Cardiovascular Responses during and after Maximal Walking in Men and Women with Symptomatic Peripheral Artery Disease.

BACKGROUND: Walking is recommended for patients with peripheral arterial disease (PAD). It has been shown that patients with PAD present sharper increases in blood pressure (BP) and heart rate (HR) during maximal walking when compared with healthy subjects. Additionally, women with PAD present a worse physiological profile, and it is possible that they may present higher cardiovascular load during and after a bout of maximal walking than men. Thus, the objective of this study was to compare cardiovascular and autonomic responses during and after maximal walking between men and women with PAD and intermittent claudication (IC). METHODS: Forty patients with PAD and IC (20 men and 20 women) underwent, in random order, 2 sessions: control (standing on treadmill) and exercise (maximal treadmill walking test with Gardner's protocol). During the exercise, HR and BP were measured. Before and after the sessions, cardiovascular variables (BP HR, cardiac output, peripheral vascular resistance, and stroke volume) and autonomic modulation (HR and BP variabilities and baroreflex sensitivity) were assessed. In addition, an ambulatory BP monitoring was recorded after each session. RESULTS: Men and women presented similar maximal walking capacity. During the walking test, HR and systolic BP increased similarly in men and women. After the maximal walking, cardiovascular and autonomic responses did not differ between the genders. In addition, postintervention ambulatory BP parameters were also similar in men and women. Therefore, in men and women, maximal walking similarly reduced clinic systolic BP and stroke volume, and increased HR and total power of HR variability during the recovery period. CONCLUSIONS: Men and women with PAD and IC present similar cardiovascular and autonomic responses during and after maximal walking.

Effects of a Real-Life Park-Based Physical Activity Interventional Program on Cardiovascular Risk and Physical Fitness.

INTRODUCTION: Regular physical activity (PA) practice is a way to combat cardiovascular disease, and a PA interventional program, including individualized prescription of walking with limited supervision of execution, may be a strategy to be applied in public parks. Thus, our study tested the effects of a real-world program like this on cardiovascular risk and cardiorespiratory fitness (CF) of the users of a public park. METHODS: Data came from the Exercise and Heart Project, a real-life park-based PA interventional program. The study phases were 1) a preintervention evaluation; 2) the individualized prescription of PA; 3) the supervision of the first practice sessions; 4) the unsupervised execution of the prescription; and 5) a postintervention evaluation. RESULTS: Data from 152 participants (mainly women and aged 40 to 80 years) were analyzed. The intervention significantly increased CF (mean [standard deviation], 99 [19] steps vs 110 [21] steps, P < .001) and reduced body mass index, waist circumference, and systolic blood pressure, decreasing global cardiovascular risk (mean [standard deviation], 0.15 [2.84] vs -0.52 [2.60]; P < .001). The effects of intervention on cardiovascular risk were not different between the participants with low and high initial CF or PA levels. CONCLUSION: The proposed real-life park-based PA interventional program decreased cardiovascular risk of the participants independently of their initial PA or CF levels.

Reliability and validity of a sedentary behavior questionnaire for South American pediatric population: SAYCARE study.

BACKGROUND: Multicenter studies from Europe and the United States have developed specifically standardized questionnaires for assessing and comparing sedentary behavior, but they cannot be directly applied for South American countries. The aim of this study was to assess the reliability and validity of the South American Youth Cardiovascular and Environmental (SAYCARE) sedentary behavior questionnaire. METHODS: Children and adolescents from seven South American cities were involved in the test-retest reliability (children: n = 55; adolescents: n = 106) and concurrent validity (children: n = 93; adolescents: n = 94) studies. The SAYCARE sedentary behavior questionnaire was administered twice with two-week interval and the behaviors were parent-reported for children and self-reported for adolescents. Questions included time spent watching television, using a computer, playing console games, passive playing (only in children) and studying (only in adolescents) over the past week. Accelerometer was used for at least 3 days, including at least one weekend day. We compared values of sedentary time, using accelerometers, by quartiles of reported sedentary behavior time and their sum. RESULTS: The reliability of sedentary behavior time was moderate for children (rho ≥0.45 and k ≥ 0.40) and adolescents (rho ≥0.30). Comparisons between the questionnaire and accelerometer showed a low overall agreement, with the questionnaire systematically underreporting sedentary time in children (at least, - 332.6 ± 138.5 min/day) and adolescents (at least, - 399.7 ± 105.0 min/day). CONCLUSION: The SAYCARE sedentary behavior questionnaire has acceptable reliability in children and adolescents. However, the findings of current study indicate that SAYCARE questionnaire is not surrogate of total sedentary time.

Recommendations in Post-exercise Hypotension: Concerns, Best Practices and Interpretation.

Post-exercise hypotension (PEH) is a clinically relevant phenomenon that has been widely investigated. However, the characteristics of study designs, such as familiarization to blood pressure measurements, duration of PEH assessments or strategies to analyze PEH present discrepancies across studies. Thus identifying key points to standardize across PEH studies is necessary to help researchers to build stronger study designs, to facilitate comparisons across studies, and to avoid misinterpretations of results. The goal of this narrative review of methods used in PEH studies was therefore to gather and find possible influencers in the characteristics of study design and strategies to analyze blood pressure. Data found in this review suggest that PEH studies should have at least two familiarization screening visits, and should assess blood pressure for at least 20 min, but preferably for 120 min, during recovery from exercise. Another important aspect is the strategy to analyze PEH, which may lead to different interpretations. This information should guide a priori study design decisions.

Aerobic Stimulus Induced by Virtual Reality Games in Stroke Survivors.

OBJECTIVE: To evaluate whether virtual reality games (VRGs) in stroke survivors produce significant and reproducible heart rate and oxygen consumption (V˙o2) responses during their execution, corresponding to an intensity between the anaerobic threshold (AT) and the respiratory compensation point (RCP). DESIGN: Single-subject, repeated-measure design. SETTING: Stroke survivors registered from a rehabilitation program. PARTICIPANTS: Chronic hemiparetic stroke survivors (N=12; 10 men; mean age ± SD, 58±12y) rated at 3 or 4 in the Functional Ambulation Categories. INTERVENTIONS: Participants underwent, in a random order, 2 identical sessions of VRGs (console Xbox 360 + Kinect) and 1 control session (38min watching a movie). The VRG sessions were composed of 4 sets of VRGs (3min of tennis, 1min for changing the game, and 4min of boxing) interspaced with 2 minutes of rest. MAIN OUTCOME MEASURES: Heart rate and V˙o2 were measured during the experimental sessions and compared with heart rate and V˙o2 obtained at AT and RCP assessed during a maximal cardiopulmonary exercise test. RESULTS: Heart rate and V˙o2 during VRGs had good reproducibility (intraclass correlation coefficients, ≥.91 and ≥.85, respectively; coefficients of variation, ≤6.7% and ≤13.7%, respectively). Heart rate during VRGs was similar to AT and significantly lower than RCP (P≤.05), while V˙o2 was significantly lower than AT and RCP (P<.05). CONCLUSIONS: An acute session of VRGs composed of tennis and boxing games using the console XBox 360 + Kinect promotes reproducible responses of heart rate and V˙o2 that corresponded, respectively, to AT and below AT, characterizing a low-intensity aerobic stimulus.

The Oporto mixed-longitudinal growth, health and performance study. Design, methods and baseline results.

BACKGROUND: Studies concerning child and adolescent growth, development, performance and health aimed at the multiple interactions amongst this complex set of variables are not common in the Portuguese speaking countries. AIM: The aim of this paper is to address the key ideas, methodology and design of the Oporto Growth, Health and Performance Study (OGHPS). SUBJECTS AND METHODS: The OGHPS is a multidisciplinary mixed-longitudinal study whose main purpose is to examine the multiple interactions among biological, environmental and lifestyle indicators that affect growth, development, health and performance of Portuguese adolescents aged 10-18 years old. RESULTS: This study briefly presents baseline results for growth, physical fitness and lifestyle behaviours for those participating in the cross-sectional sample (n ≈ 8000). Approximately 30% were over-fat or obese. On average, boys were more physically fit and active than girls. Few adolescents meet the guidelines for sleep duration (≈10%) and eating habits (16.2-24.8%), while 76-85% meet the recommended levels of moderate-to-vigorous physical activity. CONCLUSIONS: The OGHPS has an innovative approach due to its mixed-longitudinal design and the broad array of variables. Furthermore, subsequent analyses of the longitudinal data will enable a detailed exploration of important factors affecting the growth trajectories of health and performance variables and will also help to identify some of the most opportune times for interventions in terms of health behaviours.

Metaboreflex activation delays heart rate recovery after aerobic exercise in never-treated hypertensive men.

KEY POINTS: Recent evidence indicates that metaboreflex regulates heart rate recovery after exercise (HRR). An increased metaboreflex activity during the post-exercise period might help to explain the reduced HRR observed in hypertensive subjects. Using lower limb circulatory occlusion, the present study showed that metaboreflex activation during the post-exercise period delayed HRR in never-treated hypertensive men compared to normotensives. These findings may be relevant for understanding the physiological mechanisms associated with autonomic dysfunction in hypertensive men. ABSTRACT: Muscle metaboreflex influences heart rate (HR) regulation after aerobic exercise. Therefore, increased metaboreflex sensitivity may help to explain the delayed HR recovery (HRR) reported in hypertension. The present study assessed and compared the effect of metaboreflex activation after exercise on HRR, cardiac baroreflex sensitivity (cBRS) and heart rate variability (HRV) in normotensive (NT) and hypertensive (HT) men. Twenty-three never-treated HT and 25 NT men randomly underwent two-cycle ergometer exercise sessions (30 min, 70% V̇O2 peak ) followed by 5 min of inactive recovery performed with (occlusion) or without (control) leg circulatory occlusion (bilateral thigh cuffs inflated to a suprasystolic pressure). HRR was assessed via HR reduction after 30, 60 and 300 s of recovery (HRR30s, HRR60s and HRR300s), as well as by the analysis of short- and long-term time constants of HRR. cBRS was assessed by sequence technique and HRV by the root mean square residual and the root mean square of successive differences between adjacent RR intervals on subsequent 30 s segments. Data were analysed using two- and three-way ANOVA. HRR60s and cBRS were significant and similarly reduced in both groups in the occlusion compared to the control session (combined values: 20 ± 10 vs. 26 ± 9 beats min-1 and 2.1 ± 1.2 vs. 3.2 ± 2.4 ms mmHg-1 , respectively, P < 0.05). HRR300s and HRV were also reduced in the occlusion session, although these reductions were significantly greater in HT compared to NT (-16 ± 11 vs. -8 ± 15 beats min-1 for HRR300s, P < 0.05). The results support the role of metaboreflex in HRR and suggest that increased metaboreflex sensitivity may partially explain the delayed HRR observed in HT men.

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

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·L and R + E: +0.05 ± 0.05 mm Hg·min·L) and the decreases in cardiac output (E + R: +0.04 ± 0.28 L·min and R + E: -0.26 ± 0.28 L·min) 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 and R + E: +4 ± 1 b·min) 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-dynamic, isometric and combined resistance exercise responses in medicated hypertensive men.

This study investigated the effects of dynamic resistance exercise (DRE), isometric handgrip exercise (IHE) and combined resistance exercise (DRE+IHE) on post-exercise hypotension (PEH) and its hemodynamic, autonomic, and vascular mechanisms. For that, 70 medicated hypertensives men (52 ± 8 years) were randomly allocated to perform one of the following interventions: DRE (3 sets, 8 exercises, 50% of 1RM), IHE (4 sets, 2 min, 30% of MVC), CRE (DRE+IHE) and control (CON, seated rest). Before and after the interventions, blood pressure (BP), systemic hemodynamics, cardiovascular autonomic modulation and brachial vascular parameters were evaluated. After the DRE and CRE, systolic and mean BP decreased (SBP = -7 ± 6 and -8 ± 8 mmHg; MBP -4 ± 5 and -5 ± 5 mmHg, respectively, all P < 0.05), vascular conductance increased (+ 0.47 ± 0.61 and +0.40 ± 0.47 ml.min-1.mmHg-1, respectively, both P < 0.05) and baroreflex sensitivity decreased (-0.15 ± 0.38 and -0.29 ± 0.47 ms/mmHg, respectively, both P < 0.05) in comparison to pre-exercise values. No variable presented any significant change after IHE. The responses observed after CRE were similar to DRE and significantly different from CON and IHE. In conclusion, DRE, but not IHE, elicits PEH, which happens concomitantly to skeletal muscle vasodilation and decreased baroreflex sensitivity. Moreover, adding IHE to DRE does not potentiate PEH and neither changes its mechanisms.Clinical Trial Registration: Data from this study derived from an ongoing longitudinal clinical trial approved by the Institution's Ethics Committee of Human Research (process 2.870.688) and registered at the Brazilian Clinical Trials (RBR-4fgknb) at http://www.ensaiosclinicos.gov.br .

Can blood pressure decrease after maximal exercise test predict the blood pressure lowering effect of aerobic training in treated hypertensive men?

The acute decrease in blood pressure (BP) observed after a session of exercise (called post-exercise hypotension) has been proposed as a tool to predict the chronic reduction in BP induced by aerobic training. Therefore, this study investigated whether post-exercise hypotension observed after a maximal exercise test is associated to the BP-lowering effect of aerobic training in treated hypertensives. Thirty hypertensive men (50 ± 8 years) who were under consistent anti-hypertensive treatment underwent a maximal exercise test (15 watts/min until exhaustion), and post-exercise hypotension was determined by the difference between BP measured before and at 30 min after the test. Subsequently, the patients underwent 10 weeks of aerobic training (3 times/week, 45 min/session at moderate intensity), and the BP-lowering effect of training was assessed by the difference in BP measured before and after the training period. Pearson correlations were employed to evaluate the associations. Post-maximal exercise test hypotension was observed for systolic and mean BPs (-8 ± 6 and -2 ± 4 mmHg, all P < 0.05). Aerobic training reduced clinic systolic/diastolic BPs (-5 ± 6/-2 ± 3 mmHg, both P < 0.05) as well as awake and 24 h mean BPs (-2 ± 6 and -2 ± 5 mmHg, all P < 0.05). No significant correlation was detected between post-exercise hypotension and the BP-lowering effect of training either for clinic or ambulatory BPs (r values ranging from 0.00 to 0.32, all p > 0.05). Post-exercise hypotension assessed 30 min after a maximal exercise test cannot be used to predict the BP-lowering effect of aerobic training in treated hypertensive men.

Physiological responses during walking in men and women with intermittent claudication.

BACKGROUND: Miyasato et al. show that peak oxygen consumption, walking economy, anaerobic threshold, and cardiovascular responses (heart rate, blood pressure, and rate pressure product) during walking were similar between men and women with peripheral artery disease and intermittent claudication. There were no differences in the physiological responses to walking between men and women with intermittent claudication. Sex per se is not a factor that demands changes in walking prescription for patients with intermittent claudication. OBJECTIVE: Peak oxygen consumption (VO2peak), anaerobic threshold, walking economy, and cardiovascular responses during walking are used to guide and monitor walking training in patients with peripheral artery disease and intermittent claudication. Women with peripheral artery disease and intermittent claudication present greater impairments than men, and evaluating training markers according to sex for decisions regarding walking prescription in this population is important. This study aimed to compare VO2peak, walking economy, anaerobic threshold, and cardiovascular responses during walking in men and women with peripheral artery disease and intermittent claudication. METHODS: Forty patients (20 men and 20 women with similar baseline characteristics) underwent a cardiopulmonary treadmill test (3.2km/h and 2% increase in slope every 2 minutes until maximal leg pain). The VO2 and rate-pressure product were assessed. Data from men and women were compared using t-tests. RESULTS: There were no significant differences between men and women (VO2peak: 15.0±4.8 versus 13.9±2.9mL∙kg-1∙min-1, p=0.38; walking economy: 9.6±2.7 versus 8.4±1.6mL∙kg-1∙min-1, p=0.09; anaerobic threshold: 10.5±3.2 versus 10.5±2.2mL∙kg-1∙min-1, p=0.98; rate pressure product at 1st stage: 13,465± 2,910 versus 14,445±4,379bpm∙mmHg, p=0.41; and rate pressure product at anaerobic threshold:13,673±3,100 versus 16,390±5,870bpm∙mmHg, p=0.08 and rate pressure product at peak exercise: 21,253±6,141 versus 21,923±7,414bpm∙mmHg, p=0.76, respectively). CONCLUSION: Men and women with peripheral artery disease and similar baseline characteristics presented similar responses to walking, suggesting that decisions regarding walking prescription and monitoring can be made regardless of sex in this specific population.

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.

Post-concurrent exercise hemodynamics and cardiac autonomic modulation.

Concurrent training is recommended for health improvement, but its acute effects on cardiovascular function are not well established. This study analyzed hemodynamics and autonomic modulation after a single session of aerobic (A), resistance (R), and concurrent (A + R) exercises. Twenty healthy subjects randomly underwent four sessions: control (C:30 min of rest), aerobic (A:30 min, cycle ergometer, 75% of VO(2) peak), resistance (R:6 exercises, 3 sets, 20 repetitions, 50% of 1 RM), and concurrent (AR: A + R). Before and after the interventions, blood pressure (BP), heart rate (HR), cardiac output (CO), and HR variability were measured. Systolic BP decreased after all the exercises, and the greatest decreases were observed after the A and AR sessions (-13 ± 1 and -11 ± 1 mmHg, respectively, P < 0.05). Diastolic BP decreased similarly after all the exercises, and this decrease lasted longer after the A session. CO also decreased similarly after the exercises, while systemic vascular resistance increased after the R and AR sessions in the recovery period (+4.0 ± 1.7 and +6.3 ± 1.9 U, respectively, P < 0.05). Stroke volume decreased, while HR increased after the exercises, and the greatest responses were observed after the AR session (SV, A = -14.6 ± 3.6, R = -22.4 ± 3.5 and AR = -23.4 ± 2.4 ml; HR, A =+13 ± 2, R =+15 ± 2 vs. AR =+20 ± 2 bpm, P < 0.05). Cardiac sympathovagal balance increased after the exercises, and the greatest increase was observed after the AR session (A = +0.7 ± 0.8, R = +1.0 ± 0.8 vs. AR = +1.2 ± 0.8, P < 0.05). In conclusion, the association of aerobic and resistance exercises in the same training session did not potentiate post-exercise hypotension, and increased cardiac sympathetic activation during the recovery period.

Consistency of hemodynamic and autonomic mechanisms underlying post-exercise hypotension.

Post-exercise hypotension (PEH) is a clinically relevant phenomenon, but its mechanisms vary between different studies and between the participants within each study. Additionally, it is possible that PEH mechanisms are not consistent in each individual (i.e. within-individual variation), which has not been investigated yet. Thus, the aim of the current study was to assess the within-individual consistency of PEH hemodynamic and autonomic mechanisms. For that, 30 subjects performed 4 sessions divided in 2 blocks (test and retest). In each block, an exercise (cycling, 45 min, 50%VO2peak) and a control (seated rest, 45 min) session was randomly conducted. Blood pressure (BP) and its mechanisms were evaluated pre- and post-interventions. In each block, individual responses were calculated as post-exercise minus post-control, and a response was considered present when its magnitude reached the typical error of the measurement. Consistencies were evaluated by comparing test and retest responses through kappa coefficient (k). PEH consistency was calculated using role sample, while mechanisms consistency was evaluated in those with consistent PEH. Twenty-one (70%) participants showed consistent PEH, 5 (17%) presented PEH in only test or retest and 4 (13%) had absent PEH response, characterising a good consistency (k = 0.510). Regarding mechanisms' responses, good consistency was found for heart rate (k = 0.456), sympathovagal balance (k = 0.438), and baroreflex sensitivity (k = 0.458); while systemic vascular resistance (k = 0.152), cardiac output (k = -0.400), stroke volume (k = -0.055), and sympathetic vasomotor modulation (k = -0.096) presented marginal consistencies. Thus, PEH is a highly consistent physiological phenomenon, although its mechanisms present variable consistencies.

Physiological Responses to Maximal and Submaximal Walking in Patients with Symptomatic Peripheral Artery Disease. / Respostas Fisiológicas à Caminhada Máxima e Submáxima em Pacientes com Doença Arterial Periférica Sintomática.

BACKGROUND: Although maximal and submaximal walking are recommended for patients with peripheral artery disease (PAD), performing these exercises may induce different physiological responses. OBJECTIVES: To compare the acute effects of maximal and submaximal walking on post-exercise cardiovascular function, regulation, and associated pathophysiological processes in patients with symptomatic PAD. METHODS: Thirty male patients underwent 2 sessions: maximal walking (Gardner's protocol) and submaximal walking (15 bouts of 2 minutes of walking separated by 2 minutes of upright rest). In each session, blood pressure (BP), heart rate (HR), cardiac autonomic modulation (HR variability), forearm and calf blood flows (BF), vasodilatory capacity (reactive hyperemia), nitric oxide (NO), oxidative stress (lipid peroxidation), and inflammation (four markers) were measured pre- and post-walking. ANOVAs were employed, and p < 0.05 was considered significant. RESULTS: Systolic and mean BP decreased after the submaximal session, but they increased after the maximal session (interactions, p < 0.001 for both). Diastolic BP did not change after the submaximal session (p > 0.05), and it increased after maximal walking (interaction, p < 0.001). HR, sympathovagal balance, and BF increased similarly after both sessions (moment, p < 0.001, p = 0.04, and p < 0.001, respectively), while vasodilatory capacity, NO, and oxidative stress remained unchanged (p > 0.05). Vascular and intercellular adhesion molecules increased similarly after both maximal and submaximal walking sessions (moment, p = 0.001). CONCLUSIONS: In patients with symptomatic PAD, submaximal, but not maximal walking reduced post-exercise BP, while maximal walking maintained elevated cardiac overload during the recovery period. On the other hand, maximal and submaximal walking sessions similarly increased post-exercise HR, cardiac sympathovagal balance, and inflammation, while they did not change post-exercise NO bioavailability and oxidative stress.

FUNDAMENTO: Embora a caminhada máxima e submáxima sejam recomendadas para pacientes com doença arterial periférica (DAP), a realização desses exercícios pode induzir diferentes respostas fisiológicas. OBJETIVOS: Comparar os efeitos agudos de caminhada máxima e submáxima na função cardiovascular, a regulação e os processos fisiopatológicos associados pós-exercício em pacientes com DAP sintomática. MÉTODOS: Trinta pacientes do sexo masculino foram submetidos a 2 sessões: caminhada máxima (protocolo de Gardner) e caminhada submáxima (15 períodos de 2 minutos de caminhada separados por 2 minutos de repouso ereto). Em cada sessão, foram medidos a pressão arterial (PA), a frequência cardíaca (FC), a modulação autonômica cardíaca (variabilidade da FC), os fluxos sanguíneos (FS) do antebraço e da panturrilha, a capacidade vasodilatadora (hiperemia reativa), o óxido nítrico (ON), o estresse oxidativo (a peroxidação lipídica) e a inflamação (quatro marcadores), pré e pós-caminhada. ANOVAs foram empregadas e p < 0,05 foi considerado significativo. RESULTADOS: A PA sistólica e a PA média diminuíram após a sessão submáxima, mas aumentaram após a sessão máxima (interações, p < 0,001 para ambas). A PA diastólica não foi alterada após a sessão submáxima (p > 0,05), mas aumentou após a caminhada máxima (interação, p < 0,001). A FC, o equilíbrio simpatovagal e os FS aumentaram de forma semelhante após as duas sessões (momento, p < 0,001, p = 0,04 e p < 0,001, respectivamente), enquanto a capacidade vasodilatadora, o ON e o estresse oxidativo permaneceram inalterados (p > 0,05). As moléculas de adesão vascular e intercelular aumentaram de forma semelhante após as sessões de caminhada máxima e submáxima (momento, p = 0,001). CONCLUSÕES: Nos pacientes com a DAP sintomática, a caminhada submáxima, mas não a máxima, reduziu a PA pós-exercício, enquanto a caminhada máxima manteve a sobrecarga cardíaca elevada durante o período de recuperação. Por outro lado, as sessões de caminhada máxima e submáxima aumentaram a FC, o equilíbrio simpatovagal cardíaco e a inflamação pós-exercício de forma semelhante, enquanto não alteraram a biodisponibilidade de ON e o estresse oxidativo pós-exercício.

Walking Training Improves Ambulatory Blood Pressure Variability in Claudication. / Treinamento de Caminhada Melhora a Variabilidade da Pressão Arterial Ambulatorial em Claudicantes.

BACKGROUND: Walking training (WT) improves walking capacity and reduces clinic blood pressure (BP) in patients with peripheral artery disease (PAD), but its effects on ambulatory BP remains unknown. OBJECTIVE: To investigate the effect of 12 weeks of WT on ambulatory BP and its variability in patients with PAD. METHODS: Thirty-five male patients with PAD and claudication symptoms were randomly allocated into two groups: control (n = 16, 30 min of stretching) and WT (n = 19, 15 bouts of 2 min of walking at the heart rate of leg pain threshold interspersed by 2 min of upright rest). Before and after 12 weeks, 24-hour ambulatory BP was assessed. Ambulatory BP variability indices assessed at both time points included the 24-hour standard deviation (SD24), the awake and asleep weighted standard deviation (SDdn), and the 24-hour average real variability (ARV24). Data were analyzed by mixed two-way ANOVAs, considering P<0.05 as significant. RESULTS: After 12 weeks, neither group had significant changes in 24-hour, awake and sleep BPs. The WT decreased systolic and mean BP variabilities (Systolic BP - 13.3±2.8 vs 11.8±2.3, 12.1±2.84 vs 10.7±2.5 and 9.4±2.3 vs 8.8±2.2 mmHg); Mean BP - 11.0±1.7 vs 10.4±1.9, 10.1±1.6 vs 9.1±1.7 and 8.0.±1.7 vs 7.2±1.5 mmHg) for SD24, SDdn and ARV24, respectively). Neither group had significant changes in diastolic BP variabilities after 12 weeks. CONCLUSIONS: The WT does not change ambulatory BP levels but decreases ambulatory BP variability in patients with PAD. This improvement may have a favorable impact on the cardiovascular risk of patients with symptomatic PAD. (Arq Bras Cardiol. 2021; 116(5):898-905).

FUNDAMENTO: O treinamento de caminhada (TC) melhora a capacidade de caminhar e reduz a pressão arterial (PA) clínica em pacientes com doença arterial periférica (DAP), mas seus efeitos na PA ambulatorial permanecem desconhecidos. OBJETIVO: Investigar o efeito de 12 semanas de TC na PA ambulatorial e sua variabilidade em pacientes com DAP. MÉTODOS: Trinta e cinco pacientes do sexo masculino com DAP e sintomas de claudicação foram alocados aleatoriamente em dois grupos: controle (n = 16, 30 min de alongamento) e TC (n = 19, 15 séries de 2 minutos de caminhada na frequência cardíaca em que ocorreu limiar de dor intercalados por 2 minutos de repouso em pé). Antes e depois de 12 semanas, a PA ambulatorial de 24 horas foi avaliada. Os índices de variabilidade da PA ambulatorial avaliados em ambos os momentos incluíram o desvio-padrão de 24 horas (DP24), o desvio-padrão ponderado de vigília e sono (DPvs) e a variabilidade real média de 24 horas (VRM24). Os dados foram analisados por ANOVAs mistas de dois fatores, considerando significativo P<0,05. RESULTADOS: Após 12 semanas, nenhum dos grupos apresentou alterações na PA de 24 horas, vigília e sono. O TC diminuiu as variabilidades da PA sistólica e média (PA sistólica ­ 13,3 ± 2,8 vs 11,8 ± 2,3; 12,1 ± 2,84 vs 10,7 ± 2,5; e 9,4 ± 2,3 vs 8,8 ± 2,2 mmHg; PA média ­ 11,0 ± 1,7 vs 10,4 ± 1,9; 10,1 ± 1,6 vs 9,1 ± 1,7; e 8,0 ± 1,7 vs 7,2 ± 1,5 mmHg para DP24, DPvs e VRM24, respectivamente). Nenhum dos grupos apresentou mudanças significantesnos índices de variabilidade da PA diastólica após 12 semanas. CONCLUSÕES: O TC não altera os níveis ambulatoriais da PA, mas diminui a sua variabilidade em pacientes com DAP. Essa melhora pode ter um impacto favorável no risco cardiovascular de pacientes com DAP sintomática. (Arq Bras Cardiol. 2021; 116(5):898-905).

Effects of resistance training on metabolic and cardiovascular responses to a maximal cardiopulmonary exercise test in Parkinson`s disease.

OBJECTIVE: To evaluate the effects of resistance training on metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson's disease. METHODS: Twenty-four patients with Parkinson's disease (modified Hoehn and Yahr stages 2 to 3) were randomly assigned to one of two groups: Control or Resistance Training. Patients in the Resistance Training Group completed an exercise program consisting of five resistance exercises (two to four sets of six to 12 repetitions maximum per set) twice a week. Patients in the Control Group maintained their usual lifestyle. Oxygen uptake, systolic blood pressure and heart rate were assessed at rest and during cycle ergometer-based maximal cardiopulmonary exercise testing at baseline and at 12 weeks. Assessments during exercise were conducted at absolute submaximal intensity (slope of the linear regression line between physiological variables and absolute workloads), at relative submaximal intensity (anaerobic threshold and respiratory compensation point) and at maximal intensity (maximal exercise). Muscle strength was also evaluated. RESULTS: Both groups had similar increase in peak oxygen uptake after 12 weeks of training. Heart rate and systolic blood pressure measured at absolute and relative submaximal intensities and at maximal exercise intensity did not change in any of the groups. Muscle strength increased in the Resistance Training but not in the Control Group after 12 weeks. CONCLUSION: Resistance training increases muscle strength but does not change metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson's disease without cardiovascular comorbidities.

The influence of a supervised group exercise intervention combined with active lifestyle recommendations on breast cancer survivors' health, physical functioning, and quality of life indices: study protocol for a randomized and controlled trial.

BACKGROUND: Most cancer patients, under active treatment or not, are sedentary, despite increasing scientific and clinical understanding of the benefits of exercise and physical activity, such as improving quality of life, limiting disease symptoms, decreasing cancer recurrence, and increasing overall survival. Studies have shown that both supervised exercise and unsupervised physical activity programs have low adherence and limited long-term benefits among cancer survivors. Therefore, interventions focused on increasing physical activity levels have clinical and psychological relevance. The present study will examine the feasibility and efficacy of an intervention that combines supervised group exercise with active lifestyle recommendations, analyzing its clinical, psychological, physiological, functional, and immunological effects in breast cancer survivors. METHODS: Women aged 35-75 years who have completed chemotherapy, radiotherapy, and surgery for breast cancer will be recruited from the Cancer Institute of the State of Sao Paulo (ICESP) and take part in a 16-week, parallel-group, randomized, and controlled trial. They will receive a booklet with recommendations for achieving a physically active lifestyle by increasing overall daily movement and undertaking at least 150 min/week of structured exercise. Then, they will be randomized into two groups: the supervised group will take part in two canoeing group exercise sessions every week, and the unsupervised group will increase their overall physical activity level by any means, such as active commuting, daily activities, or home-based exercise. Primary outcome includes aerobic capacity. Secondary outcomes are physical activity, physical functioning, self-reported quality of life, fatigue, presence of lymphedema, body composition, immune function, adherence to physical activity guidelines, and perceptions of self-image. DISCUSSION: Results should contribute to advance knowledge on the impact of a supervised group exercise intervention to improve aspects related to health, physical functioning, and quality of life in female breast cancer survivors. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials Number: RBR-3fw9xf. Retrospectively Registered on 27 December 2018. Items from the World Health Organization Trial Registration Data Set can be accessed on http://www.ensaiosclinicos.gov.br/rg/RBR-3fw9xf/ .

Post-exercise hypotension and its hemodynamic determinants depend on the calculation approach.

Post-exercise hypotension (PEH) has been assessed by three calculation approaches: I = (post-exercise - pre-exercise), II = (post-exercise - post-control), and III = [(post-exercise - pre-exercise) - (post-control - pre-control)]. This study checked whether these calculation approaches influence PEH and its determinants. For that, 30 subjects underwent two exercise (cycling, 45 min, 50% VO2 peak) and two control (seated rest, 45 min) sessions. Systolic (SBP) and diastolic (DBP) blood pressures, cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and stroke volume (SV) were measured pre- and post-interventions in each session. The mean value for each moment in each type of session was calculated, and responses to exercise were analyzed with each approach (I, II, and III) to evaluate the occurrence of PEH and its determinants. Systolic PEH was significant when calculated by all approaches (I = -5 ± 1, II = -11 ± 2, and III = -11 ± 2 mmHg, p < 0.05), while diastolic PEH was only significant when calculated by approaches II and III (-6 ± 1 and -6 ± 1 mmHg, respectively, p < 0.05). CO decreased significantly after the exercise when calculated by approach I, but remained unchanged with approaches II and III, while SVR increased significantly with approach I, but decreased significantly with approaches II and III. HR was unchanged after the exercise with approach I, but increased significantly with approaches II and III, while SV decreased significantly with all approaches. Thus, PEH and its hemodynamic determinants are influenced by the calculation approach, which should be considered when designing, analyzing, and comparing PEH studies.

Effects of postexercise cooling on heart rate recovery in normotensive and hypertensive men.

BACKGROUND: Postexercise heart rate recovery (HRR) is determined by cardiac autonomic restoration after exercise and is reduced in hypertension. Postexercise cooling accelerates HRR in healthy subjects, but its effects in a population with cardiac autonomic dysfunction, such as hypertensives (HT), may be blunted. This study assessed and compared the effects of postexercise cooling on HRR and cardiac autonomic regulation in HT and normotensive (NT) subjects. METHODS: Twenty-three never-treated HT (43 ± 8 years) and 25 NT (45 ± 8 years) men randomly underwent two exercise sessions (30 min of cycling at 70% VO2peak ) followed by 15 min of recovery. In one randomly allocated session, a fan was turned on in front of the subject during the recovery (cooling), while in the other session, no cooling was performed (control). HRR was assessed by heart rate reductions after 60 s (HRR60s) and 300 s (HRR300s) of recovery, short-term time constant of HRR (T30) and the time constant of the HRR after exponential fitting (HRRτ). HRV was assessed using time- and frequency-domain indices. RESULTS: HRR and HRV responses in the cooling and control sessions were similar between the HT and NT. Thus, in both groups, postexercise cooling equally accelerated HRR (HRR300s = 39±12 versus 36 ± 10 bpm, P≤0·05) and increased postexercise HRV (lnRMSSD = 1·8 ± 0·7 versus 1·6 ± 0·7 ms, P≤0·05). CONCLUSION: Differently from the hypothesis, postexercise cooling produced similar improvements in HRR in HT and NT men, likely by an acceleration of cardiac parasympathetic reactivation and sympathetic withdrawal. These results suggest that postexercise cooling equally accelerates HRR in hypertensive and normotensive subjects.