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Santos JCDS, Ritti-Dias RM, Cucato GG, Wolosker N, Correia MDA, Farah BQ. Are Barriers to Physical Activity Associated With Changing Physical Activity Levels and Sedentary Time in Patients With Peripheral Arterial Disease? A Longitudinal Study. J Aging Phys Act 2024; 32:581-587. [PMID: 38663846 DOI: 10.1123/japa.2023-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/14/2024] [Accepted: 02/21/2024] [Indexed: 09/18/2024]
Abstract
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 (β = 392.9 [159.7] min/week, p = .02) and a decrease in low-light physical activity (β = -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.
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Affiliation(s)
| | | | - Gabriel Grizzo Cucato
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | | | - Marilia de Almeida Correia
- Graduated Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, SP, Brazil
- Graduated Program in Medicine, Universidade Nove de Julho, São Paulo, SP, Brazil
| | - Breno Quintella Farah
- Graduate Program in Physical Education, Federal University of Pernambuco, Recife, PE, Brazil
- Federal Rural University of Pernambuco, Recife, PE, Brazil
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Santos JCDS, Correia MA, Kanegusuku H, Wolosker N, Ritti-Dias RM, Farah BQ. Does frailty affect barriers to physical activity in patients with symptomatic peripheral artery disease? A cross-sectional study. JOURNAL OF VASCULAR NURSING 2024; 42:203-207. [PMID: 39244332 DOI: 10.1016/j.jvn.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 06/04/2024] [Accepted: 06/09/2024] [Indexed: 09/09/2024]
Abstract
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.
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Affiliation(s)
| | - Marilia Almeida Correia
- Graduate Program in Medicine, Universidade Nove de Julho, São Paulo, SP, Brazil; Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, SP, Brazil
| | | | | | | | - Breno Quintella Farah
- Graduate Program in Physical Education, Universidade Federal de Pernambuco, Recife, PE, Brazil; Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, SP, Brazil; Graduate Program in Moviment Sciences, Universidade Federal Rural de Pernambuco, Recife, PE, Brazil.
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Santanna FDS, Cunha PM, Costa RM, Cucato GG, Wolosker N, Dal Corso S, Kanegusuku H, Farah BQ, Ritti-Dias RM, Correia MDA. The bodyweight walking distance product and its relationship with clinical markers in patients with symptomatic peripheral artery disease. JOURNAL OF VASCULAR NURSING 2024; 42:105-109. [PMID: 38823969 DOI: 10.1016/j.jvn.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 06/03/2024]
Abstract
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.
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Affiliation(s)
| | - Paolo M Cunha
- Albert Einstein Israeli Teaching and Research Institute, São Paulo, SP, Brazil
| | - Renan Massena Costa
- Postgraduate Program in Medicine, Nove de Julho University, São Paulo, SP, Brazil; Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, SP, Brazil
| | | | - Nelson Wolosker
- Albert Einstein Israeli Teaching and Research Institute, São Paulo, SP, Brazil
| | - Simone Dal Corso
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, SP, Brazil
| | - Hélcio Kanegusuku
- Albert Einstein Israeli Teaching and Research Institute, São Paulo, SP, Brazil
| | - Breno Quintella Farah
- Department of Physical Education, Universidade Federal Rural de Pernambuco, Recife, PE, Brazil
| | | | - Marilia de Almeida Correia
- Postgraduate Program in Medicine, Nove de Julho University, São Paulo, SP, Brazil; Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, SP, Brazil.
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Peñín-Grandes S, López-Ortiz S, Maroto-Izquierdo S, Menéndez H, Pinto-Fraga J, Martín-Hernández J, Lista S, Lucia A, Santos-Lozano A. Winners do what they fear: exercise and peripheral arterial disease-an umbrella review. Eur J Prev Cardiol 2024; 31:380-388. [PMID: 37611200 DOI: 10.1093/eurjpc/zwad261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/25/2023]
Abstract
AIMS This systematic review aims to evaluate and summarize findings from published meta-analyses on the effects of regular exercise in patients with peripheral arterial disease (PAD). The review will assess the impact of exercise on functional parameters, health-related quality of life, haemodynamic parameters, physical activity levels, adverse events, and mortality. METHODS AND RESULTS A systematic search was performed in PubMed, Web of Science, Scopus, and Cochrane Library databases (up to May 2023) to identify meta-analyses including randomized controlled trials that examined the effects of regular exercise in patients with PAD. Sixteen studies, with a total of 198 meta-analyses, were identified. Results revealed with strong evidence that patients with PAD who exercised improved functional and health-related quality of life parameters. Specifically, supervised aerobic exercise (i.e. walking to moderate-maximum claudication pain) improves maximum walking distance [mean difference (MD): 177.94 m, 95% confidence interval (CI) 142.29-213.60; P < 0.00001; I2: 65%], pain-free walking distance (fixed MD: 68.78 m, 95% CI 54.35-83.21; P < 0.00001; I2: 67%), self-reported walking ability [i.e. distance score (MD: 9.22 points, 95% CI 5.74-12.70; P < 0.00001; I2: 0%), speed score (MD: 8.71 points, 95% CI 5.64-11.77; P < 0.00001, I2: 0%), stair-climbing score (MD: 8.02 points, 95% CI 4.84-11.21; P < 0.00001, I2: 0%), and combined score (MD: 8.76 points, 95% CI 2.78-14.74; P < 0.0001, I2: 0%)], aerobic capacity (fixed MD: 0.62 mL/kg/min, 95% CI 0.47-0.77, P < 0.00001, I2: 64%), and pain score (MD: 7.65, 95% CI 3.15-12.15; P = 0.0009; I2: 0%), while resistance exercise improves lower limb strength (standardized mean difference: 0.71, 95% CI 0.29-1.13, P = 0.0009; I2: 0%]. Regarding other outcomes, such as haemodynamic parameters, no significant evidence was found, while physical activity levels, adverse events, and mortality require further investigation. CONCLUSION Synthesis of the currently available meta-analyses suggests that regular exercise may be beneficial for a broad range of functional tasks improving health-related quality of life in patients with PAD. Supervised aerobic exercise is the best type of exercise to improve walking-related outcomes and pain, while resistance exercise is more effective to improve lower limb strength.
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Affiliation(s)
- Saúl Peñín-Grandes
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Susana López-Ortiz
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Sergio Maroto-Izquierdo
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Héctor Menéndez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - José Pinto-Fraga
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Juan Martín-Hernández
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Simone Lista
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre ('imas12' and 'PaHerg group'), Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
- Research Institute of the Hospital 12 de Octubre ('imas12' and 'PaHerg group'), Madrid, Spain
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Miyasato RS, Felix AJ, Andrade-Lima A, Silva Júnior NDD, Ritti-Dias RM, Wolosker N, Cornelissen V, Goessler KF, Forjaz CLDM. Physiological responses during walking in men and women with intermittent claudication. EINSTEIN-SAO PAULO 2023; 21:eAO0120. [PMID: 38126545 DOI: 10.31744/einstein_journal/2023ao0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/16/2023] [Indexed: 12/23/2023] Open
Abstract
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.
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Affiliation(s)
- Roberto Sanches Miyasato
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alex Jesus Felix
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aluísio Andrade-Lima
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
- Postgraduate Program in Physical Education, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| | - Natan Daniel da Silva Júnior
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Nelson Wolosker
- Vascular Unit, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | - Claúdia Lúcia de Moraes Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
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Du G, Tao T. Effects of a paddling-based high-intensity interval training prescribed using anaerobic speed reserve on sprint kayak performance. Front Physiol 2023; 13:1077172. [PMID: 36685190 PMCID: PMC9848400 DOI: 10.3389/fphys.2022.1077172] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to investigate physiological and performance adaptations to high-intensity interval training (HIIT) prescribed as a proportion of anaerobic speed reserve (ASR) compared to HIIT prescribed using maximal aerobic speed (MAS). Twenty-four highly trained sprint kayak athletes were randomly allocated to one of three 4-weak conditions (N = 8) (ASR-HIIT) two sets of 6 × 60 s intervals at ∆%20ASR (MAS-HIIT) six 2 min paddling intervals at 100% maximal aerobic speed (MAS); or controls (CON) who performed six sessions/week of 1-h traditional endurance paddling at 70%-80% maximum HR. A graded exercise test was performed on a kayak ergometer to determine peak oxygen uptake (V̇O2peak), MAS, V̇O2/HR, and ventilatory threshold. Also, participants completed four consecutive upper-body wingate tests to asses peak and average power output. Significant increases in V̇O2peak (ASR-HIIT = 6.9%, MAS-HIIT = 4.8%), MAS (ASR-HIIT = 7.2%, MAS-HIIT = 4.8%), ASR (ASR-HIIT = -25.1%, MAS-HIIT = -15.9%), upper-body Wingate peak power output and average power output (p < 0.05 for both HIIT groups) were seen compared with pre-training. Also, ASR-HIIT resulted in a significant decrease in 500-m - 1.9 % , and 1,000 - m - 1.5 % paddling time. Lower coefficient of variation values were observed for the percent changes of the aforementioned factors in response to ASR-HIIT compared to MAS-HIIT. Overall, a short period of ASR-HIIT improves 500-m and 1,000-m paddling performances in highly trained sprint kayak athletes. Importantly, inter-subject variability (CV) of physiological adaptations to ASR-HIIT was lower than MAS-HIIT. Individualized prescription of HIIT using ASR ensures similar physiological demands across individuals and potentially facilitates similar degrees of physiological adaptation.
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Affiliation(s)
- Geng Du
- Sports Training Department, Wuhan Sports University, Wuhan, China
| | - Tao Tao
- College of Sport, Huzhou University, Huzhou, China,*Correspondence: Tao Tao,
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Martini AD, Dalleck LC, Mejuto G, Larwood T, Weatherwax RM, Ramos JS. Changes in the Second Ventilatory Threshold Following Individualised versus Standardised Exercise Prescription among Physically Inactive Adults: A Randomised Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073962. [PMID: 35409646 PMCID: PMC8997390 DOI: 10.3390/ijerph19073962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 01/13/2023]
Abstract
The second ventilatory threshold (VT2) is established as an important indicator of exercise intensity tolerance. A higher VT2 allows for greater duration of higher intensity exercise participation and subsequently greater reductions in cardiovascular disease (CVD) risk. This study aimed to compare the efficacy of standardised and individualised exercise prescription on VT2 among physically inactive adults. Forty-nine physically inactive male and female participants (48.6 ± 11.5 years) were recruited and randomised into a 12-week standardised (n = 25) or individualised (n = 24) exercise prescription intervention. The exercise intensity for the standardised and individualised groups was prescribed as a percentage of heart rate reserve (HRR) or relative to the first ventilatory threshold (VT1) and VT2, respectively. Participants were required to complete a maximal graded exercise test at pre-and post-intervention to determine VT1 and VT2. Participants were categorised as responders to the intervention if an absolute VT2 change of at least 1.9% was attained. Thirty-eight participants were included in the analysis. A significant difference in VT2 change was found between individualised (pre vs. post: 70.6% vs. 78.7% maximum oxygen uptake (VO2max)) and standardised (pre vs. post: 72.5% vs. 72.3% VO2max) exercise groups. Individualised exercise prescription was significantly more efficacious (p = 0.04) in eliciting a positive response in VT2 (15/19, 79%) when compared to the standardised exercise group (9/19, 47%). Individualised exercise prescription appears to be more efficacious than standardised exercise prescription in eliciting a positive VT2 change among physically inactive adults. Increasing VT2 allows for greater tolerance to higher exercise intensities and therefore greater cardiovascular health outcomes.
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Affiliation(s)
- Alex D. Martini
- SHAPE Research Centre, Caring Futures Institute, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (A.D.M.); (L.C.D.); (T.L.)
| | - Lance C. Dalleck
- SHAPE Research Centre, Caring Futures Institute, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (A.D.M.); (L.C.D.); (T.L.)
- Recreation, Exercise, and Sport Science Department, Western Colorado University, Gunnison, CO 81231, USA
| | - Gaizka Mejuto
- Faculty of Education, University of the Basque Country, 48940 Leioa, Spain;
| | - Trent Larwood
- SHAPE Research Centre, Caring Futures Institute, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (A.D.M.); (L.C.D.); (T.L.)
| | - Ryan M. Weatherwax
- Health and Kinesiology Department, University of Utah, Salt Lake City, UT 84112, USA;
| | - Joyce S. Ramos
- SHAPE Research Centre, Caring Futures Institute, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (A.D.M.); (L.C.D.); (T.L.)
- Correspondence:
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Effect of frailty on physical activity levels and walking capacity in patients with peripheral artery disease: A cross-sectional study. JOURNAL OF VASCULAR NURSING 2021; 39:84-88. [PMID: 34507705 DOI: 10.1016/j.jvn.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/24/2021] [Accepted: 07/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aimed to analyze the effect of frailty on walking capacity and physical activity levels of patients with peripheral artery disease (PAD). METHODS A cross-sectional study including 216 symptomatic PAD patients (e.g. claudication) was conducted. Moreover, the frailty profile was established, for which six-minute walk test, Walking Impairment Questionnaire (WIQ), and physical activity level were evaluated. RESULTS Frailty was prevalent in 13.4%, 72.2%, and 14.4% of frail, pre-frail, and not-frail patients, respectively. Walking capacity was lower in frail patients than in not-frail patients (p < 0.024). The domains of distance and speed of WIQ were lower in frail patients than in not-frail patients, and these domains were also lower in pre-frail than in not-frail patients (p < 0.050 for all). The domain of stairs was lower in frail patients than in not-frail and pre-frail patients (p = 0.016). Physical activity levels were similar among groups (p > 0.050). CONCLUSION Frailty is associated with further walking impairment in patients with PAD.
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Duscha BD, Kraus WE, Jones WS, Robbins JL, Piner LW, Huffman KM, Allen JD, Annex BH. Skeletal muscle capillary density is related to anaerobic threshold and claudication in peripheral artery disease. Vasc Med 2020; 25:411-418. [PMID: 32841100 DOI: 10.1177/1358863x20945794] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peripheral artery disease (PAD) is characterized by impaired blood flow to the lower extremities, causing claudication and exercise intolerance. Exercise intolerance may result from reduced skeletal muscle capillary density and impaired muscle oxygen delivery. This cross-sectional study tested the hypothesis that capillary density is related to claudication times and anaerobic threshold (AT) in patients with PAD. A total of 37 patients with PAD and 29 control subjects performed cardiopulmonary exercise testing on a treadmill for AT and gastrocnemius muscle biopsies. Skeletal muscle capillary density was measured using immunofluorescence staining. PAD had decreased capillary density (278 ± 87 vs 331 ± 86 endothelial cells/mm2, p = 0.05), peak VO2 (15.7 ± 3.9 vs 24.3 ± 5.2 mL/kg/min, p ⩽ 0.001), and VO2 at AT (11.5 ± 2.6 vs 16.1 ± 2.8 mL/kg/min, p ⩽ 0.001) compared to control subjects. In patients with PAD, but not control subjects, capillary density was related to VO2 at AT (r = 0.343; p = 0.038), time to AT (r = 0.381; p = 0.020), and time after AT to test termination (r = 0.610; p ⩽ 0.001). Capillary density was also related to time to claudication (r = 0.332; p = 0.038) and time after claudication to test termination (r = 0.584; p ⩽ 0.001). In conclusion, relationships between capillary density, AT, and claudication symptoms indicate that, in PAD, exercise limitations are likely partially dependent on limited skeletal muscle capillary density and oxidative metabolism.
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Affiliation(s)
- Brian D Duscha
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - William S Jones
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer L Robbins
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Lucy W Piner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jason D Allen
- Department of Kinesiology, Curry School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
- Division of Cardiovascular Medicine, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Brian H Annex
- Department of Medicine, Medical College of Georgia, Augusta, GA, USA
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Farah BQ, Ritti-Dias RM, Montgomery P, Cucato GG, Gardner A. Exercise Intensity during 6-Minute Walk Test in Patients with Peripheral Artery Disease. Arq Bras Cardiol 2020; 114:486-492. [PMID: 32267319 PMCID: PMC7792737 DOI: 10.36660/abc.20190053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/23/2019] [Accepted: 05/15/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Non-supervised ground walking has been recommended for patients with symptomatic peripheral artery disease (PAD). However, the magnitude of the effort required by this activity and the characteristics of patients whose ground walking is more intense are unclear. OBJECTIVES To determine whether ground walking exceeds the ventilatory threshold (VT), a recognized marker of exercise intensity, in patients with symptomatic PAD. METHODS Seventy patients (61.4% male and aged 40 to 85 years old) with symptomatic PAD were recruited. Patients performed a graded treadmill test for VT determination. Then, they were submitted to a 6-minute walk test so the achievement of VT during ground ambulation could be identified. Multiple logistic regression was conducted to identify predictors of VT achievement during the 6-minute walk test. The significance level was set at p < 0.05 for all analyses. RESULTS Sixty percent of patients achieved VT during the 6-minute walk test. Women (OR = 0.18 and 95%CI = 0.05 to 0.64) and patients with higher cardiorespiratory fitness (OR = 0.56 and 95%CI = 0.40 to 0.77) were less likely to achieve VT during ground walking compared to men and patients with lower cardiorespiratory fitness, respectively. CONCLUSION More than half of patients with symptomatic PAD achieved VT during the 6-minute walk test. Women and patients with higher cardiorespiratory fitness are less likely to achieve VT during the 6-minute walk test, which indicates that ground walking may be more intense for this group. This should be considered when prescribing ground walking exercise for these patients. (Arq Bras Cardiol. 2020; 114(3):486-492).
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Affiliation(s)
| | - Raphael Mendes Ritti-Dias
- Universidade Nove de Julho - Programa de Pós-Graduação em Ciências da Reabilitação, São Paulo, SP - Brasil
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Influence of smoking on physical function, physical activity, and cardiovascular health parameters in patients with symptomatic peripheral arterial disease: A cross-sectional study. JOURNAL OF VASCULAR NURSING 2019; 37:106-112. [PMID: 31155156 DOI: 10.1016/j.jvn.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 12/24/2022]
Abstract
The aim of this study was to analyze the impact of smoking on physical activity, walking capacity, and cardiovascular health in patients with symptomatic peripheral arterial disease (PAD). This cross-sectional study included 180 patients with symptomatic PAD. Patients were classified into 3 groups according to smoking history: smoker (n = 39), ex-smoker (n = 113), and never smoker (n = 28). Physical activity levels, physical function, walking capacity, and cardiovascular health parameters (clinical blood pressure, arterial stiffness, and heart rate variability) were assessed. Smoker patients presented higher sympathetic modulation to the heart (low frequency of heart rate variability: smokers, 71 ± 17 nu; ex-smokers, 53 ± 32 nu; never smokers, 49 ± 21 nu, P < .05) and sympathovagal balance (smokers: 2.44 ± 2.76, ex-smokers: 1.14 ± 1.74, never smokers: 1.04 ± 0.99, P < .05) and lower parasympathetic modulation to the heart (high frequency of heart rate variability: smokers, 29 ± 27 nu; ex-smokers, 47 ± 32 nu; never smokers, 51 ± 21 nu, P < .05) than other patients. In conclusion, nonsignificant differences were observed on physical activity levels, physical function, blood pressure, and arterial stiffness (P > .05). Smoking impairs cardiac autonomic modulation in patients with symptomatic PAD.
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Walking Capacity Is Positively Related with Heart Rate Variability in Symptomatic Peripheral Artery Disease. Eur J Vasc Endovasc Surg 2016; 52:82-9. [DOI: 10.1016/j.ejvs.2016.03.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/30/2016] [Indexed: 01/16/2023]
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Cucato GG, Correia MDA, Farah BQ, Saes GF, Lima AHDA, Ritti-Dias RM, Wolosker N. Validation of a Brazilian Portuguese Version of the Walking Estimated-Limitation Calculated by History (WELCH). Arq Bras Cardiol 2015; 106:49-55. [PMID: 26647720 PMCID: PMC4728595 DOI: 10.5935/abc.20160004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/21/2015] [Indexed: 11/20/2022] Open
Abstract
Background The Walking Estimated-Limitation Calculated by History (WELCH) questionnaire has
been proposed to evaluate walking impairment in patients with intermittent
claudication (IC), presenting satisfactory psychometric properties. However, a
Brazilian Portuguese version of the questionnaire is unavailable, limiting its
application in Brazilian patients. Objective To analyze the psychometric properties of a translated Brazilian Portuguese
version of the WELCH in Brazilian patients with IC. Methods Eighty-four patients with IC participated in the study. After translation and
back-translation, carried out by two independent translators, the concurrent
validity of the WELCH was analyzed by correlating the questionnaire scores with
the walking capacity assessed with the Gardner treadmill test. To determine the
reliability of the WELCH, internal consistency and test-retest reliability with a
seven-day interval between the two questionnaire applications were calculated. Results There were significant correlations between the WELCH score and the claudication
onset distance (r = 0.64, p = 0.01) and total walking distance (r = 0.61, p =
0.01). The internal consistency was 0.84 and the intraclass correlation
coefficient between questionnaire evaluations was 0.84. There were no differences
in WELCH scores between the two questionnaire applications. Conclusion The Brazilian Portuguese version of the WELCH presents adequate validity and
reliability indicators, which support its application to Brazilian patients with
IC.
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Affiliation(s)
| | | | | | - Glauco Fernandes Saes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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