Self-initiated changes in physical activity levels improve cardiometabolic profiles: A longitudinal follow-up study.

BACKGROUND AND AIMS: While studies have described the importance of higher physical activity levels (PAL) in weight loss, the impact of self-initiated PAL on health status warrants further study. We aimed to prospectively examine the effects of self-initiated longitudinal PAL changes on body mass index (BMI) and cardiometabolic parameters in normal weight, overweight and obese adults. METHODS AND RESULTS: We included 4840 adults (mean age 41.6 ± 7.9 years, 79% male) undergoing routine health screening examinations. Self-reported PAL, height, weight, blood pressure and blood samples were collected at baseline and after a mean (95% confidence interval) follow up of 536 (531-541) days. Subjects were stratified according to BMI [39.8% normal weight (<25 kg/m2), 45.1% overweight (25.0-29.9 kg/m2), and 19.1% obese (≥30 kg/m2)]. In normal weight individuals, BMI increased from baseline to follow-up, irrespective of PAL changes. On the other hand, overweight and obese individuals that increased PAL experienced a decrease in BMI by -0.9% and -3.1%, respectively (p < 0.05). Overweight and obese individuals that increased PAL also experienced a decrease in -5.8% -4.6% in non-HDL concentrations from baseline to follow-up (p < 0.05). Finally, in overweight individuals, LDL cholesterol concentrations decreased from baseline to follow-up, irrespective of PAL changes whereas in obese individuals, a maintenance or increased PAL were associated with a decrease in -4.7% and -6.1% (p < 0.05), respectively. CONCLUSIONS: In a large cohort of screening patients, longitudinal self-initiated PAL is associated with improved BMI and cardiometabolic profile in overweight and obese individuals.

A Single Bout of Arm-crank Exercise Promotes Positive Emotions and Post-Exercise Hypotension in Patients with Symptomatic Peripheral Artery Disease.

OBJECTIVE/BACKGROUND: The objective was to analyze the acute effects of a single bout of arm cranking exercise on affective and cardiovascular parameters in patients with symptomatic peripheral artery disease (PAD). METHODS: This was a prospective, controlled, crossover study. Eleven men with symptomatic PAD underwent two experimental sessions in a random order: control or arm crank exercise (15 × 2 minutes bouts of arm crank exercise interrupted by 2 minutes rest intervals). During exercise, ratings of perceived exertion (Borg scale) and affective responses (pleasure/displeasure) were obtained at the first, fifth, tenth, and fifteenth bouts. Before and after the experimental sessions, cardiovascular parameters (blood pressure and heart rate) were obtained. Data were analysed by a two-way repeated measure analysis of variance with significance achieved at p < .05. RESULTS: During the arm crank exercise, patients reported positive feelings of pleasure. During exercise, heart rate (HR) remained within 80-90% of peak HR. Additionally, patients performed arm crank exercise with moderate levels of perceived exertion (Borg rating of 11-13) and with pleasant affective scores (Feeling Scale of +1 to +5). Blood pressure (systolic, diastolic, and mean) increase was lower after arm crank exercise than for control (greatest net effect: -15 ± 11 mmHg [p < .001]; -9 ± 5 mmHg [p < .001]; -9 ± 6 mmHg [p < .001], respectively), while HR increased (greatest net effect: +9 ± 6 beats per minute; p < .001). CONCLUSION: A single bout of arm crank exercise promotes pleasurable feelings while reducing blood pressure in patients with symptomatic PAD.

Factors Associated with Sedentary Behavior in Patients with Intermittent Claudication.

OBJECTIVES: Time spent in sedentary behavior has been associated with cardio-metabolic risk factors in the general population and in patients with symptomatic peripheral artery disease (PAD). Given the association of sedentary behavior and poor health outcomes, it is important to identify factors associated with sedentary behavior in these patients. The aim of this study was to identify factors associated with the sedentary time in patients with symptomatic PAD. METHODS: The sample included 297 patients with symptomatic PAD. Sedentary behavior was assessed using a step activity monitor and the patients were divided into tertiles. Demographic data, body mass index, comorbid conditions, and measures of severity of PAD (ankle brachial index, ischemic window, claudication measurements, peak oxygen uptake and walking economy) were obtained. RESULTS: Patients in the highest tertile (i.e. more sedentary) had a higher body mass index and a higher prevalence of diabetes mellitus, metabolic syndrome, and obesity than patients in the lowest tertile, whereas their peak walking time, peak oxygen uptake, and walking economy were lower (p < .05 for all). Using multiple regression procedures, the factors associated with the sedentary time were male sex (b = .217, R2 = .180, p = .001), body mass index (b = .154, R2 = .059, p = .013), peak walking time (b = -.360, R2 = .066, p ≤ .001), and walking economy (b = -.187, R2 = .142, p = .004). CONCLUSION: In patients with symptomatic PAD, greater time spent in sedentary behavior was found in men, and in patients with higher body mass index, lower peak walking time, and lower walking economy.

Walking Capacity Is Positively Related with Heart Rate Variability in Symptomatic Peripheral Artery Disease.

OBJECTIVES: The aim was to investigate the association between walking capacity and HRV in patients with symptomatic peripheral artery disease (PAD). METHODS: This was a cross sectional study. Ninety-five patients were recruited. Patients undertook a supine position for 20 minutes, with the final 10 minutes used to examine for resting HRV. Time domain, frequency domain, and non-linear indices were evaluated. A maximal treadmill test (Gardner protocol) was performed to assess maximal walking distance (MWD) and claudication distance (CD) in groups of PAD patients based upon their walking abilities (low, moderate, high). Differences between PAD patient groups were examined using non-parametric analyses, and Spearman rank correlations identified the relationship between MWD and CD, and HRV parameters. RESULTS: Symptomatic PAD patients with high MWD exhibited significantly greater HRV than patients with low MWD. Furthermore, MWD was positively associated with time domain and non-linear indices of HRV (all p < .05). However, no statistically significant correlations were observed between CD and HRV parameters or between PAD groups. CONCLUSION: A greater walking capacity is associated with better HRV in symptomatic PAD patients.

Vascular Mechanisms of Post-exercise Blood Pressure Responses in Peripheral Artery Disease.

This study aimed to analyze the vascular mechanisms involved in post-resistance decreases in blood pressure in patients with peripheral artery disease. 17 patients underwent 2 experimental sessions conducted in random order: resistance exercise (REx-3×10 reps in 8 exercises with intensity of ~ 60% of 1 RM) and control (C- resting on the exercise machines for 50 min). Before and after each experimental session, blood pressure, reflected wave indicators, pulse wave velocity, blood flow, blood flow post-reactive hyperemia and peripheral vascular resistance responses were obtained. Both sessions increased brachial systolic, diastolic and mean blood pressure (greatest increase REx: 11 mmHg; greatest increase C: 19 mmHg; P<0.01); however, the increases were greater after the C session (P<0.01). Reflected wave indicators increased only after the C session (P<0.06), while pulse wave velocity increased similarly after both sessions (P=0.66). Individual analyses indicated a large variability between patients in vascular variables responses. A single bout of REx decreased blood pressure in peripheral artery disease patients, and these responses were followed by changes in reflected wave indicators. The other factors presented high individual variability, and thus it was not possible to identify specific factors associated with blood pressure reduction in peripheral artery disease patients.

Ventilatory threshold is related to walking tolerance in patients with intermittent claudication.

BACKGROUND: This study assessed the relationship between lower limb hemodynamics and metabolic parameters with walking tolerance in patients with intermittent claudication (IC). PATIENTS AND METHODS: Resting ankle-brachial index (ABI), baseline blood flow (BF), BF response to reactive hyperemia (BFRH), oxygen uptake (VO2), initial claudication distance (ICD) and total walking distance (TWD) were measured in 28 IC patients. Pearson and Spearman correlations were calculated. RESULTS: ABI, baseline BF and BF response to RH did not correlate with ICD or TWD. VO2 at first ventilatory threshold and VO2peak were significantly and positively correlated with ICD (r = 0.41 and 0.54, respectively) and TWD (r = 0.65 and 0.71, respectively). CONCLUSIONS: VO2peak and VO2 at first ventilatory threshold, but not ABI, baseline BF and BFHR were associated with walking tolerance in IC patients. These results suggest that VO2 at first ventilatory threshold may be useful to evaluate walking tolerance and improvements in IC patients.

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

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