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.

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

OBJECTIVE: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. METHODS: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. RESULTS: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. CONCLUSION: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease. BACKGROUND: ▪ Sitting time increased in 73.9% of women and 84.9% of men at the onset of the pandemic. BACKGROUND: ▪ Physical activity was practiced by 23.9% of women and 39.6% of men at the onset of the pandemic. BACKGROUND: ▪ The prevalence of both women and men reporting physical mobility difficulties increased at follow-up. BACKGROUND: ▪ Hospitalization rates for reasons unrelated to COVID-19 have increased in both women and. BACKGROUND: While women experience more consequences related to peripheral artery disease than men, such as worse functional capacity and higher morbidity, there was a similar increase in physical mobility difficulty and frequency of hospitalization for reasons other than COVID-19 one year after the onset of the pandemic.

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.

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

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

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.

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.

Impact of physical activity on self-reported health parameters in peripheral artery disease in two periods of the COVID-19 pandemic.

BACKGROUND: Prolonged social isolation intended to mitigate the spread of Coronavirus 2019 (COVID-19), may potentially affect the physical activity level and health of patients with peripheral artery disease (PAD). OBJECTIVES: To analyze the impact of physical activity practice on longitudinal changes in self-reported health parameters during the COVID-19 pandemic in patients with PAD. DESIGN: Longitudinal study. SETTING: The database of studies developed by our group involving patients with PAD from public hospitals in São Paulo, Brazil. METHODS: In this longitudinal study, 99 patients with PAD were evaluated in two periods during the COVID-19 pandemic (i.e., May to August 2020 and May to August 2021). Patients were interviewed by telephone, and information was obtained regarding physical activity practice and self-reported health (i.e., current global, physical, and mental health). Patients were divided into two groups: the physically inactive group (patients who were or became physically inactive, n=76, 51.3% male, 67±10 years old, 8±7 years of disease duration) and the physically active group (patients who started or continued practicing physical activity, n=23, 65.2% male, 71±8years old, 7±6 years of disease). RESULTS: The physically inactive group more frequently self-reported their current health as poor (6.6 vs. 17.1%, P=0.045) and were more frequently hospitalized for reasons other than COVID-19 (6.6 vs. 27.6%, P=0.001) between the two periods evaluated during the COVID-19 pandemic. The physically active group self-reported lower declines in walking capacity (13.0 vs. 43.5%, P=0.022) between the two periods evaluated. We did not observe any differences in other parameters in either group between the two periods evaluated (p>0.05). CONCLUSIONS: The practice of physical activity during the COVID-19 pandemic can help maintain or mitigate the negative impacts on self-reported global and physical health parameters in patients with PAD.

What are the Main Risk Factors Associated with Erectile Dysfunction in the Elderly? A Cross-Sectional Study of 2436 Brazilian Elderly Men.

Background: Erectile dysfunction (ED) is a multifactorial medical disorder often neglected in clinical practice between elderly men, defined as the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse and a common clinical entity among men and associated with impaired quality of life and cardiovascular diseases in elderly men. The aim of this study is to evaluate the association between ED and clinical, demographic and behavioral parameters in elderly men. Methods: A total of 2436 males aged 60 years and over who participated in the health screening between January 2008 and December 2018 were included in this study. Laboratory exams, clinical and behavior profiles were analyzed. Logistic regression models were used. Results: Men with ED were older (65.87±5.49 vs. 63.85±4.05 years old. p<0.001), higher prevalence of physical inactivity (23.8 vs. 19%, p = 0.039) and had a higher body mass index (BMI; 28.36±4.06 vs. 27.72±3.89 kg/m2. p<0.001) than men without ED. The multivariate model shown that hypertension (p = 0.001), diabetes mellitus (p<0.001), lower urinary tract symptoms (LUTS), depressive symptoms (p<0.001) and age (p<0.001), were strongly associated with ED. Conclusion: The main risk factors associated with ED in elderly men were hypertension, diabetes mellitus, LUTS, depressive symptoms and age.

Physiological responses during walking in men and women with intermittent claudication

ABSTRACT 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.

The association between physical activity and erectile dysfunction: A cross-sectional study in 20,789 Brazilian men.

INTRODUCTION: Erectile dysfunction, defined as the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse is associated with impaired quality of life and cardiovascular diseases in men older than 40 years. OBJECTIVE: To evaluate the association between erectile dysfunction and physical activity levels in a large cohort of men. METHODS: Data from 20,789 males aged 40 years and over who participated in the check-up screening between January of 2008 and December of 2018 were included in this study. In this sample, data about erectile dysfunction, physical activity levels, clinical profile and laboratory exams were obtained. Logistic regression models were performed. RESULTS: Individuals with erectile dysfunction were older (49.1 ±6.9 vs. 54.8±8.8 years old, p<0.001), had a higher body mass index (27.6 ±3.9 vs. 28.5 ± 4.3 kg/m2, p<0,001), and presented with a higher prevalence of physical inactivity (25 vs. 19%, p<0.001) than individuals without erectile dysfunction. The multivariate model revealed that age (p<0.001), hypertension (p = 0.001), diabetes mellitus (p<0.001), high body mass index (p<0.001), lower urinary tract symptoms and depressive symptoms (p<0.001) were independent risk factors for erectile dysfunction. Low or high physical activity levels (OR = 0.77; CI95%: 0.68-0.87, p<0.001 and OR = 0.85; CI95%: 0.72-0.99, p = 0.04 respectively) were protective factors against erectile dysfunction. CONCLUSION: Low and high physical activity levels were associated with more than 20% reduction in the risk of erectile dysfunction in men aged 40 years or older.

Transcutaneous Auricular Vagus Nerve Stimulation Improves Inflammation but Does Not Interfere with Cardiac Modulation and Clinical Symptoms of Individuals with COVID-19: A Randomized Clinical Trial.

Transcranial auricular vagus nerve stimulation (taVNS) has shown effectiveness in reducing inflammation and depression. Thus, this study evaluated its effect on inflammation, cardiac autonomic modulation, and clinical symptoms in individuals affected by COVID-19. Methods: There were 52 randomized participants hospitalized with COVID-19 diagnosis who were to receive active (a-taVNS) or sham taVNS (s-taVNS) for 90 min twice a day for seven consecutive days. Interleukin 6 (IL-6), 10 (IL-10), cortisol, C-reactive protein (CRP), heart rate variability (HRV), and clinical symptoms were assessed before and after seven days of treatment. There were also seven- and fourteen-day follow-ups for clinical symptoms, including anxiety and depression levels, as well as a six-month follow-up for memory and attention levels. Results: There was significant reduction in CRP −23.9%, (95% CI −46.3 to −1.4) and IL-6 −37.7%, (95% CI −57.6 to −17.7) for the a-taVNS group. There were no changes in IL-10, cortisol levels, or in HRV results (p > 0.05) in both groups. There were no changes regarding clinical symptoms, except for a significant decrease in depression level (−2.85, 95% CI −5.44 to −0.27) in the a-taVNS group. Conclusion: taVNS showed effects on CRP, IL-6, and depression levels; however, it did not affect other clinical symptoms.

Efeito da estimulação elétrica transcutânea do nervo vago na inflamação, modulação autonômica cardíaca e evolução clínica dos pacientes com COVID-19: estudo de protocolo para um ensaio clínico, controlado, randomizado e cego / Efecto de la estimulación eléctrica transcutánea del nervio vago sobre la inflamación, la modulación autonómica cardiac y la evolución clínica de pacientes con COVID-19: estudio de protocolo para un ensayo clínico, controlado, aleatorizado y ciego / Effects of transcutaneous auricular vagus nerve stimulation on inflammation, cardiac autonomic modulation, and clinical evolution of patients with COVID-19: protocol for a clinical, controlled, randomized, and blind trial

RESUMO O objetivo deste estudo é avaliar o efeito da estimulação elétrica transcutânea do nervo vago (EETNV) na inflamação, modulação autonômica cardíaca e evolução clínica dos pacientes com COVID-19. Trata-se de um ensaio clínico, controlado por sham, randomizado e cego, no qual participarão 52 indivíduos hospitalizados com diagnóstico de COVID-19, que serão randomizados em dois grupos de tratamento: grupo experimental (tratamento médico usual associado à EETNV ativa) ou grupo-controle (tratamento médico usual associado à EETNV sham). A EETNV será realizada por meio de um estimulador elétrico neuromuscular (modelo Dualpex 071 da Quark Medical Products), com o eletrodo de estimulação posicionado sobre o tragus esquerdo, com corrente alternada, frequência de 30Hz e variação de 50%, intensidade ajustada para o limiar sensorial do paciente, com duração de 90 minutos cada sessão de estimulação, duas vezes ao dia, durante sete dias consecutivos, totalizando 14 sessões. Serão avaliados pré e pós-intervenção o nível de interleucina-6 (IL-6) e interleucina-10 (IL-10), cortisol e proteína C reativa (PCR), pressão arterial, variabilidade da frequência cardíaca pelos parâmetros de baixa frequência (BF), alta frequência (AF) e pela razão da baixa e alta frequência (BF/AF), além de evolução clínica dos pacientes, incluindo o nível de ansiedade e depressão, cujos dados serão obtidos por meio de prontuários e questionários. Será realizado também um acompanhamento 7 e 14 dias após o término das intervenções para verificar a evolução clínica, incluindo nível de ansiedade e depressão, e durante seis meses serão avaliadas memória e atenção.

RESUMEN El objetivo de este estudio es evaluar el efecto de la estimulación eléctrica transcutánea del nervio vago (EETNV) sobre la inflamación, la modulación autonómica cardíaca y la evolución clínica de pacientes con COVID-19. Se trata de un ensayo clínico, controlado por simulado, aleatorizado y ciego, en el que participarán 52 individuos hospitalizados diagnosticados de COVID-19, que serán aleatorizados en dos grupos de tratamiento: grupo experimental (tratamiento médico habitual asociado a la EETNV activa) o grupo control (tratamiento médico habitual asociado a la EETNV simulada). La EETNV se realizará mediante un estimulador eléctrico neuromuscular (modelo Dualpex 071 de Quark Medical Products), con el electrodo de estimulación colocado en el trago izquierdo, con corriente alterna, frecuencia de 30Hz y 50% de variación, intensidad ajustada al umbral sensorial del paciente, con una duración de 90 minutos cada sesión de estimulación, dos veces al día, durante siete días consecutivos, lo que totaliza 14 sesiones. Se evaluarán antes y después de la intervención la interleucina-6 (IL-6) y la interleucina-10 (IL-10), el cortisol y la proteína C reactiva (PCR), la presión arterial, la variabilidad de la frecuencia cardíaca por los parámetros de baja frecuencia (BF), alta frecuencia (AF) y razón de baja y alta frecuencia (BF/AF), así como la evolución clínica de los pacientes, incluidos los parámetros de ansiedad y depresión cuyos datos se obtendrán de historias clínicas y cuestionarios. También se realizará un seguimiento de 7 y 14 días tras finalizadas las intervenciones para verificar la evolución clínica, incluidos el nivel de ansiedad y de depresión, y durante seis meses se evaluará la memoria y la atención.

ABSTRACT This study aims to evaluate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on inflammation, cardiac autonomic modulation, and clinical evolution of patients with COVID-19. This is a clinical, sham-controlled, randomized, and blind trial, in which 52 hospitalized individuals diagnosed with COVID-19 will participate. They will be randomized into: experimental group (usual medical treatment associated with active taVNS) and control group (usual medical treatment associated with sham taVNS). The taVNS will be performed by a neuromuscular electric stimulator (Dualpex model 071 of Quark Medical Products), with the stimulation electrode positioned on the left tragus, with alternating current, at a 30Hz frequency with 50% variation. Intensity will be adjusted to the patient's sensory threshold, with 90-minutes-long stimulation sessions, happening twice per day for seven consecutive days, totaling 14 sessions. Interleukin-6 (IL-6) and interleukin-10 (IL-10), cortisol and C-reactive protein (CRP), blood pressure, heart rate variability (HRV) by low frequency (LF), high frequency (HF) and low and high frequency ratio (LF/HF) parameters will be evaluated before and after the intervention, as well as patients' clinical evolution-including anxiety and depression levels-whose data will be obtained through medical records and questionnaires. A follow-up will also be performed seven and 14 days after the end of the interventions to verify the clinical evolution, including anxiety and depression levels. Memory and attention levels will be evaluated for six months.