Does frailty affect barriers to physical activity in patients with symptomatic peripheral artery disease? A cross-sectional study.

BACKGROUND: Frailty syndrome is prevalent among many patients experiencing intermittent claudication symptoms. Considering that components of the frailty syndrome can affect both physical and psychological functions, it is likely that barriers to physical activity are heightened in these individuals. AIM: To analyze the association between barriers to physical activity and frailty in patients with symptomatic peripheral artery disease (PAD). METHODS: This cross-sectional study included 216 patients with symptomatic PAD (64.8% men, 65.6±9.4 yrs.). Nine personal and 8 environmental barriers to physical activity were investigated through a questionnaire on barriers to practicing physical activity in patients with intermittent claudication. Frailty was defined according to Fried et al. (2001) criteria which included unintentional weight loss, exhaustion, low grip strength, slow walking speed, physical inactivity. Three or more criteria defined frail, one or 2 criteria defined pre-frail, and absence of criteria defined non-frail. Data are presented as median (interquartile range). RESULTS: Frail and pre-frail patients have more barriers than non-frail patients [frail: 11 (4); pre-frail: 10 (6); non-frail: 8 (7), p = 0.001]. Absence of a companion for physical activity, lack of knowledge and uncertainty about the benefits of physical activity, pain induced by walking and presence of obstacles that worsen leg pain were associated with frail and pre-frail status, independent of sex, age, ankle-brachial index, and total walking distance. CONCLUSION: Patients with PAD who are frail and pre-frail have more barriers to physical activity than non-frail patients. Therefore, specific interventions promoting PA are essential for these patients to improve their health outcomes.

BREAKING UP SITTING TIME WITH ISOMETRIC WALL SQUAT EXERCISE DURING OCCUPATIONAL ACTIVITIES: A FEASIBILITY RANDOMIZED TRIAL.

OBJECTIVE: To analyze the feasibility of isometric wall squat exercise (IWSE) over a 12-week period as a method of breaking up sitting time during occupational activities in sedentary adults. METHODS: This feasibility randomized study involved sedentary adults. Participants in the IWSE group (n = 12) performed isometric wall squats, while participants in the STAND group (n = 12) were recommended to stand-up up for 12 weeks. Feasibility was assessed through online questionnaires in the 8 th week regarding adherence, safety, satisfaction, and acceptability. RESULTS: Adherence to weekly breaks was similar between groups (p > 0.05). No serious side effects have been reported in the groups. Dropout rates (IWSE: 40%vs. STAND: 40%, p = 1.000), satisfaction [IWSE +3.4(1.2) vs. STAND +3.0(1.7), p = 0.709], and intention to continue with the intervention (IWSE: 75% vs. STAND: 83%, p = 0.368) were similar between groups. CONCLUSION: The IWSE is as feasible as stand up as a strategy to breaking-up sedentary time in workplace.

The bodyweight walking distance product and its relationship with clinical markers in patients with symptomatic peripheral artery disease.

PURPOSE: The six-minute walk test (6MWT) is extensively employed to evaluate gait impairment in patients with symptomatic peripheral artery disease (PAD) and has been associated with different health outcomes. However, various approaches exist for calculating and interpreting the six-minute test in order to address the needs of patients more effectively. Therefore, we investigated how these different approaches correlate with functional capacity and cardiovascular health in patients with symptomatic PAD. METHODS: In total, 227 PAD patients [65.2% men and 67 (13) y.o.] were included in this cross-sectional study. The 6MWT was performed along a 30-meter corridor and the distance was expressed in three ways: absolute (described as the meters walked during the test), relativized (based on the results of the 6MWT in healthy individuals), and DW (multiplying the body weight in kilograms by the absolute distance in the 6MWT). A functional capacity z-score was calculated using the results of the handgrip strength test, 4-meter walking test, and sit-and-stand test. A cardiovascular parameter z-score was calculated with data on brachial and central blood pressure, the low-frequency component/high-frequency component ratio, and carotid-femoral pulse wave velocity. RESULTS: The absolute (b = 0.30, 95%CI: 18-0.43, R² = 0.11, p < 0.001) and DW (b = 0.40, 95%CI: 27-0.53, R² = 0.17, p < 0.001) measures were related to functional capacity, independently of sex, age, and the ankle-arm index of the patients. Neither absolute nor DW were related to cardiovascular health. The relativized measure was not associated with either functional capacity or cardiovascular health. CONCLUSION: In patients with symptomatic PAD, absolute and DW measures are related to functional capacity, but not cardiovascular function.

Are Barriers to Physical Activity Associated With Changing Physical Activity Levels and Sedentary Time in Patients With Peripheral Arterial Disease? A Longitudinal Study.

The aims of the current study were to analyze the association between the barriers to and changes in physical activity levels and sedentary behavior, as well as to examine whether these barriers change over time in patients with peripheral artery disease. In this longitudinal study, we assessed 72 patients (68% men; 65.7 ± 9.2 years). Physical activity was measured over a 7-day period using an accelerometer, and data were collected on time spent in sedentary activities, low-light physical activities, and moderate-to-vigorous physical activities. Personal and environmental barriers to physical activity were collected using yes or no questions. Assessments were repeated in the same patients after 27 months (95% confidence interval [26, 28] months). Most barriers remained stable in these patients; however, those who reported lack of money experienced an increase in sedentary behavior (ß = 392.9 [159.7] min/week, p = .02) and a decrease in low-light physical activity (ß = -372.4 [140.1] min/week, p = .02). These findings suggest that patients with symptomatic peripheral artery disease typically exhibit stable barriers over time, and individuals reporting lack of money demonstrated a decrease in low-light physical activity and an increase in sedentary behavior after 27 months.

The joint profiles of cardiorespiratory fitness and muscle strength on daily physical activity levels in patients with symptomatic peripheral artery disease: A cross-sectional study.

INTRODUCTION: In peripheral artery disease (PAD) patients, the joint profile of low strength and cardiorespiratory fitness on movement behaviors, specifically physical activity levels and sedentary time, remains unclear. PURPOSE: To investigate the joint profiles between cardiorespiratory and neuromuscular fitness and daily physical activity among PAD patients. METHODS: Cross-sectional study in a sample of 155 PAD patients. We measured their physical activity level per week using accelerometers, assessed their muscle strength through a sit-to-stand test and cardiorespiratory fitness through a six-minute walk test. Patients were categorized into three groups: those with high strength and cardiorespiratory fitness (NC, n = 28), those with at least one component classified as low (1C, n = 88), and those with both components classified as low fitness (2C, n = 39). RESULTS: The patients in the 1C and 2C groups spent less time engaged in low-light and moderate activities compared to the NC group (low-light: NC: 2291 ± 680 minutes/week vs. 1C: 1826 ± 649 minutes/week vs. 2C: 1885 ± 651 minutes/week, p = .005; moderate: NC: 2617 ± 796 minutes/week vs. 1C: 2071 ± 767 minutes/week vs. 2C: 2092 ± 776 minutes/week, p = .005) and the patients in the 2C group spent less time engaged in vigorous activities compared to the NC and 1C groups (NC: 155 ± 148 minutes/week vs. 1C: 110 ± 110 minutes/week vs. 2C: 64 ± 70 minutes/week, p = .003). CONCLUSION: PAD patients with low strength and/or cardiorespiratory fitness are more likely to spend less time engaging in low-light and moderate physical activities and patients with low fitness in both components are more likely to spend less time engaging in vigorous physical activity.

Effects of 12-Weeks of Home-Based Exercise Training on Physical and Cognitive Function of Older Adults: Randomized Trial Comparing Virtual Versus Minimal Supervision in the Context of the Covid-19 Pandemic in Brazil.

Background: We investigated the effects of a 12-week home-based exercise program delivered with virtual or minimal supervision on the physical and cognitive function of community-dwelling older adults in the context of the COVID-19 pandemic in Brazil. Methods: The study was registered on the Brazilian Registry of Clinical Trials platform (code: RBR-8qby2wt). Thirty-eight older adults (81% female and 68±7 years old), non-disabled, and without cognitive impairment or dementia, were randomly assigned to a 12-week home-based exercise program: 1) virtual supervision (classes remotely delivered through video conference by trained staff), or 2) minimal supervision (once-weekly contact to touch base through standardized text messages). The participants initially performed two sets of 10 repetitions three times a week, with a 60-second interval. The volume and complexity of the exercises were progressively increased. (e.g., the number of sets increased to 3 and later to 4). At baseline and follow-up, we collected remote measurements of physical function (muscle strength and power, functional muscular fitness) and cognition (processing speed, inhibitory control, verbal fluency). Results: Participants in the minimal supervision home-based exercise group significantly improved the Stroop test (-1.6 sec, 95% CI = -3.20; -0.09). No significant between-group differences were observed for physical and cognitive outcomes. Conclusion: A home-based exercise program delivered with virtual or minimal supervision can produce similar effects, and may help to maintain physical and cognitive capabilities among healthy, high-functioning older adults who experienced mobility restrictions due to the COVID-19 pandemic in Brazil.

Is there cardiac autonomic dysfunction in children and adolescents with exercise-induced bronchospasm?

BACKGROUND: The pulmonary impairment in patients with bronchoconstriction induced by eucapnic voluntary hyperpnea(EVH) goes beyond the respiratory system, also impairing autonomic nervous modulation. This study aimed to evaluate the behavior of cardiac autonomic modulation in young asthmatics with and without EIB after the EVH test. RESEARCH DESIGN AND METHODS: A cross-sectional study design using 54 asthmatics(51.9% female), aged between 10 and 19 years, investigated with the EVH test. Forced expiratory volume in one second(FEV1) was measured at 5, 10, 15, and 30 min after EVH. Heart rate variability(HRV) measures of time were assessed pre and 30 min-post EVH. The diagnosis of Exercise-Induced bronchoconstriction with underlying clinical asthma(EIBA) was confirmed by a fall in FEV1 ≥10% compared to baseline. RESULTS: Thirty(55.5%) asthmatics had EIBA. Subjects with EIBA have reduced mean of the R-R intervals in relation to baseline until 15 minutes after EVH. Individuals without EIBA had increased parasympathetic activity compared to baseline(rMSSD) from 5 min after EVH(p < 0.05). This parasympathetic activity increase in relation to baseline was seen in individuals with EIBA after 25 minutes (rMSSD = 49.9 ± 5.3 vs 63.5 ± 7.2, p < 0.05). CONCLUSION: Young asthmatics with EIBA present a delay in the increase of the parasympathetic component after EVH when compared to asthmatics without EIBA.

Objective assessment of functional capacity in patients with peripheral artery disease: a narrative review.

INTRODUCTION: Peripheral artery disease (PAD) patients with claudication symptoms exhibit impaired functional capacity, which has been associated with disease severity, worse quality of life and higher risk of cardiovascular events. Different tests have been used to assess functional capacity in PAD patients. Therefore, understanding the characteristics, strengths and limitations of these tests are important to support the choice of tests to be used in clinical practice. AREAS COVERED: This review summarizes the main methods to assess functional capacity in PAD patients, discussing their psychometric properties, applications, and limitations. EXPERT OPINION: Robust evidence supports the use of treadmill and six-minute walk tests in PAD patients, as their results are associated with clinically meaningful outcomes, adequate psychometric properties and are sensitive to effects of interventions. On the other hand, other functional tests (Shuttle-walk test, outdoor walking capacity test, timed-up and go, four-meter walk test, heel-rise test, short physical performance battery and modified physical performance battery) are related to activities of daily living and do not require sophisticated equipment and can be easily used in clinical practice. However, these other tests still need evidence regarding their clinical relevance, reliability, and ability to detect long-term intervention changes, providing further investigation directions.

Team sports as a protective factor against mental health problems and suicidal ideation in adolescents / El deporte colectivo como factor protector ante problemas de salud mental e ideación suicida en adolescentes

Abstract Introduction Adolescents who practice sports have better mental health indicators. Objective To analyze the association between different types of physical activity (systematized exercise, individual, and collective sports), mental health, and suicidal ideation in adolescents. Method We conducted a cross-sectional study with 666 Brazilian adolescents (14-19 y.o.) attending high schools and selected using random cluster sampling. The mental health indicators analyzed were evaluated through the Self Reporting Questionnaire and the Strengths and Difficulties Questionnaire, including suicidal ideation. We also obtained physical activity information through questionnaires. Results There was a higher prevalence related to mental disorders (54.2% vs. 32.5%), difficulties related to mental health (79.6% vs. 48.4%), and suicidal thoughts (22.9% vs. 11.4%) in girls than in boys (p < .001 for all). The boys engaged in more team sports (41.0 vs. 23.8), whereas girls performed more exercise (45.1 vs. 26.5; p < .001). Discussion and conclusion The practice of team sports helps develop the collective spirit, stimulates social interaction, and develops reasoning and emotional intelligence. Boys who play team sports have fewer symptoms of common mental disorders, lower mental health problems, and less suicidal ideation than physically inactive boys.

Resumen Introducción Los adolescentes que practican deportes tienen mejores indicadores de salud mental. Objetivo Analizar la asociación entre los diferentes tipos de actividad física (ejercicio sistematizado, deportes individuales y colectivos), la salud mental y la ideación suicida en adolescentes. Método Se realizó un estudio transversal realizado con 666 adolescentes brasileños (14-19 años) que asisten a escuelas secundarias y fueron seleccionados mediante muestreo aleatorio por conglomerados. Los indicadores de salud mental analizados fueron evaluados a través del Cuestionario de Autoinforme y el Cuestionario de Fortalezas y Dificultades, incluyendo la ideación suicida. También obtuvimos información de la actividad física a través de cuestionarios. Resultados Hubo una mayor prevalencia relacionada con trastornos mentales (54.2% contra 32.5%), dificultades relacionadas con la salud mental (79.6% contra 48.4%) y pensamientos suicidas (22.9% contra 11.4%) en niñas que en niños (p < .001 para todos). Los chicos practicaban más deportes de equipo (41.0 contra 23.8), mientras que las chicas hacían más ejercicio (45.1 contra 26.5; p < .001). Discusión y conclusión La práctica de deportes de equipo ayuda en el desarrollo del espíritu colectivo, estimula la interacción social, desarrolla el razonamiento y la inteligencia emocional. Los niños que practican deportes de equipo tienen menos síntomas de trastornos mentales comunes, menos problemas de salud mental y menos ideación suicida en comparación con los niños físicamente inactivos.

Association between Sleep Quality and Cardiac Autonomic Modulation in Adolescents: A Cross Sectional Study.

Objective To analyze the impact of sleep quality/duration on cardiac autonomic modulation on physically active adolescents with obesity. Materials and Methods The present cross-sectional study included 1,150 boys with a mean age of 16.6 ± 1.2 years. The assessment of cardiac functions included the frequency domain of heart rate variability (HRV; low frequency - LF; high frequency - HF; and the ratio between these bands -LF/HF -, defined as the sympathovagal balance), and each parameter was categorized as low / high . Physical activity levels and sleep quality/duration were obtained by questionnaires. Abdominal obesity was assessed and defined as waist circumference > 80 th percentile. Results Poor sleep quality resulted in lower HF (odds ratio [OR]: 1.8; 95% confidence interval [95%CI]: 1.01-3.21]) regardless of physical activity and abdominal obesity. Moreover, the study found no association between sleep duration and HRV parameters in adolescents. Conclusion Sleep quality, not sleep duration, reduces parasympathetic cardiac modulation apart from other factors such as physical activity and abdominal obesity in adolescents.

Videoconference assessment of functional and cognitive measures in Brazilian older adults: a reliability and feasibility study / Uso de videoconferência para a avaliação de medidas funcionais e cognitivas de idosos brasileiros: um estudo de confiabilidade e viabilidade

OBJECTIVE: We aimed to determine the feasibility and reliability of videoconference assessment of functional and cognitive status among older adults in the context of the COVID-19 pandemic. METHODS: Thirty community-dwelling older adults (86.70% women) with a mean age of 69.77 (SD = 6.60) years who were physically independent and had no signs of cognitive impairment were included in the sample. An independent and experienced researcher assessed functional (chair rise test, chair stand test, sitting and rising test) and cognitive (Montreal Cognitive Assessment, parts A and B of the Trail Making Test, the Stroop test, the verbal fluency test) performance in real-time on the Google Meet platform on 2 non-consecutive days. The reliability of the measures was analyzed using the intraclass correlation coefficient (ICC), a paired t-test, or Wilcoxon and Bland-Altman analysis. The feasibility of the assessment was investigated using a standardized 14-item questionnaire. RESULTS: All functional performance measures showed excellent intra-rater reliability, with ICCs from 0.90 (95%CI 0.78 ­ 0.95) for the sitting and rising test to 0.98 (95%CI 0.96 ­ 0.99) for the chair rise test. Our analysis also showed mixed levels of reliability across measures, including good ICC (ranging from 0.79 ­ 0.91) for the Montreal Cognitive Assessment, part B of the Trail Making Test, and the congruent and neutral trials in the Stroop test, but poor-to-moderate ICC (ranging from 0.42 ­ 0.58) for the other cognitive assessments. In general, the participants reported good feasibility for the assessment format. CONCLUSION: In healthy and highly educated older adults, videoconferencing is a feasible method of determining functional and cognitive performance. Functional measures showed excellent reliability indexes, whereas cognitive data should be interpreted carefully, since the reliability varied from poor to moderate. (AU)

OBJETIVO: Nosso objetivo foi determinar a viabilidade e confiabilidade de medidas funcionais e cognitivas por meio de uma videoconferência baseada na web entre idosos no contexto da pandemia de COVID-19. METODOLOGIA: Trinta idosos [idade = 69,77 (desvio padrão ­ DP = 6,60) anos; 86,70% mulheres], que vivem de forma independente na comunidade (independente fisicamente e sem sinais de comprometimento cognitivo) participaram do estudo. Um avaliador independente e experiente entregou, em tempo real, avaliações funcionais (Chair Rise Test ­ CRT, Chair Stand Test, Sitting and Rising Test ­ SRT) e cognitivas (MoCA, Teste de Trilhas A e B, Stroop Test e Fluência Verbal) por meio da Plataforma Google Meet em dois dias não consecutivos. A confiabilidade das medidas foi analisada pelo Coeficiente de Correlação Intraclasse (CCI), teste t pareado ou análise de Wilcoxon e Bland-Altman. A viabilidade da avaliação foi examinada com o uso de um questionário padronizado de 14 itens. RESULTADOS: Todas as medidas de desempenho funcional demonstraram excelente confiabilidade intra-avaliador [CCI variando de 0,90 (intervalo de confiança ­ IC95% 0,78 ­ 0,95) para SRT e 0,98 (IC95% 0,96 ­ 0,99) para CRT]. Além disso, nossa análise mostrou níveis mistos de confiabilidade entre as medidas, enquanto o MoCA, Teste de Trilhas B e as fases Interferência e Leitura do Stroop Test tiveram excelente CCI (variando de 0,79 a 0,91) e as outras avaliações cognitivas com CCI ruim a moderado (variando de 0,42 a 0,58). Em geral, os participantes demonstraram boa viabilidade com o formato das avaliações. CONCLUSÃO: Em idosos saudáveis e com alta escolaridade, a videoconferência baseada na web é uma alternativa viável para determinar o desempenho funcional e medidas cognitivas. As medidas funcionais apresentaram excelentes índices de confiabilidade, enquanto os dados cognitivos devem ser interpretados com cautela, visto que atingiram índices de confiabilidade de ruim a moderado. (AU)

Affective response of postmenopausal women to resistance training on stable and unstable surfaces: a randomized cross-over study / Respostas afetivas de mulheres pós-menopausadas submetidas ao treinamento com pesos em superfície estável e instável: um estudo cross-over randomizado

Objective: To compare the affective response of postmenopausal women who undergo 6 weeks of resistance training on stable and unstable surfaces. Methods: This randomized counterbalanced cross-over study carried included 14 postmenopausal women (55 [SD, 3] years; height 1.55 [SD, 0.03] m; body mass 78.70 [SD, 12.00] kg; and body mass index 32.80 [SD, 4.90] kg/m²), who underwent 6 weeks of resistance training on stable and unstable surfaces. The participants were initially allocated to 1 experimental condition (stable or unstable) in a randomized counterbalanced manner. The intervention consisted of 8 exercises in 3 series of 8-10 repetitions, with intervals of 60-90 seconds, for 3 weeks. After the first 3-week protocol, they were switched to the other experimental condition for another 3 weeks. To evaluate affective response, the Hardy and Rejeski Sensation Scale was applied weekly at the end of each exercise and again at the end of the 6 weeks. Results: Affective response was similar to the general affect observed at the end of the sessions (stable surface: 5.00 [3.00]; unstable surface: 5.00 [1.00]; p = 0.114), except for the bridge exercise (stable surface: 3.00 [2.00]; unstable surface: 4.00 [2.00]; p = 0.048]). Conclusions: The affective response of these women was not affected by training on unstable surfaces, except for the bridge exercise, in which the unstable surface increased affective response

Objetivo: Comparar as respostas afetivas de mulheres pós-menopausadas submetidas a seis semanas de treinamento com pesos realizado em superfície estável e instável. Metodologia: Trata-se de um estudo cross-over, randomizado e contrabalanceado realizado com 14 mulheres pós-menopausadas (55 ± 3 anos; estatura de 1,55 ± 0,03 m; massa corporal 78,70 ± 12,00 kg; e índice de massa corporal de 32,80 ± 4,90 kg/m²) submetidas a seis semanas de treinamento com pesos em superfície estável e instável. As participantes foram alocadas, inicialmente, numa das condições experimentais de forma randomizada e contrabalanceada. A intervenção foi composta por oito exercícios em três séries de oito a dez repetições, com intervalos entre 60 e 90 segundos, durante três semanas. Para avaliação das respostas afetivas, foi aplicada a Escala de Sensação de Hardy e Rejeski ao fim da última série de cada exercício e ao final das sessões, durante as seis semanas. Resultados: As respostas afetivas foram similares para o afeto geral observado ao final das sessões [Superfície estável: 5,00 (3,00); Superfície instável: 5,00 (1,00); p = 0,114], mas não para o exercício de ponte [Superfície estável: 3,00 (2,00); Superfície instável: 4,00 (2,00); p = 0,048)]. Conclusões: Conclui-se que as respostas afetivas de mulheres pós-menopausadas, observadas ao final da sessão, não foram afetas pela instabilidade. Contudo, as sensações de prazer, no exercício de ponte, foram maiores com a inserção da instabilidade

Changes in Physical Functioning and Fall-Related Factors in Older Adults Due to COVID-19 Social Isolation.

Background: Social isolation has been one of the main measures for the prevention of COVID-19. It's possible that, in addition to the natural aging-related deficits, social isolation has accelerated the decline of the different components of physical and mental capacity in older adults. This study aimed to compare the functional capacity and concern about falling in older adults before and during COVID-19 social isolation. Method: This observational longitudinal study was carried out with 45 community dwelling older adults (mean age 65.6 ± 4.6 years, 88.8% women). Functional capacity and concerns about falling assessments were carried out before the COVID-19 pandemic, and between the 16th and 18th week of social isolation. All testes were face-to-face, except the second FES-I assessment, which took place via telephone call in order to minimize a prolonged person-to-person contact. Muscle strength, muscle power, functional mobility, functional muscle fitness, upper and lower body flexibility, dynamic balance, and Efficacy Scale were assessments. Results: Regarding functional capacity, there was 14% decline in muscle strength (p<.001), 7% in power (p=.001), 11% in functional mobility (p=.001), 20% in functional muscle fitness (p=.001), and 60% in upper body flexibility (p=.001) and 33% lower body flexibility (p=.003). The dynamic balance and the concern about falling showed no statistically significant differences. Conclusion: Thus, it can be concluded that there was a decline in older adults' functional capacity during COVID-19 social isolation.

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

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.

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.

Association between screen time exposure, anxiety, and sleep quality in adolescents / Asociación entre el tiempo de exposición a la pantalla, la ansiedad y la calidad del sueño en adolescentes

Abstract Introduction The increase in sedentary screen time can negatively affect the quality of sleep, impacting the performance of daily activities. Objective To analyze the association between sedentary screen time and sleep quality, regardless of the symptoms of anxiety in adolescents of both genders. Method Cross-sectional study integrating school-based epidemiological research with a representative sample (n = 666) of high school students (14 to 19 years old) in public schools in the municipality of Caruaru-PE. The translated versions into Portuguese of the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HAD) were applied to analyze sleep quality and anxiety, respectively. Binary logistic regression was used to analyze the association, considering sleep quality as an outcome. Results There was a positive, statistically significant (p< .001) correlation between sleep quality and symptoms of anxiety (r = .393). A significant association regarding the association between screen time and sleep quality was noted only in those adolescents classified as being possible or probable anxiety cases and only in exposure to the computer (OR = 2.337; 95% CI [1.01, 5.43]) and video games (OR = 8.083; 95% CI [2.0, 32.8]) after adjusting for gender, age, and school shift. Discussion and conclusion Increased interaction with the screen and higher levels of anxiety can be more harmful to sleep in adolescents. Exposure to screen time, specifically those which have a greater interaction such as video games and computers, can have a negative impact on sleep quality, but only in adolescents with a higher risk of anxiety.

Resumen Introducción Un elevado tiempo de exposición de pantalla puede afectar tanto la calidad del sueño como las actividades diarias. Objetivo Analizar la asociación entre el tiempo de pantalla sedentario y la calidad del sueño, independientemente de los síntomas de ansiedad en adolescentes de ambos sexos. Método Estudio transversal que integra la investigación epidemiológica escolar con una muestra representativa (n = 666) de estudiantes (14 a 19 años) de escuelas públicas de Caruaru-PE. Las versiones traducidas al portugués del Índice de Calidad del Sueño de Pittsburgh (PSQI) y la Escala de Ansiedad y Depresión Hospitalaria (HAD) se aplicaron para analizar la calidad del sueño y la ansiedad. Se utilizó regresión logística binaria para analizar la asociación, considerando como resultado la calidad del sueño. Resultados Hubo una correlación positiva y estadísticamente significativa (p< .001) entre la calidad del sueño y los síntomas de ansiedad (r = .393). Una asociación significativa en cuanto a la asociación entre el tiempo de pantalla y la calidad del sueño se observó sólo en adolescentes clasificados como casos posibles o probables de ansiedad y sólo en la exposición al ordenador (OR = 2.337; IC 95% [1.01, 5.43]) y videojuegos (OR = 8.083; 95% IC [2.0, 32.8]) después de los ajustes. Discusión y conclusión Una mayor interacción con la pantalla y altos niveles de ansiedad pueden ser perjudiciales para el sueño. La exposición al tiempo de pantalla, específicamente aquellos con mayor interacción, como los videojuegos y las computadoras, puede afectar negativamente la calidad del sueño, pero sólo en adolescentes con mayor riesgo de ansiedad.

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.

Effects of Breaking Up Prolonged Sitting on Cardiovascular Parameters: A systematic Review.

The aim of this systematic review was to analyze the acute and chronic effects of sitting breaks on cardiovascular parameters. PubMed and Web of Science databases were searched by two independent researchers for relevant studies published until February 2020. Acute or chronic studies reporting the effects of sitting breaks or reduction in sitting time on cardiovascular parameters were examined. The eligibility criteria followed PICOS: Population - Humans ≥ 18 years old; Interventions - Sitting break strategies; Comparisons - Uninterrupted sitting; Outcomes - Cardiovascular parameters (blood pressure, heart rate, ambulatory blood pressure, vascular function, pulse-wave velocity, cerebral blood flow and biomarkers); Study design - Randomized controlled trials, non-randomized non-controlled trials and randomized crossover trials. Forty-five studies were included, where 35 investigated the acute and 10 the chronic effects of sitting breaks or reductions in sitting time. Walking was the main acute study strategy, used in different volumes (1 min 30 s to 30 min), intensities (light to vigorous) and frequencies (every 20 min to every 2 h). Acute studies found improvements on cardiovascular parameters, especially blood pressure, flow-mediated dilation, and biomarkers, whereas chronic studies found improvements mostly on blood pressure. Breaking up or reducing sitting time improves cardiovascular parameters, especially with walking.

Clinical safety and hemodynamic, cardiac autonomic and inflammatory responses to a single session of inspiratory muscle training in obstructive sleep apnea.

PURPOSE: To determine clinical safety and cardiovascular, cardiac autonomic and inflammatory responses to a single session of inspiratory muscle training (IMT) in obstructive sleep apnea (OSA) subjects. METHODS: In a randomized controlled trial individuals of both sexes, aged between 30 and 70 years old with diagnosis of moderate to severe OSA were enrolled. Volunteers with OSA (n = 40) performed an IMT session with three sets of 30 repetitions with a 1-min interval between them. The IMT group (n = 20) used a load of 70% of the maximum inspiratory pressure (MIP), and the placebo group (n = 20) performed the IMT without load. Measurements of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), heart rate variability (HRV), and inflammatory markers were performed pre, post-immediate and 1 h after the IMT session. RESULTS: No differences were shown in SBP, DBP, HRV, or inflammatory markers at any of the intervals analyzed. However, HR in the IMT group was lower ​​1 h after the IMT session compared to the pre-session values ​​(p = 0002). HR was higher in the placebo group when comparing pre × post-immediate (p < 0.001). HR decreased after the first hour in relation to the pre (p < 0.001) and post-immediate (p < 0.001) values. CONCLUSION: IMT sessions promote discreet hemodynamic, cardiac autonomic and inflammatory responses. Therefore, IMT is considered clinically safe and can be performed at home, guided but unsupervised, with lower cost and greater adherence to exercise program for subjects with OSA.

Association between frequency of physical education classes and heart rate variability in adolescents boys: a cross-sectional study / Associação entre frequência de aulas de educação física e variabilidade de frequência cardíaca em meninos adolescentes: um estudo transversal

ABSTRACT Physical inactivity is associated with low heart rate variability (HRV) in adolescents. However, whether the number of physical education (PE) classes impact HRV remains unclear. This cross-sectional study verified the association between the frequency of PE classes and HRV parameters in male adolescents. This study included 1152 boys (16.6 ± 1.2 years). The quantity of PE classes was assessed though questionnaire and the adolescents were stratified accordingly (no PE class; one PE class/wk; ≥2 PE classes/wk). Time- (SDNN, RMSSD, PNN50) and frequency-domains (LF, HF, sympathovagal balance) of HRV were obtained. Generalized Linear Models were used for comparing the HRV parameters according to the quantity of PE classes, adjusting for confounders. There was no difference in HRV measures of time: (SDNN, p = 0.77; RMSSD, p=0.72; PNN50, p=0.83) and frequency (LF, p=0.61; HF, p=0.61; sympathovagal balance, p=0.60) between the different frequencies of PE classes. The frequency of PE classes in not associated with HRV parameters of male adolescents.

RESUMO A inatividade física está associada à baixa variabilidade da frequência cardíaca (VFC) em adolescentes. Entretanto, não está claro se o número de aulas de Educação Física (EF) causa impacto na VFC. Este estudo transversal verificou a associação entre a frequência das aulas de EF com parâmetros de VFC em adolescentes do sexo masculino. Foram incluídos 1.152 meninos (16,6 ± 1,2 anos). A quantidade de aulas de EF foi avaliada através de questionário e os adolescentes foram estratificados de acordo (nenhuma aula de EF; uma aula de EF / sem; ≥2 aulas de EF / sem). Os domínios do tempo (SDNN, RMSSD, PNN50) e da frequência (LF, HF, balanço simpático-vagal) da VFC foram obtidos. Modelos Lineares Generalizados foram usados ​​para comparar os parâmetros da VFC de acordo com a quantidade de aulas de EF, ajustando para fatores de confusão. Não houve diferença nas medidas de VFC de tempo: (SDNN, p = 0,77; RMSSD, p = 0,72; PNN50, p = 0,83) e frequência (LF, p = 0,61; HF, p = 0,61; balanço simpatovagal, p = 0,60) entre as diferentes frequências das aulas de EF. A frequência das aulas de EF não está associada aos parâmetros de VFC de adolescentes do sexo masculino.