Symptoms of anxiety and depression and their relationship with barriers to physical activity in patients with intermittent claudication

OBJECTIVES: Although the practice of physical exercise in patients with intermittent claudication (IC) is often encouraged, adherence is low. The difficulty in performing physical training may be related to the psychological characteristics of patients with claudication. To verify the association between anxiety and depression symptoms and barriers to physical exercise and walking capacity in patients with IC. METHODS: One-hundred and thirteen patients with a clinical diagnosis of IC were included in the study. Patients underwent clinical evaluation by a vascular surgeon, answered the Beck Depression Inventory, and Beck Anxiety Inventory tests were applied by the psychologist. The patients performed the 6-minute test and reported their barriers to physical activity practice in a questionnaire. RESULTS: Patients with signs of depression had a shorter pain-free walking distance (p=0.015) and total walking distance (p=0.035) compared to patients with no signs of depression. Pain-free walking distance (p=0.29) and total walking distance (p=0.07) were similar between patients with and without signs of anxiety. Patients with symptoms of moderate to severe depression reported more barriers to physical activity practice compared to patients without signs of depression. CONCLUSION: Symptoms of anxiety and depression are prevalent among patients with peripheral arterial occlusive disease (PAD). Depression symptoms are associated with personal barriers to exercise, while anxiety symptoms are not. The main barriers to physical activity among patients with IC are exercise-induced pain and the presence of other diseases.

Is physical activity associated with resting heart rate in boys and girls? A representative study controlled for confounders / A atividade física está associada à frequência cardíaca de repouso em meninos e meninas? Estudo representativo controlado para fatores de confusão

Abstract Objective: Investigate the relationship between different domains of physical activity and resting heart rate (RHR) in boys and girls. Method: The sample included 1011 adolescents, aged between 10 and 17 years. RHR was measured by a heart rate monitor and physical activity was assessed in total and in three different domains (school, occupational, and sports practice) by a questionnaire. Anthropometry was directly obtained for body mass index and central fat. Ethnicity, sedentary behavior, and smoking habits were self-reported and used to adjust the analysis, through hierarchical linear regression. Results: Total physical activity was associated with low RHR in boys (β = −0.52; 95% CI: −0.92, −0.12) and girls (β = −0.67; 95% CI: −1.07, −0.28). Although sporting physical activities were associated with low RHR in both boys (β = −0.58; 95% CI: −1.05, −0.11) and girls (β = −0.87; 95% CI: −1.34, −0.39), occupational physical activity was related to low RHR only in boys (β = −1.56; 95% CI: −2.99, −0.14). Conclusion: The practice of physical activity in the sport practice domain and total physical activity were related to low RHR in both sexes, while occupational physical activities were associated with RHR only in boys.

Resumo Objetivo Investigar a relação entre diferentes domínios de atividade física e frequência cardíaca de repouso (FCRep) em meninos e meninas. Método A amostra incluiu 1.011 adolescentes, entre 10 e 17 anos. A FCRep foi medida por um monitor de frequência cardíaca e a atividade física foi avaliada no total e em três diferentes domínios (escolar, ocupacional e prática esportiva) através de um questionário. A antropometria foi obtida diretamente para o índice de massa corporal e gordura central. Etnia, comportamento sedentário e tabagismo foram autorrelatados e usados para ajustar a análise, através da regressão linear hierárquica. Resultados A atividade física total foi associada à baixa FCRep nos meninos (β = −0,52; IC95% −0,92; −0,12) e meninas (β = −0,67; IC95% −1,07; −0,28). Embora as atividades físicas esportivas estivessem associadas à baixa FCRep em ambos, meninos (β = −0,58; IC95% −1,05, −0,11) e meninas (β = −0,87; IC95% −1,34, −0,39), a atividade física ocupacional estava relacionada à baixa FCRep apenas em meninos (β = −1,56; IC95% −2,99; −0,14). Conclusão A prática de atividade física no domínio da prática esportiva e a atividade física total foram relacionadas à baixa FCRep em ambos os sexos, enquanto as atividades físicas ocupacionais foram associadas à FCRep apenas em meninos.

Health self-perception and its association with physical activity and nutritional status in adolescents / Autopercepção de saúde e sua associação com atividade física e estado nutricional em adolescentes

Abstract Objective: To evaluate the association between total physical activities, physical activity in free time and nutritional status with self-perceived health in adolescents of both genders. Methods: This is a quantitative study that integrates the school-based, cross-sectional epidemiological survey with statewide coverage, whose sample consisted of 6261 adolescents (14 -19 years old) selected by random conglomerate sampling. Data were collected using the Global School-based Student Health Survey. The chi-squared test (χ 2) and the Poisson regression model with robust variance were used in the data analyses. Results: It was observed that 27.3% of the adolescents had a negative health self-perception, which was higher among girls (33.0% vs. 19.0%, p < 0.001). After adjusting for potential confounding factors, it was observed that boys who did not practice physical activity during free time (PR = 1.44, 95% CI: 1.15 -1.81) and were classified as insufficiently active (PR = 1.27, 95% CI: 1.04 -1.56), as well as girls who did not practice physical activity during free time (PR = 1.15, 95% CI: 1.02 -1.29) and were classified as overweight (PR = 1.27, 95% CI: 1.01 -1.29) had a greater chance of negative health self-perception. Conclusion: Behavioral issues may have different effects on health self-perception when comparing boys with girls. Negative health self-perception was associated with nutritional status in girls and a lower level of physical activity in boys, and the practice of physical activity in the free time was considered a protective factor against a negative health self-perception for adolescents of both genders.

Resumo Objetivo: Avaliar a associação entre atividade física total, atividade física no tempo livre e estado nutricional com a autopercepção de saúde em adolescentes de ambos os sexos. Métodos: Trata-se de um estudo com abordagem quantitativa, que integra o levantamento epidemiológico transversal de base escolar e abrangência estadual, cuja amostra foi constituída por 6.261 adolescentes (14 a 19 anos) selecionados por meio de uma estratégia de amostragem aleatória de conglomerados. Os dados foram coletados a partir do questionário Global School-based Student Health Survey. O teste de qui-quadrado (χ2) e o modelo de regressão de Poisson com variância robusta foram usados nas análises dos dados. Resultados: Observou-se que 27,3% dos adolescentes tinham uma autopercepção de saúde negativa, maior entre as meninas (33,0% vs. 19,0%; p < 0,001). Após o ajuste pelos potenciais fatores de confusão, constatou-se que tinham maior chance de ter uma autopercepção de saúde negativa os meninos que não praticavam atividade física no tempo livre (RP = 1,44; IC 95%: 1,15-1,81) e que eram classificados como insuficientemente ativos (RP = 1,27; IC 95%: 1,04-1,56) e as meninas que não praticavam atividade física no tempo livre (RP = 1,15; IC 95%: 1,02-1,29) e que eram classificadas como sobrepesadas (RP = 1,27; IC 95%: 1,01-1,29). Conclusão: Questões comportamentais podem ter diferentes repercussões na autopercepção de saúde quando comparados os meninos e meninas. A autopercepção de saúde negativa esteve associada ao estado nutricional entre as meninas e a um menor nível de atividade física entre os meninos e a prática de atividade física no tempo livre foi tida como fator de proteção para uma autopercepção de saúde negativa para os adolescentes de ambos os sexos.

Acute blood pressure responses after different isometric handgrip protocols in hypertensive patients

OBJECTIVE: The present study analyzed blood pressure responses after a single session of isometric handgrip exercise performed with different volumes and intensities by patients with hypertension. METHODS: This randomized crossover trial submitted 12 hypertensive patients (58±5 years old) to four isometric handgrip exercise sessions in a random order: 4 x 2 min at 30% of the maximal voluntary contraction (S30%); 4 x 2 min at 50% of the maximal voluntary contraction (S50%2min); 4 x 3 min at 30% of the maximal voluntary contraction (S30%3min); and a control session. The systolic and diastolic blood pressure, heart rate, and rate-pressure product were measured pre- and post-exercise (30th min). RESULTS: No significant changes were observed in cardiovascular variables after any session (p>0.05 for all comparisons). Similarly, individual analyses revealed heterogeneity in the responses, including increases in blood pressure observed in some sessions. Patients with reduced blood pressure after an isometric handgrip exercise session exhibited a higher body mass index, diastolic blood pressure and heart rate (p<0.05). They also tended to be younger (p=0.07). CONCLUSION: Isometric handgrip exercise performed with different intensities and volumes did not reduce the blood pressure of hypertensive patients.

Effects of isometric handgrip training in patients with cardiovascular disease: rationale and design of the ISOPRESS network

Meta-analytical studies have indicated that isometric handgrip training promotes significant reduction in blood pressure in hypertensive patients with similar or greater decreases in blood pressure than observed after aerobic and dynamic resistance training. However, several gaps in the literature still need to be addressed. Thus, we designed the ISOPRESS network group, which consists of a task force of different research groups aimed at analyzing the effects of isometric handgrip training on different contexts, parameters, and populations. Thus, the aim of this study was to describe the rationale and design behind the ISOPRESS, presenting the methods employed. The ISOPRESS questions involve whether isometric handgrip training is effective in hypertensives in different settings (ISOPRESS 1 - unsupervised training and ISOPRESS 2 - public health system), whether it works in patients with other cardiovascular diseases (ISOPRESS 3 - obstructive sleep apnea and ISOPRESS 4 - peripheral artery disease) and what are the mechanisms underlying the effects of isometric handgrip training in hypertensives (ISOPRESS 5 - neural mechanism). The study will yield information on the effectiveness of isometric handgrip training in different settings and patients with other cardiovascular diseases. Finally, it will help to understand the mechanisms involved in reducing blood pressure in hypertensives.(AU)

Association between general and abdominal obesity with high blood pressure: difference between genders / Associação entre a obesidade geral e abdominal com a pressão arterial elevada: diferença entre gêneros

Abstract Objective: To assess the association between general and abdominal obesity with high blood pressure in adolescents of both genders from the public school system. Methods: This was an epidemiological, descriptive, exploratory study, with a quantitative approach and local scope whose sample consisted of 481 high school students (aged 14–19), selected by using a random cluster sampling strategy. Blood pressure was measured through the use of automated monitor and was considered high when the pressure values were at or above the 95th percentile. The analyses were performed using the chi-squared test and binary logistic regression. Results: The prevalence of high blood pressure was 6.4%, and it was higher among boys (9.0% vs. 4.7%, p < 0.05). There was no significant difference between general (p = 0.903) and abdominal obesity (p = 0.157) when genders were compared. After adjusting for age, high blood pressure was associated with general (OR = 6.4; p < 0.001) and abdominal obesity (OR = 7.0; p < 0.001) only among boys, when comparing the fourth quartile with the first quartile of body mass index (≤18.6 kg/m2 vs. ≥23.5 kg/m2) and waist circumference (≤69 cm vs. ≥80.1 cm). Conclusion: It was observed that general and abdominal obesity are associated with high blood pressure only in boys, regardless of age.

Resumo Objetivo: Analisar a associação entre obesidade geral e abdominal com a pressão arterial elevada em adolescentes de ambos os gêneros da rede de ensino público. Métodos: Estudo epidemiológico, descritivo, exploratório, com abordagem quantitativa e abrangência municipal, cuja amostra foi constituída de 481 estudantes (14-19 anos) do ensino médio, selecionados por meio de uma estratégia de amostragem aleatória de cluster. A pressão arterial foi medida com equipamentos automáticos e considerada elevada quando os valores pressóricos estivessem iguais ou acima do percentil 95. As análises foram feitas com os testes de qui-quadrado e da regressão logística binária. Resultados: A prevalência de pressão arterial elevada foi de 6,4%, maior entre os rapazes (9% vs. 4,7%, p < 0,05). Não foi observada diferença significante entre a obesidade geral (p = 0,903) e abdominal (p = 0,157) quando comparados os gêneros. Após o juste pela idade, a pressão arterial elevada foi associada com a obesidade geral (OR = 6,4; p < 0,001) e abdominal (OR = 7,0; p < 0,001) apenas entre os rapazes, quando comparado o quarto quartil com o primeiro quartil do índice de massa corporal (≤ 18,6 Kg/m2 vs. ≥23,5 Kg/m2) e da circunferência da cintura (≤ 69 cm vs. ≥80,1 cm). Conclusão: Foi observado que a obesidade geral e abdominal está associada com a pressão arterial elevada apenas entre os rapazes, independentemente da idade.

Low-intensity resistance exercise does not affect cardiac autonomic modulation in patients with peripheral artery disease

OBJECTIVE: To analyze the effect of a single bout of resistance exercise on cardiac autonomic modulation in patients with peripheral artery disease. METHODS: Fifteen patients with peripheral artery disease (age: 58.3±4.0 years) underwent the following sessions in a random order: resistance exercise (three sets of 10 repetitions of the six resistance exercises with a workload of 5-7 in the OMNI-RES scale) and control (similar to the resistance session; however, the resistance exercises were performed with no load). The frequency domain (low frequency, high frequency and sympathovagal balance) and symbolic analysis (0V, 1V and 2V patterns) of heart rate variability were obtained before and until one hour after the interventions. RESULTS: After the resistance exercise and control sessions, similar increases were observed in the consecutive heartbeat intervals (control: 720.8±28.6 vs. 790.9±34.4 ms; resistance exercise: 712.9±30.1 vs. 756.8±37.9 ms; p<0.05) and in the pattern of the symbolic analysis with no variation (0V) (control: 25.1±3.5 vs. 33.4±4.1%; resistance exercise: 26.1±3.2 vs. 29.7±3.5%; p<0.05) until 50 min after both interventions. The pattern of two variations (2V) decreased similarly (control: 11.2±2.1 vs. 8.3±2.1%; resistance exercise: 9.5±1.7 vs. 7.8±1.7%; p<0.05). In contrast, the pattern of one variation (1V), the low and high frequency bands and sympathovagal balance did not change after the interventions (p>0.05). CONCLUSION: A single bout of resistance exercise did not alter cardiac autonomic modulation in patients with peripheral artery disease. .

Detecção de hipertensão arterial em adolescentes através de marcadores gerais e adiposidade abdominal / High blood pressure detection in adolescents by clustering overall and abdominal adiposity markers / Detección de hipertensión arterial en adolescentes por medio de marcadores generales y adiposidad abdominal

FUNDAMENTO: A obesidade está ligada à hipertensão arterial (HA) na infância. Entretanto, o papel da gordura como preditor de HA em adolescentes permanece desconhecido. OBJETIVO: Investigar a associação entre obesidade geral e abdominal com HA e identificar a sensibilidade e especificidade desses indicadores para detectar HA em adolescentes. MÉTODOS: A amostra consistiu em 1.021 adolescentes com idade de 10-17 anos. Os indivíduos foram classificados como normal, sobrepeso/obesidade, de acordo com as medidas do IMC, e como não-obeso com obesidade abdominal, de acordo com as medidas da circunferência da cintura (CC). A pressão arterial sistólica (PAS) e diastólica (PAD) foi avaliada através de um dispositivo oscilométrico. Regressão logística e curvas ROC foram usadas na análise estatística. RESULTADOS: A prevalência geral de HA foi 11,8 por cento (13,4 por cento em meninos e 10,2 por cento em meninas). A prevalência de HA em meninos e meninas com sobrepeso/obesidade foi 10 por cento e 11,1 por cento, respectivamente. A prevalência de HA em meninos com obesidade abdominal foi 28,6 por cento. Para ambos os sexos, o odds ratio (OR) para HA foi mais alto na obesidade abdominal do que no sobrepeso/obesidade geral (4,09 [OR IC95 por cento = 2,57-6,51]) versus 1,83 [OR IC95 por cento = 1,83-4,30]). O OR para HA foi mais alto quando sobrepeso/obesidade geral e obesidade abdominal estavam agrupados (OR = 4,35 [OR IC95 por cento = 2,68 -7,05]), do que quando identificados como sobrepeso/obesidade geral ou obesidade abdominal apenas (OR = 1,32 [OR IC95 por cento = 0,65- 2,68]). Entretanto, ambos os tipos de obesidade apresentavam baixo poder preditivo na detecção de HA. CONCLUSÃO: Obesidade geral e obesidade abdominal foram associadas com HA; entretanto, a sensibilidade e especificidade dessas variáveis na detecção de HA são baixas em adolescentes brasileiros.

BACKGROUND: Obesity is linked to high blood pressure (HBP) in childhood. However, the role of fat as a predictor of HBP in adolescents remains unknown. OBJECTIVE: To investigate the association between general and abdominal obesity with HBP and to identify the sensitivity and specificity of these indicators to detect HBP in adolescents. METHODS: The sample was composed of 1,021 adolescents aged 10-17 years. Subjects were classified as normal, overweight/obese, according to BMI measurements, and as non-obese and with abdominal obesity, according to waist circumference (WC) measurements. Systolic (SBP) and diastolic (DBP) blood pressure were assessed using an oscillometric device. Logistic regression and ROC curves were used in the statistical analysis. RESULTS: The overall prevalence of HBP was 11.8 percent (13.4 percent in boys and 10.2 percent in girls). The prevalence of HBP among general overweight/obese boys and girls was 10 percent and 11.1 percent, respectively. The prevalence of HBP among boys with abdominal obesity was 28.6 percent. For both genders, the odds ratio (OR) for HBP was higher in abdominal obesity than in general overweight/obesity (4.09 [OR95 percentCI = 2.57-6.51]) versus 1.83 [OR95 percentCI = 1.83-4.30]). The OR for HBP was higher when general overweight/obesity and abdominal obesity were clustered (OR = 4.35 [OR95 percentCI = 2.68-7.05]), than when identified by either general overweight/obesity or abdominal obesity alone (OR = 1.32 [OR95 percentCI = 0.65-2.68]). However, both types of obesity had low predictive power in HBP detection. CONCLUSION: General and abdominal obesity were associated to HBP, however, the sensitivity and specificity of these variables to detect HBP are low in Brazilian adolescents.

FUNDAMENTO: La obesidad está vinculada a la hipertensión arterial (HA) en la infancia. Sin embargo, el papel de la grasa como predictor de HA en los adolescentes permanece sin conocerse. OBJETIVO: Investigar la asociación entre la obesidad general y abdominal con HA e identificar la sensibilidad y la especificidad de esos indicadores para detectar HA en adolescentes. MÉTODOS: La muestra se constituyó de 1.021 adolescentes con una edad entre los 10 a los 17 años. Los individuos se clasificaron como normal, sobrepeso/obesidad, de acuerdo con las medidas del IMC, y como no obeso con obesidad abdominal, de acuerdo con las medidas de la circunferencia de la cintura (CC). La presión arterial sistólica (PAS) y diastólica (PAD), se evaluaron por medio de un dispositivo oscilométrico. La regresión logística y las curvas ROC fueron usadas en el análisis estadístico. RESULTADOS: La prevalencia general de HA rondó el umbral del 11,8 percent (13,4 percent en niños y 10,2 percent en niñas). La prevalencia de HA en niños y niñas con sobrepeso/obesidad fue 10 percent y 11,1 percent, respectivamente. La prevalencia de HA en niños con obesidad abdominal fue 28,6 percent. Para ambos sexos, el odds ratio (OR) para HA fue más alto en la obesidad abdominal que en el sobrepeso/obesidad general (4,09 [OR IC95 percent = 2,57-6,51]) versus 1,83 [OR IC95 percent = 1,83-4,30]). El OR para HA fue más alto cuando el sobrepeso/obesidad general y la obesidad abdominal estaban agrupados (OR = 4,35 [OR IC95 percent = 2,68-7,05]), que cuando estaban identificados como sobrepeso/obesidad general u obesidad abdominal solamente (OR= 1,32 [OR IC95 percent = 0,65-2,68]). Pero los dos tipos de obesidad presentaban un bajo poder predictivo en la detección de HA. CONCLUSIÓN: La obesidad general y la obesidad abdominal estuvieron asociadas a la HA; pero la sensibilidad y la especificidad de esas variables en la detección de HA son bajas en los adolescentes brasileños.