prevalência de pacientes do grupo DAM reportou estar mais triste e com mais dificuldade para dormir em comparação ao grupo SDAM durante a pandemia da COVID-19.

Abstract Background The Coronavirus 2019 (COVID-19) pandemic has had a negative impact on the population's behavior. In this context, the effect of the COVID-19 pandemic on drug treatment of patients with peripheral arterial disease (PAD) and intermittent claudication (IC) remains unclear. Objectives To analyze the impact of the COVID-19 pandemic on drug treatment of patients with PAD and IC. Methods In this cross-sectional, observational study, 136 patients with PAD and IC were recruited from our database and answered a questionnaire by telephone involving the following questions: a) precautions related to COVID-19; b) general health status; and c) treatment of diseases. Subsequently, patients were divided into two groups according to difficulty in obtaining their drugs (DOD: difficulty obtaining drugs, or NDOD: no difficulty obtaining drugs) and overall health was compared between groups. Results Seventeen percent of patients reported difficulties with obtaining drugs during the pandemic. A higher proportion of these patients reported being sadder (56.5% vs. 24.8%, P < 0.01) and having more difficulty sleeping (56.5% vs. 24.8%, P < 0.01) than of the patients in the NDOD group (P <0.01). The groups did not differ in terms of impairment of walking capability, anxiety, stress, or depression (P> 0.05). Conclusions A higher proportion of patients in the DOD group reported being sadder and having greater difficulty sleeping compared to the NDOD group during the COVID-19 pandemic.

Impact of hypertension on arterial stiffness and cardiac autonomic modulation in patients with peripheral artery disease: a cross-sectional study / Impacto da hipertensão na rigidez arterial e modulação autonômica cardíaca em pacientes com doença arterial periférica: um estudo transversal

ABSTRACT Objective: To examine the impact of hypertension on cardiovascular health in patients with symptomatic peripheral artery disease and to identify factors associated with uncontrolled hypertension. Methods: A cross-sectional study including 251 patients with symptomatic peripheral artery disease (63.9% males, mean age 67±10 years). Following hypertension diagnosis, blood pressure was measured to determine control of hypertension. Arterial stiffness (carotid-femoral pulse wave velocity) and cardiac autonomic modulation (sympathovagal balance) were assessed. Results: Hypertension was associated with higher carotid-femoral pulse wave velocity, regardless of sex, age, ankle-brachial index, body mass index, walking capacity, heart rate, or comorbidities (ß=2.59±0.76m/s, b=0.318, p=0.003). Patients with systolic blood pressure ≥120mmHg had higher carotid-femoral pulse wave velocity values than normotensive individuals, and hypertensive patients with systolic blood pressure of ≤119mmHg (normotensive: 7.6±2.4m/s=≤119mmHg: 8.1±2.2m/s 120-129mmHg:9.8±2.6m/s=≥130mmHg: 9.9±2.9m/s, p<0.005). Sympathovagal balance was not associated with hypertension (p>0.05). Conclusion: Hypertensive patients with symptomatic peripheral artery disease have increased arterial stiffness. Arterial stiffness is even greater in patients with uncontrolled high blood pressure.

RESUMO Objetivo: Analisar a influência da hipertensão na saúde cardiovascular em pacientes com doença arterial periférica sintomática, e identificar fatores associados à hipertensão arterial não controlada. Métodos: Neste estudo transversal foram incluídos 251 pacientes com doença arterial periférica (63,9% homens e média de idade 67±10 anos). Hipertensão foi diagnosticada e pressão arterial foi avaliada para determinar o controle da hipertensão. Foram avaliadas rigidez arterial (velocidade da onda de pulso carótida-femoral) e modulação autonômica cardíaca (balanço simpatovagal). Resultados: Hipertensão foi associada com maior velocidade da onda de pulso carótida-femoral, independentemente do sexo, idade, índice tornozelo-braço, índice de massa corpórea, capacidade de deambulação, frequência cardíaca, ou comorbidades (ß=2,59±0,76m/s, b=0,318, p=0,003). Pacientes com pressão arterial sistólica ≥120mmHg tiveram maior velocidadeda onda de pulso carótida-femoral do que normotensos, e pacientes hipertensos com pressão arterial sistólica ≤119mmHg (normotensos: 7,6±2,4m/s=≤119mmHg: 8,1±2,2m/s 120-129mmHg: 9,8±2,6m/s=≥130mmHg: 9,9±2,9m/s, p<0,005). Balanço simpatovagal não foi associado à hipertensão. Conclusão: Pacientes hipertensos com doença arterial periférica sintomática apresentam maior rigidez arterial. Em pacientes com pressão arterial não controlada, a rigidez arterial é ainda mais elevada.

Physical activity practice during COVID-19 pandemic in patients with intermittent claudication

SUMMARY OBJECTIVE: To describe physical activity habits and barriers for physical activity practice in patients with peripheral artery disease and claudication symptoms during Coronavirus 2019 (COVID-19) pandemic. METHODS: In this cross-sectional survey study, 127 patients with peripheral artery disease (59.8% men; 68±9 years old; and 81.9% had the peripheral artery disease diagnosis ≥5 years old) were included. The physical activity habits and barriers for physical activity practice were assessed through telephone interview using a questionnaire with questions related to: (a) COVID-19 personal care; (b) overall health; (c) physical activity habits; (d) for those who were inactive, the barriers for physical activity practice. RESULTS: Only 26.8% of patients reported practicing physical activity during the COVID-19 pandemic. Exercise characteristics more common among these patients include walking, performed at least 5 days a week, during 31-60 min at light intensity. In contrast, among physically inactive patients, pain, injury or disability (55%), the COVID-19 pandemic (50%), the need to rest due to leg pain (29%), and lack of energy (27%) were the most frequent barriers to physical activity practice. CONCLUSION: The physical activity level of patients with peripheral artery disease is impacted by the COVID-19 pandemic.

Intensidade de Exercício durante o Teste de Caminhada de 6 Minutos em Pacientes com Doença Arterial Periférica / Exercise Intensity during 6-Minute Walk Test in Patients with Peripheral Artery Disease

Resumo Fundamento a caminhada não supervisionada em solo tem sido indicada para pacientes com doença arterial periférica (DAP) sintomática. No entanto, a magnitude do esforço exigido por essa atividade e as características dos pacientes que a praticam com mais intensidade não estão claras. Objetivos determinar se a caminhada em solo excede o limiar ventilatório (LV), um reconhecido marcador de intensidade de exercício, em pacientes com DAP sintomática. Métodos Foram recrutados 70 pacientes (61,4% do sexo masculino e com idade entre 40 e 85 anos) com DAP sintomática. Os pacientes realizaram um teste ergométrico em esteira para definir o LV. Em seguida, foram submetidos ao teste de caminhada de 6 minutos para determinar o alcance do LV durante deambulação no solo. Realizou-se regressão logística múltipla para identificar preditores de LV durante o teste de caminhada de 6 minutos, e o valor de p<0,05 foi considerado significativo para todas as análises. Resultados Ao todo, 60% dos pacientes atingiram o LV durante o teste de caminhada de 6 minutos. Mulheres (OR = 0,18 e IC95% = 0,05 a 0,64) e pacientes com mais aptidão cardiorrespiratória (OR = 0,56 e IC 95% = 0,40 a 0,77) tiveram menor probabilidade de chegar ao LV durante a caminhada em solo em comparação a homens e pacientes com menos aptidão cardiorrespiratória, respectivamente. Conclusão Mais da metade dos pacientes com DAP sintomática alcançou o LV durante o teste de caminhada de 6 minutos. Mulheres e pacientes com mais aptidão cardiorrespiratória têm menos probabilidade de chegar ao LV durante o teste de caminhada de 6 minutos, o que indica que a caminhada no solo pode ser mais intensa para esse grupo. Isso deve ser considerado ao se prescreverem exercícios de caminhada em solo para esses pacientes. (Arq Bras Cardiol. 2020; 114(3):486-492)

Abstract Background Non-supervised ground walking has been recommended for patients with symptomatic peripheral artery disease (PAD). However, the magnitude of the effort required by this activity and the characteristics of patients whose ground walking is more intense are unclear. Objectives To determine whether ground walking exceeds the ventilatory threshold (VT), a recognized marker of exercise intensity, in patients with symptomatic PAD. Methods Seventy patients (61.4% male and aged 40 to 85 years old) with symptomatic PAD were recruited. Patients performed a graded treadmill test for VT determination. Then, they were submitted to a 6-minute walk test so the achievement of VT during ground ambulation could be identified. Multiple logistic regression was conducted to identify predictors of VT achievement during the 6-minute walk test. The significance level was set at p < 0.05 for all analyses. Results Sixty percent of patients achieved VT during the 6-minute walk test. Women (OR = 0.18 and 95%CI = 0.05 to 0.64) and patients with higher cardiorespiratory fitness (OR = 0.56 and 95%CI = 0.40 to 0.77) were less likely to achieve VT during ground walking compared to men and patients with lower cardiorespiratory fitness, respectively. Conclusion More than half of patients with symptomatic PAD achieved VT during the 6-minute walk test. Women and patients with higher cardiorespiratory fitness are less likely to achieve VT during the 6-minute walk test, which indicates that ground walking may be more intense for this group. This should be considered when prescribing ground walking exercise for these patients. (Arq Bras Cardiol. 2020; 114(3):486-492)

Does Creatine Supplementation Affect Renal Function in Patients with Peripheral Artery Disease? A Randomized, Double Blind, Placebo-controlled, Clinical Trial.

BACKGROUND: Case studies and reviews have shown that creatine supplementation can affect kidney function. The objective of this study is to verify the effects of 8 weeks of creatine supplementation on renal function (creatinine clearance: primary outcome) in patients with symptomatic peripheral arterial disease. METHODS: Twenty-nine patients, of both genders, were randomized (1:1) in a double-blind manner for administration of Placebo (PLA; n = 15) or creatine monohydrate (Cr; n = 14). The supplementation protocol consisted of 20 g/day for 1 week divided into 4 equal doses (loading phase), followed by single daily doses of 5 g in the subsequent 7 weeks (maintenance phase). Before and after the supplementation period, markers of renal function, serum creatinine, creatinine excretion rate, and creatinine clearance were evaluated. The Generalized Estimation Equation Model was used for comparison between groups. The level of significance was P < 0.05. RESULTS: No significant differences were found between groups before and after the intervention for serum creatinine (Cr: pre 1.00 ± 0.15 mL/dL vs. post 1.07 ± 0.16 mL/dL; PLA: pre 1.30 ± 0.53 mL/dL vs. post 1.36 ± 0.47 mL/dL, P = 0.590), creatinine excretion rate (Cr: pre 81.73 ± 43.80 mg/dL vs. post 102.92 ± 59.57 mg/dL; PLA: pre 74.37 ± 38.90 mg/dL vs. post 86.22 ± 39.94 mg/dL, P = 0.560), or creatinine clearance (Cr; pre 108 ± 59 mL/min/1.73 m2 vs. post 117 ± 52 mL/min/1.73 m2; PLA: pre 88 ± 49 mL/min/1.73 m2 vs. post 82 ± 47 mL/min/1.73 m2, P = 0.366). CONCLUSIONS: Eight weeks of creatine supplementation is safe and does not compromise the renal function of patients with peripheral arterial disease.

Physical Activity Levels in Peripheral Artery Disease Patients / Níveis de Atividade Física Em Pacientes Com Doença Arterial Periférica

Abstract Background: Increases in daily physical activity levels is recommended for patients with peripheral artery disease (PAD). However, despite this recommendation, little is known about the physical activity patterns of PAD patients. Objective: To describe the physical activity patterns of patients with symptomatic peripheral artery (PAD) disease. Methods: This cross-sectional study included 174 PAD patients with intermittent claudication symptoms. Patients were submitted to clinical, hemodynamic and functional evaluations. Physical activity was objectively measured by an accelerometer, and the time spent in sedentary, low-light, high-light and moderate-vigorous physical activities (MVPA) were obtained. Descriptive analysis was performed to summarize patient data and binary logistic regression was used to test the crude and adjusted associations between adherence to physical activity recommendation and sociodemographic and clinical factors. For all the statistical analyses, significance was accepted at p < 0.05. Results: Patients spent in average of 640 ± 121 min/day, 269 ± 94 min/day, 36 ± 27 min/day and 15 ± 16 min/day in sedentary, low-light, high-light and MVPA, respectively. The prevalence of patients who achieved physical activity recommendations was 3.4%. After adjustment for confounders, a significant inverse association was observed between adherence to physical activity recommendation and age (OR = 0.925; p = 0.004), while time of disease, ankle brachial index and total walking distance were not associated with this adherence criteria (p > 0.05). Conclusion: The patterns of physical activity of PAD patients are characterized by a large amount of time spent in sedentary behaviors and a low engagement in MVPA. Younger patients, regardless of the clinical and functional factors, were more likely to meet the current physical activity recommendations.

Resumo Fundamento: Aumentos nos níveis de atividade física diária são recomendados para pacientes com doença arterial periférica (DAP). No entanto, apesar dessa recomendação, pouco se sabe sobre os padrões de atividade física dos pacientes com DAP. Objetivo: Descrever os padrões de atividade física de pacientes com DAP sintomática. Métodos: Este estudo transversal incluiu 174 pacientes com DAP com sintomas de claudicação intermitente. Os pacientes foram submetidos a avaliações clínicas, hemodinâmicas e funcionais. A atividade física foi objetivamente medida por um acelerômetro, e o tempo gasto em atividades sedentárias, de baixa intensidade, de alta intensidade e atividade física moderada-a-vigorosa (AFMV) foi obtido. A análise descritiva foi realizada para resumir os dados dos pacientes e a regressão logística binária foi utilizada para testar as associações brutas e ajustadas entre a adesão à recomendação de atividade física e os fatores sociodemográficos e clínicos. Para todas as análises estatísticas, a significância foi estabelecida em p < 0,05. Resultados: Os pacientes gastaram em média 640 ± 121 min/dia, 269 ± 94 min / dia, 36 ± 27 min/dia e 15 ± 16 min/dia em atividades sedentárias, de baixa intensidade, alta intensidade e AFMV, respectivamente. A prevalência de pacientes que atingiram as recomendações de atividade física foi de 3,4%. Após ajuste para fatores de confusão, observou-se associação inversa significativa entre adesão à recomendação de atividade física e idade (OR = 0,925; p = 0,004), enquanto tempo de doença, ITB e distância total de caminhada não se associaram a esse critério de adesão (p> 0,05). Conclusão: Os padrões de atividade física dos pacientes com DAP são caracterizados por uma grande quantidade de tempo gasto em comportamentos sedentários e um baixo envolvimento na AFMV. Pacientes mais jovens, independentemente dos fatores clínicos e funcionais, apresentaram maior probabilidade de atender às recomendações atuais de atividade física.

Cardiac Autonomic Modulation Is Associated with Arterial Stiffness in Patients with Symptomatic Peripheral Artery Disease.

BACKGROUND: The objective of this study was to analyze the association between cardiac autonomic modulation and arterial stiffness in patients with peripheral artery disease (PAD). METHODS: This cross-sectional study included one hundred fourteen patients with symptomatic PAD (67.5% men; 65 ± 7 years; body mass index: 26.8 ± 4.5 kg/m2). Heart rate variability (HRV) was measured within time (standard deviation of all RR intervals [beat to beat heart interval] [SDNN], root mean square of the successive differences between adjacent normal RR intervals [RMSSD], and the proportion of successive RR intervals that differed by more than 50 msec [pNN50]) and frequency (low frequency [LF] and high frequency [HF]) domains. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Crude and adjusted linear regression analyses examined the relationship between HRV and cfPWV. RESULTS: Nonsignificant crude associations were identified among cfPWV and RMSSD (P = 0.181), SDNN (P = 0.105), pNN50 (P = 0.087), LF (P = 0.376), HF (P = 0.175), and LF/HF ratio (P = 0.426). After adjustments for age, sex, smoking, body mass index, ankle-brachial index, and use of beta-blockers, significant associations were identified among cfPWV and RMSSD (P = 0.037), SDNN (P = 0.049), and pNN50 (P = 0.049). CONCLUSIONS: Cardiac autonomic modulation was significantly associated with arterial stiffness in patients with PAD after adjustment for confounding factors. This relationship may contribute to the enhanced cardiovascular disease risk for PAD patients and provides a target for strategies to improve patient clinical outcomes.

Factors Associated to Arterial Stiffness in Patients With Symptomatic Peripheral Artery Disease.

BACKGROUND: The aim of this study was to identify the clinical factors associated with arterial stiffness in patients with symptomatic peripheral artery disease. METHODS: In this cross-sectional study, 181 patients (67% men; mean aged 66 ± 9 years) were recruited and had their central arterial stiffness assessed by carotid-femoral pulse wave velocity (cf-PWV). Clinical characteristics are sociodemographic data, body mass index, comorbid conditions, and walking capacity. RESULTS: Multiple linear regression analysis showed that age (b = 0.182, P = 0.032), body mass index (b = 0.254, P = 0.002), and mean blood pressure (b = 0.249, P = 0.021) were positively associated with cf-PWV. CONCLUSIONS: Our results showed that the aging, elevated body mass index, and higher blood pressure are clinical factors associated with increased arterial stiffness in patients with peripheral artery disease.

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

OBJECTIVE: To analyse the factors associated with low health-related quality of life (HRQoL) in older people living in Brazil. METHODS: In this cross-sectional study of the Jewish community residing in Sao Paulo, Brazil, we extensively evaluated the characteristics - including clinical, functional and sociodemographic - of 496 older people. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF), while the Geriatric Depression Scale (GDS) was used to measure depressive symptoms. RESULTS: After adjusting for potential confounders, we found that GDS score (ß = -0.07; P = 0.04) and cancer (ß = -0.47; P = 0.05) were associated with a low WHOQOL-BREF score. CONCLUSION: Depressive symptoms and cancer were independently associated with low HRQoL among older people living in Brazil.

Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease

OBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ - Walking Impairment Questionnaire and WELCH - Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (r<0.55, p<0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (β=0.001, p<0.001), sit-to-stand test score (β=-0.005, p=0.012), and WIQ stairs score (β=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (β=0.002, p<0.001), WIQ stairs score (β=0.003, p=0.010), and WELCH total score (β=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients.

Association between respiratory capacity, quality of life and cognitive function in elderly individuals / Associação entre capacidade respiratória, qualidade de vida e cognição em idosos

ABSTRACT Objective To investigate associations between respiratory capacity, quality of life and cognitive function in elderly individuals. Methods The sample included 386 elderly individuals (232 women). Respiratory capacity assessment was based on maximal expiratory pressure measured at peak expiratory flow. Subjects were classified according to peak expiratory flow values adjusted for sex, age and height of individuals with normal (peak expiratory flow curve <80% and >60%) or reduced (peak expiratory flow curve < 60%) respiratory capacity. The World Health Organization Quality of Life Questionnaire and the Mini-Mental State Examination were used to assess quality of life and cognitive function, respectively. Results Elderly women with reduced respiratory capacity scored lower on the Mini-Mental State Examination (p=0.048) and quality of life questionnaire (p=0.040) compared to those with normal respiratory capacity. These differences were not observed in men (p>0.05). Conclusion Reduced respiratory capacity was associated with poorer quality of life and cognitive function in elderly women. These associations were not observed in elderly men.

RESUMO Objetivo Investigar a associação entre capacidade respiratória, qualidade de vida e função cognitiva em idosos. Métodos A amostra incluiu 386 idosos (232 mulheres). A capacidade respiratória foi avaliada pela pressão expiratória máxima obtida no pico de fluxo expiratório. Com base nos resultados máximos de fluxo expiratório, os indivíduos foram classificados de acordo com o valor previsto para sexo, idade e estatura em capacidade respiratória normal (curva de fluxo expiratório de pico inferior a 80% e superior a 60%) ou capacidade respiratória reduzida (curva de fluxo expiratório de pico menor que 60%). O questionário World Health Organization Quality of Life e o Miniexame do Estado Mental foram utilizados para avaliar a qualidade de vida e a função cognitiva, respectivamente. Resultados Em comparação com mulheres idosas com capacidade respiratória normal, as pessoas com capacidade respiratória reduzida apresentaram escores mais baixos para o Miniexame do Estado Mental (p=0,048) e qualidade de vida (p=0,040). Nos homens, não foram observadas diferenças (p>0,05). Conclusão Capacidade respiratória reduzida foi associada à pior qualidade de vida e à função cognitiva em mulheres idosas. Essas associações não foram observadas em idosos do sexo masculino.