RESUMO
PURPOSE: This study aimed to determine the association between light-intensity physical activity and the incidence of all-cause and cardiovascular mortality in patients with peripheral artery disease (PAD) limited by claudication followed for up to 18.7 yr. METHODS: A total of 528 patients with PAD and claudication were screened in Baltimore between 1994 and 2002, and 386 were deemed eligible for the study. At baseline, patients were classified into three physical activity groups: 1) physically sedentary, 2) light intensity, and 3) moderate to vigorous intensity based on a questionnaire. All-cause and cardiovascular mortality of patients through December 2014 was determined using the National Death Index and the U.S. Department of Veterans Affairs and the U.S. Department of Defense Suicide Data Repository. RESULTS: Median survival time was 9.9 yr (interquartile range, 4.9-15.7 yr; range, 0.38-18.7 yr). During follow-up, 257 patients (66.6%) died, consisting of 40/48 (83.3%) from the sedentary group, 135/210 (64.3%) from the light-intensity group, and 82/128 (64.0%) from the moderate- to vigorous-intensity group. For all-cause mortality, light-intensity activity status (hazard ratio [HR] = 0.523, P = 0.0007) and moderate- to vigorous-intensity status (HR = 0.425, P < 0.0001) were significant predictors. During follow-up, 125 patients died because of cardiovascular causes (32.4%), in which light-intensity activity status (HR = 0.511, P = 0.0113) and moderate- to vigorous-intensity activity status (HR = 0.341, P = 0.0003) were significant predictors. CONCLUSIONS: Light-intensity physical activity is associated with nearly 50% lower risk of all-cause and cardiovascular mortality in high-risk patients with PAD and claudication. Furthermore, moderate- to vigorous-intensity physical activity performed regularly is associated with 58% and 66% lower risk of all-cause and cardiovascular mortality, respectively. The survival benefits associated with light-intensity physical activity make it a compelling behavioral intervention that extends beyond improving ambulation.
Assuntos
Exercício Físico , Claudicação Intermitente/mortalidade , Doença Arterial Periférica/mortalidade , Idoso , Baltimore/epidemiologia , Causas de Morte , Feminino , Seguimentos , Humanos , Claudicação Intermitente/etiologia , Masculino , Doença Arterial Periférica/complicações , Prognóstico , Modelos de Riscos Proporcionais , Comportamento Sedentário , Fatores de TempoRESUMO
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).
FUNDAMENTO: a caminhada não supervisionada em solo tem sido indicada para pacientes com doença arterial periférica (DAP) sintomática. No entanto, a magnitude do esforço exigido por essa atividade e as características dos pacientes que a praticam com mais intensidade não estão claras. OBJETIVOS: determinar se a caminhada em solo excede o limiar ventilatório (LV), um reconhecido marcador de intensidade de exercício, em pacientes com DAP sintomática. MÉTODOS: Foram recrutados 70 pacientes (61,4% do sexo masculino e com idade entre 40 e 85 anos) com DAP sintomática. Os pacientes realizaram um teste ergométrico em esteira para definir o LV. Em seguida, foram submetidos ao teste de caminhada de 6 minutos para determinar o alcance do LV durante deambulação no solo. Realizou-se regressão logística múltipla para identificar preditores de LV durante o teste de caminhada de 6 minutos, e o valor de p<0,05 foi considerado significativo para todas as análises. RESULTADOS: Ao todo, 60% dos pacientes atingiram o LV durante o teste de caminhada de 6 minutos. Mulheres (OR = 0,18 e IC95% = 0,05 a 0,64) e pacientes com mais aptidão cardiorrespiratória (OR = 0,56 e IC 95% = 0,40 a 0,77) tiveram menor probabilidade de chegar ao LV durante a caminhada em solo em comparação a homens e pacientes com menos aptidão cardiorrespiratória, respectivamente. CONCLUSÃO: Mais da metade dos pacientes com DAP sintomática alcançou o LV durante o teste de caminhada de 6 minutos. Mulheres e pacientes com mais aptidão cardiorrespiratória têm menos probabilidade de chegar ao LV durante o teste de caminhada de 6 minutos, o que indica que a caminhada no solo pode ser mais intensa para esse grupo. Isso deve ser considerado ao se prescreverem exercícios de caminhada em solo para esses pacientes. (Arq Bras Cardiol. 2020; 114(3):486-492).
Assuntos
Doença Arterial Periférica , Adulto , Idoso , Idoso de 80 Anos ou mais , Teste de Esforço , Terapia por Exercício , Tolerância ao Exercício , Feminino , Humanos , Claudicação Intermitente , Masculino , Pessoa de Meia-Idade , Teste de Caminhada , CaminhadaRESUMO
Resumo Fundamento a caminhada não supervisionada em solo tem sido indicada para pacientes com doença arterial periférica (DAP) sintomática. No entanto, a magnitude do esforço exigido por essa atividade e as características dos pacientes que a praticam com mais intensidade não estão claras. Objetivos determinar se a caminhada em solo excede o limiar ventilatório (LV), um reconhecido marcador de intensidade de exercício, em pacientes com DAP sintomática. Métodos Foram recrutados 70 pacientes (61,4% do sexo masculino e com idade entre 40 e 85 anos) com DAP sintomática. Os pacientes realizaram um teste ergométrico em esteira para definir o LV. Em seguida, foram submetidos ao teste de caminhada de 6 minutos para determinar o alcance do LV durante deambulação no solo. Realizou-se regressão logística múltipla para identificar preditores de LV durante o teste de caminhada de 6 minutos, e o valor de p<0,05 foi considerado significativo para todas as análises. Resultados Ao todo, 60% dos pacientes atingiram o LV durante o teste de caminhada de 6 minutos. Mulheres (OR = 0,18 e IC95% = 0,05 a 0,64) e pacientes com mais aptidão cardiorrespiratória (OR = 0,56 e IC 95% = 0,40 a 0,77) tiveram menor probabilidade de chegar ao LV durante a caminhada em solo em comparação a homens e pacientes com menos aptidão cardiorrespiratória, respectivamente. Conclusão Mais da metade dos pacientes com DAP sintomática alcançou o LV durante o teste de caminhada de 6 minutos. Mulheres e pacientes com mais aptidão cardiorrespiratória têm menos probabilidade de chegar ao LV durante o teste de caminhada de 6 minutos, o que indica que a caminhada no solo pode ser mais intensa para esse grupo. Isso deve ser considerado ao se prescreverem exercícios de caminhada em solo para esses pacientes. (Arq Bras Cardiol. 2020; 114(3):486-492)
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)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doença Arterial Periférica , Caminhada , Tolerância ao Exercício , Teste de Esforço , Terapia por Exercício , Teste de Caminhada , Claudicação IntermitenteRESUMO
PURPOSE: To compare functional and cardiovascular variables of men and women with peripheral artery disease (PAD). METHODS: This observational, cross-sectional study included 67 women and 144 men (age 66 ± 9 and 67 ± 10 yr, respectively) with PAD. Patients were submitted to a clinical evaluation, 6-min walk test (6MWT) and cardiovascular evaluation, including blood pressure, arterial stiffness variables, and heart rate variability. RESULTS: Women had lower claudication onset distance (P = .033) and 6MWT distance (P < .001), and similar percentage of the predicted 6MWT distance (P > .05). Women had higher pulse pressure (P = .002), augmentation index (P < .001), augmentation index corrected by 75 bpm (P < .001), and brachial and central systolic blood pressure (P = .041 and P = .029). Diastolic blood pressure, pulse wave velocity, and heart rate variability were similar between sexes (P > .05). CONCLUSION: Although predicted 6MWT performance was similar between sexes, women had higher blood pressure and wave reflection variables compared with men. Interventions to reduce blood pressure and wave reflection should be emphasized in women with PAD.
Assuntos
Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Doença Arterial Periférica/fisiopatologia , Rigidez Vascular/fisiologia , Teste de Caminhada/estatística & dados numéricos , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores SexuaisRESUMO
OBJECTIVE: Time spent in sedentary behavior has been associated with worse inflammation and cardiometabolic biomarkers in various populations. However, the association between time spent in sedentary behavior and biomarkers remains unknown in patients with intermittent claudication. The aim of the current study was to analyze the relationship between sedentary behavior and inflammatory and cardiometabolic biomarkers in patients with symptomatic peripheral arterial disease (PAD). METHODS: The sample included 297 patients with intermittent claudication. Sedentary behavior was assessed using a step activity monitor. Biomarkers of inflammation, oxidative stress, lipid profile, insulin resistance, and endogenous fibrinolysis were assessed. Demographic data, body mass index, physical activity status, and measures of severity of PAD (ankle-brachial index, peak walking time, and ischemic window) also were obtained. RESULTS: Time spent in sedentary behavior was related with high-sensitivity C-reactive protein (b = 0.187; P = .005), glucose (b = 0.238; P < .001), fibrinogen (b = 0.167; P = .017), plasminogen activator inhibitor 1 activity (b = 0.143; P = .036), and high-density lipoprotein cholesterol (b = -0.133; P = .029). After adjustment for sex, age, physical activity status, body mass index, and severity of PAD, sedentary behavior remained related with high-sensitivity C-reactive protein (b = 0.170; P = .015), glucose (b = 0.178; P = .004), fibrinogen (b = 0.189; P = .010), and high-density lipoprotein cholesterol (b = -0.128; P = .032). CONCLUSIONS: Time spent in sedentary activities was associated with worse inflammatory and cardiometabolic profile in patients with intermittent claudication.
Assuntos
Glicemia/análise , Tolerância ao Exercício , Comportamentos Relacionados com a Saúde , Mediadores da Inflamação/sangue , Insulina/sangue , Claudicação Intermitente/sangue , Lipídeos/sangue , Comportamento Sedentário , Actigrafia/instrumentação , Idoso , Índice Tornozelo-Braço , Biomarcadores/sangue , Estudos Transversais , Teste de Esforço , Feminino , Fibrinólise , Humanos , Resistência à Insulina , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/fisiopatologia , Claudicação Intermitente/psicologia , Masculino , Pessoa de Meia-Idade , Atividade Motora , Estresse Oxidativo , Índice de Gravidade de Doença , Fatores de TempoRESUMO
BACKGROUND: The main barriers reported by the patients with claudication are related to claudication symptoms. However, it remains unclear whether these barriers are associated with physical activity levels in these patients. PURPOSE: The aim of this study was to analyze the barriers to and the factors associated with physical activity (PA) in intermittent claudication (IC) patients. METHODS: The sample included 150 IC Brazilian patients and mean age 64 ± 9 years old. Sociodemographic factors, comorbid conditions and cardiovascular risk factors, personal and environmental barriers to PA, and walking capacity (claudication onset distance-COD and peak walking distance-PWD) were obtained. PA was assessed using a pedometer over seven consecutive days. RESULTS: Patients performed 6,041 ± 3,166 steps/day. The most prevalent personal and environmental barriers to PAs were exercise-induced pain and the presence of obstacles that aggravate the leg pain. Multiple linear regression showed that level of PA was inversely associated with age (ß = -81.13; p < 0.001), lack of green areas (ß = -1363.54; p < 0.001), and positively associated with PWD (ß = 3.07; p < 0.001). CONCLUSION: Older IC patients who live in neighborhoods that lack green areas to walk in, and who have poor walking capacity present lower levels of PA.
Assuntos
Doenças Cardiovasculares/etiologia , Claudicação Intermitente/fisiopatologia , Dor/epidemiologia , Caminhada/fisiologia , Idoso , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Características de Residência , Fatores de RiscoRESUMO
We assessed the reliability of the Baltimore Activity Scale for Intermittent Claudication (BASIC) for the evaluation of physical activity levels in individuals with intermittent claudication. We also identify the characteristics of the patients that influence the reliability of this questionnaire. A total of 38 men and women with peripheral artery disease and symptoms of intermittent claudication participated in the study. BASIC was administered to patients by the same evaluator at 2 different visits, separated by 7 days. The concordance coefficient ranged from .43 (How often do you walk at a fast pace?) to .85 (What happens when you feel pain while you walk?). The concordance coefficient of BASIC total score was .60. Higher concordance coefficients were observed in women (.66 vs .55), in younger patients (.63 vs .56), and in patients with lower ankle-brachial index (.64 vs .55). The reliability of BASIC questionnaire ranged from moderate to good in patients with claudication.
Assuntos
Claudicação Intermitente/diagnóstico , Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/diagnóstico , Inquéritos e Questionários , Baltimore , Feminino , Humanos , Masculino , Atividade Motora , Reprodutibilidade dos TestesRESUMO
PURPOSES: The study's purposes were to assess the cardiovascular responses during constant-load walking and to identify predictors of this response in peripheral artery disease (PAD) patients. METHODS: Seventy-nine patients with PAD performed a constant-load treadmill test (2 mph, 0% grade). During the test, systolic blood pressure (BP), diastolic BP, and HR were obtained at the fourth minute to the last minute of exercise. Patients were also characterized by demographic measures, cardiovascular risk factors, baseline exercise performance, and vascular measures. RESULTS: During constant-load walking, there was a significant increase (P < 0.01) in systolic BP (+12 ± 10 mm Hg), diastolic BP (+6 ± 9 mm Hg), and HR (+5 ± 5 bpm). The HR responses were negatively correlated with the ischemic window (r = -0.23, P < 0.05), expressed as an area under the curve of the resting ankle systolic BP and its recovery from a maximal graded treadmill test, and positively correlated with the HR during the first minute of recovery from the maximal graded treadmill test (r = 0.27, P < 0.05). The increase in cardiovascular variables during constant-load walking was greater in subjects with a higher body mass index and in men (P < 0.05). CONCLUSIONS: Patients with PAD had an increased cardiovascular response during constant-load walking, and these responses were greater in obese patients and in men. The clinical implication is that PAD patients engaged in walking training programs, particularly men and those with obesity, require frequent assessment of cardiovascular parameters to avoid exaggerated increases in BP and HR during constant-load walking.