Resistance training (RT) improves walking ability in persons with peripheral artery disease. We conducted a meta-analysis of randomised controlled trials (RCTs) investigating the effect of RT on ...peripheral artery disease (as measured by walking ability).
We included RCTs that investigated the effect of RT on treadmill and/or 6 min walk (6-MWT) distances. RT intensity was assessed according to the American College of Sports Medicine guidelines by 1 repetition maximum or rating of perceived exertion. Standardised mean (SMD) and mean differences (MD) were calculated using a random-effects inverse variance model. Heterogeneity and bias were assessed using RevMan V.5.3. Meta-regression and meta-analysis of variance were performed as moderator analyses.
Databases (Medline, Embase, Web of Science, Cinahl and Google Scholar) were searched until July 2018.
Fifteen trials isolated RT; 7 trials compared RT with aerobic exercise. We analysed 826 patients (n=363 completing RT), with a mean age of 67.1±3.8 years. Training ranged from low-high intensity, 2-7 times per week for 17±7 weeks, with a mix of upper, lower or whole body training. Overall RT significantly improved constant load treadmill claudication onset (COD) (SMD 0.66 0.40, 0.93, p<0.00001) and total walking distance (WD) (SMD 0.51 0.23, 0.79, p=0.0003), progressive treadmill COD (SMD 0.56 0.00, 1.13, p=0.05) and total WD (SMD 0.45 0.08, 0.83, p=0.02), and 6-MWT COD (MD 82.23 m 40.91, 123.54, p<0.0001). Intensity played a role in improvement, with high-intensity training yielding the greatest improvement (p=0.02).
RT clinically improved treadmill and flat ground walking ability in persons with peripheral artery disease. Higher intensity training was associated with better outcomes. Our study makes a case for clinicians to include high-intensity lower body RT in the treatment of peripheral artery disease.
CRD42017081184.
Baecke questionnaire have been widely used to assess physical activity. However, the role of educational level on validity and reliability of Baecke questionnaire is still not stablished, being a ...factor that can potentially influence the accuracy of self-reported measures. The present study aimed to verify the validity and reliability of Baecke questionnaire for the measurement of physical activity in community dwelling adults according to education level. The sample included 251 adults (42.4±17.0 years, 55% of women). Physical activity was self-reported by Baecke questionnaire and objectively measured by accelerometer. The education level (EL) was classified by years of study into low (<8 years), medium (8–11 years) and high (>11 years). A 7-day test-retest reliability was analyzed by intraclass correlation coefficient. The relationship, agreement and validity of the Baecke questionnaire against accelerometry were analyzed by Spearman’s correlation, Kappa index, and ROC curve, respectively. The reliability of Baecke questionnaire were r = 0.97 (high EL), r = 0.78 (medium EL), and r = 0.68 (low EL). Sensitivity and specificity were 77% and 71% in high EL, 54% and 80% in medium EL and 33% and 89% in the low EL. Baecke questionnaire proved to be reliable and a valid measurement of habitual physical activity in adults with medium and high EL.
The risk of malnutrition is an important predictor of functional capacity in the elderly population. However, whether malnutrition is associated with functional capacity in patients with peripheral ...artery disease (PAD) is poorly known. To analyse the association between the risk of malnutrition and functional capacity in patients with PAD. This cross-sectional study included 135 patients with PAD of both genders, greater than or equal to50 years old, with symptomatic PAD (Rutherford stage I to III) in one or both limbs and with ankle-brachial index less than or equal to0.90. The risk of malnutrition was assessed by the short form of the Mini Nutritional Assessment-Short Form and patients were classified as having normal nutritional status (n = 92) and at risk of malnutrition (n = 43). Functional capacity was objectively assessed using the six-minute walking test (6MWT, absolute maximal distance and relativized and expressed as a percentage of health subjects), short-physical performance battery (SPPB, balance, gait speed and the sit and stand test) and the handgrip test, and subjectively, using the Walking Impairment Questionnaire and Walking Estimated-Limitation Calculated by History. The association between the risk of malnutrition and functional capacity was analysed using bivariate and multivariate logistic regression adjustments for gender, age, ankle-brachial index, body mass index, use of statins, coronary arterial disease and stroke. For all statistical analyses, significance was accepted at p<0.05. Thirty-two per cent of our patients were classified with a risk of malnutrition. The risk of malnutrition was associated with the absolute 6MWT total distance (OR = 0.994, P = 0.031) relative 6MWT total distance (OR = 0.971, P = 0.038), lowest SPPB total score (OR = 0.682, P = 0.011), sit and stand (OR = 1.173, P = 0.003) and usual 4-meter walk test (OR = 1.757, P = 0.034). In patients with PAD, the risk of malnutrition was associated with objective measurements of functional capacity.
The effects of resistance training on flow-mediated dilation (FMD), which has been the gold standard non-invasive assessment of endothelial function and is associated with the risk of cardiovascular ...events, are not well known. We conducted a systematic review to analyze the effects of resistance training on FMD.
We searched Pubmed, Embase, CINAHL, SPORTDiscuss, Scopus, Web of Science and PEDro databases for studies that met the following criteria: (a) randomized controlled trials of resistance exercise with a comparative non-exercise group or contralateral untrained limb in adults and/or elderly; (b) studies that measured post-occlusion brachial artery FMD by ultrasonography, before and after intervention. Mean differences (MDs) with 95 % confidence interval (95 % CI) were calculated using an inverse variance method with a random effects model.
Twenty-three studies were included in the meta-analysis (n = 785 participants; 53 % females). Resistance training on FMD responses showed a favorable result for the resistance training group (n = 366) compared to the control group (n = 358) (MD 2.39, 95%CI 1.65, 3.14; p<0.00001). Subgroup analysis indicated favorable results for the dynamic resistance training (n = 545; MD 2.12, 95 % CI 1.26, 2.98; p<0.00001) and isometric handgrip training (n = 179; MD 3.32, 95 % CI 1.68, 4.96; p<0.0001) compared to the control group. The effect of resistance training on FMD responses was also favorable regardless of the condition of the participants (Healthy n = 261: MD 2.11, 95 % CI 1.04, 3.18; p<0.0001; Cardiovascular disease n = 310: MD 2.89, 95 % CI 0.88, 4.90; p = 0.005; metabolic disease n = 153: MD 2.40, 95 % CI 1.59, 3.21; p<0.00001).
Resistance training improves FMD in healthy individuals and patients with cardiovascular and metabolic diseases.
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•This systematic review and meta-analysis aims to analyze the effects of resistance training on endothelial function.•Dynamic and isometric resistance training improves endothelial function in healthy subjects and those with cardiovascular and metabolic diseases.•The improvements of endothelial function is 2.28–3.32%, which is clinically relevant for cardiovascular health.
The objective of this study was to analyze the acute effects of breaking up prolonged sitting with isometric exercise on the cardiovascular health of sedentary adults. This is a three‐condition ...randomized crossover trial. The sample was comprised of 17 subjects (11 women; 29 ± 10 years old; 25,1 ± 5,1 kg/m2). The participants completed, in randomized order, three experimental conditions (control, breaks with isometric leg extension exercise, and breaks with walking), with the order of the conditions determined through simple automatic randomization. All the conditions had in common a sitting period of 3 h. During the conditions with isometric exercise and walking breaks the participants performed breaks with isometric leg extension exercise and with walking every 30 min, while in the control condition they remained seated with no breaks. Before and after this period, vascular function (primary outcome), blood pressure, and cardiac autonomic modulation (secondary outcomes) were measured. Generalized estimated equations were used to analyze the data. The results did not indicate significant interaction effects for vascular function among experimental conditions (p > 0,05 for all). We also did not find significant interaction effects for systolic or diastolic blood pressure among the conditions (p > 0,05 for all). The heart rate variability parameters did not present significant interaction effects among conditions (p > 0,05 for all). In conclusion, breaking up sitting with isometric exercise does not seem to lead to significant effects on the cardiovascular health of sedentary adults.
Peripheral arterial disease (PAD) is characterised by obstruction or narrowing of the large arteries of the lower limbs, usually caused by atheromatous plaques. Most people with PAD who experience ...intermittent leg pain (intermittent claudication) are typically treated with secondary prevention strategies, including medical management and exercise therapy. Lower limb revascularisation may be suitable for people with significant disability and those who do not show satisfactory improvement after conservative treatment. Some studies have suggested that lower limb revascularisation for PAD may not confer significantly more benefits than supervised exercise alone for improved physical function and quality of life. It is proposed that supervised exercise therapy as adjunctive treatment after successful lower limb revascularisation may confer additional benefits, surpassing the effects conferred by either treatment alone.
To assess the effects of a supervised exercise programme versus standard care following successful lower limb revascularisation in people with PAD.
We searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, two other databases, and two trial registers, most recently on 14 March 2023.
We included randomised controlled trials which compared supervised exercise training following lower limb revascularisation with standard care following lower limb revascularisation in adults (18 years and older) with PAD.
We used standard Cochrane methods. Our primary outcomes were maximum walking distance or time (MWD/T) on the treadmill, six-minute walk test (6MWT) total distance, and pain-free walking distance or time (PFWD/T) on the treadmill. Our secondary outcomes were changes in the ankle-branchial index, all-cause mortality, changes in health-related quality-of-life scores, reintervention rates, and changes in subjective measures of physical function. We analysed continuous data by determining the mean difference (MD) and 95% confidence interval (CI), and dichotomous data by determining the odds ratio (OR) with corresponding 95% CI. We used GRADE to assess the certainty of evidence for each outcome.
We identified seven studies involving 376 participants. All studies involved participants who received either additional supervised exercise or standard care after lower limb revascularisation. The studies' exercise programmes varied, and included supervised treadmill walking, combined exercise, and circuit training. The duration of exercise therapy ranged from six weeks to six months; follow-up time ranged from six weeks to five years. Standard care also varied between studies, including no treatment or advice to stop smoking, lifestyle modifications, or best medical treatment. We classified all studies as having some risk of bias concerns. The certainty of the evidence was very low due to the risk of bias, inconsistency, and imprecision. The meta-analysis included only a subset of studies due to concerns regarding data reporting, heterogeneity, and bias in most published research. The evidence was of very low certainty for all the review outcomes. Meta-analysis comparing changes in maximum walking distance from baseline to end of follow-up showed no improvement (MD 159.47 m, 95% CI -36.43 to 355.38; I
= 0 %; 2 studies, 89 participants). In contrast, exercise may improve the absolute maximum walking distance at the end of follow-up compared to standard care (MD 301.89 m, 95% CI 138.13 to 465.65; I
= 0 %; 2 studies, 108 participants). Moreover, we are very uncertain if there are differences in the changes in the six-minute walk test total distance from baseline to treatment end between exercise and standard care (MD 32.6 m, 95% CI -17.7 to 82.3; 1 study, 49 participants), and in the absolute values at the end of follow-up (MD 55.6 m, 95% CI -2.6 to 113.8; 1 study, 49 participants). Regarding pain-free walking distance, we are also very uncertain if there are differences in the mean changes in PFWD from baseline to treatment end between exercise and standard care (MD 167.41 m, 95% CI -11 to 345.83; I
= 0%; 2 studies, 87 participants). We are very uncertain if there are differences in the absolute values of ankle-brachial index at the end of follow-up between the intervention and standard care (MD 0.01, 95% CI -0.11 to 0.12; I
= 62%; 2 studies, 110 participants), in mortality rates at the end of follow-up (OR 0.92, 95% CI 0.42 to 2.00; I
= 0%; 6 studies, 346 participants), health-related quality of life at the end of follow-up for the physical (MD 0.73, 95% CI -5.87 to 7.33; I
= 64%; 2 studies, 105 participants) and mental component (MD 1.04, 95% CI -6.88 to 8.95; I
= 70%; 2 studies, 105 participants) of the 36-item Short Form Health Survey. Finally, there may be little to no difference in reintervention rates at the end of follow-up between the intervention and standard care (OR 0.91, 95% CI 0.23 to 3.65; I
= 65%; 5 studies, 252 participants).
There is very uncertain evidence that additional exercise therapy after successful lower limb revascularisation may improve absolute maximal walking distance at the end of follow-up compared to standard care. Evidence is also very uncertain about the effects of exercise on pain-free walking distance, six-minute walk test distance, quality of life, ankle-brachial index, mortality, and reintervention rates. Although it is not possible to confirm the effectiveness of supervised exercise compared to standard care for all outcomes, studies did not report any harm to participants from this intervention after lower limb revascularisation. Overall, the evidence incorporated into this review was very uncertain, and additional evidence is needed from large, well-designed, randomised controlled studies to more conclusively demonstrate the role additional exercise therapy has after lower limb revascularisation in people with PAD.
Objective To establish reference values of heart rate variability (HRV) measures in a cohort of adolescent boys and to determine the relationship between HRV and the clustering of risk factors (RFs) ...for cardiovascular disease. Study design This cross-sectional study included 1152 adolescent boys (age: 16.6 ± 1.2 years old). Demographic data, health-related habits, obesity indicators, and blood pressure were evaluated. HRV measures of time (SD of all RR intervals, root mean square of the squared differences between adjacent normal RR intervals, and the percentage of adjacent intervals over 50 ms) and frequency domains were assessed (low LF and high HF frequency). Results The components of HRV were RR interval (827 ± 128 ms), SD of all RR intervals (61.9 ± 23.5 ms), root mean square of the squared differences between adjacent normal RR intervals (54.5 ± 29.4 ms), percentage of adjacent intervals over 50 ms (29.4 ± 20.4%), LF (53 ± 16 nu), HF (47 ± 16), and LF/HF (1.44 ± 1.08). Greater sympathetic and lower parasympathetic modulation at rest were associated with higher adiposity, higher blood pressure and physical inactivity. Adolescents with 2 or more RFs also presented lower HRV than subjects with no RFs ( P < .001). Conclusions The study has provided descriptive indicators that help the interpretation of HRV results in adolescents. Lower HRV measures are associated with the clustering of cardiovascular RFs.
Physical activity is recommended as a part of a comprehensive lifestyle approach in the treatment of hypertension, but there is a lack of data about the relationship between different intensities of ...physical activity and cardiovascular parameters in hypertensive patients. The purpose of this study was to investigate the association between the time spent in physical activities of different intensities and blood pressure levels, arterial stiffness and autonomic modulation in hypertensive patients.
In this cross-sectional study, 87 hypertensive patients (57.5 ± 9.9 years of age) had their physical activity assessed over a 7 day period using an accelerometer and the time spent in sedentary activities, light physical activities, moderate physical activities and moderate-to-vigorous physical activities was obtained. The primary outcomes were brachial and central blood pressure. Arterial stiffness parameters (augmentation index and pulse wave velocity) and cardiac autonomic modulation (sympathetic and parasympathetic modulation in the heart) were also obtained as secondary outcomes.
Sedentary activities and light physical activities were positively and inversely associated, respectively, with brachial systolic (r = 0.56; P < 0.01), central systolic (r = 0.51; P < 0.05), brachial diastolic (r = 0.45; P < 0.01) and central diastolic (r = 0.42; P < 0.05) blood pressures, after adjustment for sex, age, trunk fat, number of antihypertensive drugs, accelerometer wear time and moderate-to-vigorous physical activities. Arterial stiffness parameters and cardiac autonomic modulation were not associated with the time spent in sedentary activities and in light physical activities (P > 0.05).
Lower time spent in sedentary activities and higher time spent in light physical activities are associated with lower blood pressure, without affecting arterial stiffness and cardiac autonomic modulation in hypertensive patients.
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.
To evaluate the association between erectile dysfunction and physical activity levels in a large cohort of men.
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.
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.
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.
To compare high-sensitivity C-reactive protein (hsCRP) levels according to smoking status and physical activity (PA) changes in adults. The sample consisted of 6028 participants (4833 men) who ...underwent a voluntary routine health evaluation at the Preventive Medicine Center at the Hospital Israelita Albert Einstein, Sao Paulo, Brazil, from January 2007 to December 2013. Data were collected at baseline and follow-up (2.7±1.6 years). Plasma hsCRP (in mg/L) was analyzed in both moments. Smoking status was obtained through a self-reported questionnaire, being participants classified as non-smokers, once smokers (report smoking at baseline or follow-up), and persistently smokers (reported smoking at both baseline and follow-up). PA was assessed by questionnaire in both moments, being participants classified as persistently inactive, became inactive, became active, and persistently active. The Rank Analysis of Covariance was used to compare hsCRP follow-up values according to smoking and physical activity status. Persistently smokers showed significantly higher median values of hsCRP at follow-up (1.3 mg/L, IQR:0.6-2.8) than once smokers (1.1 mg/L, IQR: 0.6-2.4) and non-smokers (1.0 mg/L, IQR: 0.5-2.2), even considering covariates (p<0.001). Persistently actives had lower levels of hsCRP at follow-up when compared to persistently inactive in the three smoking status groups (non-smokers p<0.001, once smokers p = 0.001, and persistently smokers p = 0.037). Persistently active participants had lower hsCRP values at follow-up than those persistently inactive in all the smoking status groups. Regular practice of PA is an important strategy for facing low-grade inflammation, even among smokers.
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