Heart Rate Reactivity to Acute Mental Stress is Associated With Parasympathetic Withdrawal and Adiposity in Firefighters

Abstract Background Firefighters are regularly exposed to stress and have a high incidence of cardiovascular events. Investigating cardiovascular and autonomic reactivity to acute mental stress (AMS) and its association with adiposity may contribute to explaining the increased cardiovascular risk in these professionals. Objectives To evaluate cardiovascular and autonomic reactivity to AMS in firefighters while considering adiposity parameters. Methods This study recorded the blood pressure and heart rate (HR) of twenty-five firefighters (38±8 years) at rest, while performing the Stroop color-word test to induce AMS, and recovery. Cardiac autonomic modulation (HR variability), baroreflex sensitivity (BRS — sequential method), and adiposity (electrical bioimpedance) were assessed. One-way or two-way analysis of variance followed by Tukey's post hoc test and multiple linear regression were performed. The significance level was P<0.05. Results The AMS increased mean arterial pressure (MAP — Δ16±13 mmHg) and HR (Δ14±7 bpm) ( P <0.05). These responses were associated with parasympathetic modulation withdrawal (RMSSD: baseline: 29.8±18 vs. AMS: 21.5±14 ms; High-frequency: baseline: 5.2±1.4 vs. AMS: 4.5±1.3 Ln ms 2 ; P <0.05) and decreased in the Up gain of the baroreflex (baseline: 8.9±5.1 vs. AMS: 6.3±3.0 mmHg/ms; P <0.05). Groups divided by HR reactivity peak showed parasympathetic modulation withdrawal only in firefighters with lower adiposity (RMSSD: baseline: 27.8±17.6 vs. AMS: 14.4±9.2 ms; High-Frequency: baseline: 5.3±1.2 vs. AMS: 3.8±1.4 Ln ms 2 ; P <0.05). Fat percentage (β = -0.499), BRS (β = 0.486), and sympathetic/parasympathetic balance (β = -0.351) were predictors of HR reactivity ( P <0.05). Conclusion Our results demonstrated that HR reactivity to AMS modulated by cardiac vagal withdrawal seems to be influenced by body composition in this group of firefighters.

A systematic review to investigate whether birth weight affects the autonomic nervous system in adulthood / Uma revisão sistemática para investigar se o peso ao nascer afeta o sistema nervoso autônomo na vida adulta

ABSTRACT Objective: To evaluate the relationship between birth weight and the autonomic nervous system in adulthood through a systematic review. Data source: This is a systematic review of publications without limitation of year and language. We included studies involving the autonomic nervous system and birth weight in adults. Manuscripts were selected based on electronic searches of Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Cochrane Library and Scopus databases, using "Autonomic Nervous System" OR "Heart Rate" OR "Heart Rate Variability" AND "Birth Weight" as a search strategy. This review is registered on the International Prospective Register of Systematic Reviews — PROSPERO (ID: CRD42020165622). Data synthesis: We found 894 articles; 215 were excluded for duplicity. Of the remaining 679 studies, 11 remained. Two were excluded because they did not specifically treat the autonomic nervous system or birth weight. There were nine publications, two cohort and seven cross-sectional studies. The main findings were that extreme, very low, low or high birth weight may have some impact on the autonomic nervous system in adult life. Conclusions: Birth weight outside the normality rate may have a negative influence on the autonomic nervous system, causing autonomic dysfunction and increasing the risk of cardiovascular diseases in adult life. Thus, the importance of the follow-up of health professionals from pregnancy to gestation and throughout life, with preventive care being emphasized.

RESUMO Objetivo: Avaliar a relação entre o peso ao nascer e o sistema nervoso autônomo na vida adulta por meio de uma revisão sistemática. Fontes de dados: Esta é uma revisão sistemática de publicações, sem limitação de ano e idioma. Incluímos estudos envolvendo o sistema nervoso autônomo e peso ao nascer em adultos. Os manuscritos foram selecionados das bases de dados eletrônicos Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Cochrane Library e Scopus, utilizando "Autonomic Nervous System" OR "Heart Rate" OR "Heart Rate Variability" AND "Birth Weight" como estratégia de busca. Esta revisão está registrada pelo International Prospective Register of Systematic Reviews — PROSPERO (ID: CRD42020165622). Síntese dos dados: Nós encontramos 894 artigos. Deles, 215 foram excluídos por duplicidade. Entre os 679 remanescentes, 11 permaneceram, dos quais dois foram excluídos por não tratarem especificamente do sistema nervoso autônomo ou do peso ao nascer. Restaram nove publicações, sendo duas longitudinais e sete transversais. Os principais achados foram que o peso extremo baixo, muito baixo, baixo ou alto ao nascer pode ter algum impacto no sistema nervoso autônomo na vida adulta. Conclusões: O peso ao nascer fora da normalidade pode influenciar negativamente o sistema nervoso autônomo, causando disfunção autonômica e aumentando o risco de doenças cardiovasculares na vida adulta. Assim, ressalta-se a importância do acompanhamento dos profissionais de saúde desde a gravidez até a gestação, pré-natal e ao longo da vida, com cuidados preventivos para esta situação.

Evaluation of cardiac autonomic function and low-grade inflammation in children with obesity living in the Northeast Brazilian region

Abstract Objective Evaluate autonomic function and low-grade inflammation and characterize the correlation between these variables in schoolchildren with obesity living in the Brazilian northeast region. Methods 84 children with obesity and 41 with normal weight were included in this cross-sectional study. Anthropometry, body composition, blood pressure (BP), inflammatory biomarkers, and heart rate variability (HRV) indexes were analyzed in children aged 7 to 11 years. Results children with obesity had increased systolic (p= 0.0017) and diastolic (p= 0.0131) BP and heart rate (p= 0.0022). The children with obesity displayed significantly lower SDNN, RMSSD, NN50, HF (ms), HF (nu), SD1, SD2, and higher LF (ms), LF (nu), LF/HF, SD1/SD2, DFA-α1, and DFA-α2, compared to normal weight. A lower and higher capacity for producing IL-10 (p= 0.039) and IL-2 (p= 0.009), respectively, were found in children with obesity compared to children with normal weight. Although IL-2, IL-4 and IL17A did not correlate with HRV parameters, IL-6 was positively correlated with SDNN, LF (ms) and SD2, TNF-α was positively correlated with LF/HF and SD1/SD2 ratio, and IFN-γ was positively correlated with SDNN, RMMSSD, NN50, LF (ms), HF (ms), SD1, and SD2. Conclusions The findings suggest that children with obesity have impaired autonomic function and systemic low-grade inflammation compared to children within the normal weight range, the inflammatory biomarkers were correlated with HRV parameters in schoolchildren living in the northeastern region of Brazil.

Influência do tempo de internação hospitalar sobre a variabilidade da frequência cardíaca pediátrica por meio de método linear / Influence of hospital stay on the variability of pediatric heart rate by linear method / Influencia de la estancia hospitalaria en la variabilidad de la frecuencia cardiaca pediátrica por método lineal

INTRODUÇÃO: A imobilização prolongada acarreta prejuízos sistêmicos que repercute diretamente em maiores agravos aos pacientes, dentre eles se encontra a redução da VFC, indicativo de maior morbimortalidade clínica. OBJETIVO: Analisar se o tempo de internação hospitalar influencia a modulação autonômica da frequência cardíaca em pacientes pediátricos. METODOLOGIA: Estudo longitudinal, quantitativo e prospectivo, realizado em uma enfermaria pediátrica. A amostra foi de pacientes entre 4 a 11 anos, ambos gêneros, internados dentro das primeiras 48 horas. A coleta iniciou após a assinatura do TCLE pelo responsável, seguida do colhimento dos dados pessoais e clínicos dos pacientes seguida da coleta da VFC, repetida no último dia de internação. A captação da VFC foi realizada pelo monitor Polar RS800CX. Os dados foram transferidos e passados por uma análise matemática no programa Kubios HRV2.2. Por fim, os dados foram tabulados e analisados pelo Microsoft Excel 2013 e software BioEstat® 5.3 respectivamente. RESULTADOS: Os valores lineares no domínio do tempo obtiveram média pré (IRR=644,7 com P=0,42; RMSSD= 46,1 com P=0,017 e SDNN=43,5 com P=0,017) e pós (IRR=656,3; RMSSD=34,8; SDNN=35,38) e no domínio da frequência média pré (LF=41,9 com P=0,013; HF=58,0 com P=0,013; LF/HF=1,03 com P=0,04) e pós (LF=52,2; HF=47,7; LF/HF=3,56). A correlação de Pearson na análise tanto de RMSSD pós x tempo de internação, quanto SDNN pós x tempo de internação demonstraram R=0,55 e R=0,59 respectivamente. CONCLUSÃO: Foi observado que o tempo de internação exerce influência negativa sobre a modulação autonômica da frequência cardíaca em pacientes pediátricos.

INTRODUCTION: Prolonged immobilization causes systemic damage that has a direct impact on greater harm to patients, among which is the reduction in HRV, indicative of greater clinical morbidity and mortality. OBJECTIVE: To analyze whether the length of hospital stay influences the autonomic modulation of heart rate in pediatric patients. METHODOLOGY: Longitudinal, quantitative and prospective study, carried out in a pediatric ward. The sample consisted of patients between 4 and 11 years old, both genders, hospitalized within the first 48 hours. The collection began after the signature of the TCLE by the guardian, followed by the collection of the patients' personal and clinical data, followed by the HRV collection, repeated on the last day of hospitalization. HRV capture was performed by the Polar RS800CX monitor. The data were transferred and passed through a mathematical analysis in the Kubios HRV2.2 program. Finally, data were tabulated and analyzed using Microsoft Excel 2013 and BioEstat® 5.3 software, respectively. RESULTS: Linear values in the time domain obtained mean pre (IRR=644.7 with P=0.42; RMSSD=46.1 with P=0.017 and SDNN=43.5 with P=0.017) and post (IRR=656.3; RMSSD=34.8; SDNN=35.38) and in the pre mean frequency domain (LF=41.9 with P=0.013; HF=58.0 with P=0.013; LF/HF=1,03 with P=0.04) and powders (LF=52.2; HF=47.7; LF/HF=3.56). Pearson's correlation in the analysis of both the RMSSD post x length of stay and the SDNN post x length of stay showed R=0.55 and R=0.59 respectively. CONCLUSION: It was observed that the length of stay has a negative influence on the autonomic modulation of heart rate in pediatric patients.

INTRODUCCIÓN: La inmovilización prolongada provoca daños sistémicos que repercuten directamente en un mayor perjuicio para los pacientes, entre los que se encuentra la disminución de la VFC, indicativa de una mayor morbimortalidad clínica. OBJETIVO: Analizar si la duración de la estancia hospitalaria influye en la modulación autonómica de la frecuencia cardiaca en pacientes pediátricos. METODOLOGÍA: Estudio longitudinal, cuantitativo y prospectivo, realizado en una planta de pediatría. La muestra consistió en pacientes entre 4 y 11 años, de ambos sexos, hospitalizados dentro de las primeras 48 horas. La recogida se inició tras la firma del TCLE por el tutor, seguida de la recogida de los datos personales y clínicos de los pacientes, seguida de la recogida de la VFC, repetida el último día de hospitalización. La captura de la VFC se realizó con el monitor Polar RS800CX. Los datos se transfirieron y pasaron por un análisis matemático en el programa Kubios HRV2.2. Finalmente, los datos fueron tabulados y analizados utilizando Microsoft Excel 2013 y el software BioEstat® 5.3, respectivamente. RESULTADOS: Se obtuvieron valores lineales en el dominio temporal medios pre (TIR=644,7 con P=0,42; RMSSD=46,1 con P=0,017 y SDNN=43,5 con P=0,017) y post (TIR=656,3; RMSSD=34. 8; SDNN=35,38) y en el dominio de la frecuencia media pre (LF=41,9 con P=0,013; HF=58,0 con P=0,013; LF/HF=1,03 con P=0,04) y polvos (LF=52,2; HF=47,7; LF/HF=3,56). La correlación de Pearson en el análisis tanto de la RMSSD post x duración de la estancia como de la SDNN post x duración de la estancia mostró R=0,55 y R=0,59 respectivamente. CONCLUSIÓN: Se observó que la duración de la estancia influye negativamente en la modulación autonómica de la frecuencia cardíaca en pacientes pediátricos.

Cardio-Physiological and Anthropometric Profile of Elite International Handball Players from Top Ranking Macedonian Teams / Perfil Cardiofisiológico y Antropométrico de Jugadores Internacionales de Balonmano de Élite de Equipos Macedonios de Primer Nivel

SUMMARY: Monitoring of body composition and cardiophysiological parameters are main part of the general health status of handball players and significant indicators of their physical fitness. The assessment of body components, especially skeletal muscle mass and body fat mass are important because of their influence on sport performance. The aim of this study is to determine the body composition and cardiophysiological characteristics of elite handball players from Republic of North Macedonia. 27 male HB players from two top ranking teams from RNM were tested ergometrically with Bruce protocol for determination of maximal oxygen consumption; body analysis was made with bioelectrical impedance analyzer, InBody 720. Anthropometric parameters were as follows: mean height was 190.4±7.8 cm and weight 96.3±15.5 kg, skeletal muscle mass (SMM)=47.11±6.69 kg; BMI=26.38±3.1; BF%=15.04±6.01 and WHR=0.9±1.8. The result of ergometrical test produce mean VO2 max=43.92 ml/kg/min which is 100.46 % of reference value. The body composition of elite international handball players from the top handball teams in Republic of North Macedonia showed similar body components as other European handball players. The obesity diagnose parameters were negatively associated with exercise time and maximal oxygen consumption.

El seguimiento de la composición corporal y los parámetros cardiofisiológicos son una parte principal del estado de salud general de los jugadores de balonmano y son indicadores importantes de su condición física. La evaluación de los componentes corporales, especialmente la masa muscular esquelética y la masa grasa corporal, son importantes debido a su influencia en el rendimiento deportivo. El objetivo de este estudio fue determinar la composición corporal y las características cardiofisiológicas de jugadores de balonmano de élite de la República de Macedonia del Norte. Se evaluaron 27 jugadores masculinos de HB de dos equipos de primer nivel de RNM ergométricamente con el protocolo de Bruce para determinar el consumo máximo de oxígeno; el análisis corporal se realizó con el analizador de impedancia bioeléctrica InBody 720. Los parámetros antropométricos fueron los siguientes: talla media 190,4±7,8 cm y peso 96,3±15,5 kg, masa músculo esquelética (SMM)=47,11±6,69 kg; IMC=26,38±3,1; %GC=15,04±6,01 y RCC=0,9±1,8. El resultado de la prueba ergométrica produce un VO2 máximo medio = 43,92 ml/kg/ min, que es el 100,46 % del valor de referencia. La composición corporal de los jugadores de balonmano internacionales de élite de los mejores equipos de balonmano de la República de Macedonia del Norte mostró componentes corporales similares a los de otros jugadores de balonmano europeos. Los parámetros diagnósticos de obesidad se asociaron negativamente con el tiempo de ejercicio y el consumo máximo de oxígeno.

Recuperación aguda de la frecuencia cardíaca en una sesión de functional fitness y su relación con el consumo máximo de oxígeno

Fundamento: la frecuencia cardiaca de recuperación en esfuerzos físicos es un indicador relevante para los profesionales de la salud y el deporte. Objetivo: relacionar la recuperación aguda de la frecuencia cardíaca en una sesión submáxima de functional fitness con el consumo máximo de oxígeno en sujetos físicamente activos. Mètodos: estudio descriptivo de enfoque cuantitativo con una muestra a conveniencia conformada por 14 hombres (edad 21,32±4,36 años; masa corporal 71,42±14,68 kg; talla 1,75±0,17 m; IMC 23,01±3,61 kg/m2) y 5 mujeres (edad 22,81±3,48 años; masa corporal 65,82±8,45 kg; talla 1,56±0,21 m; IMC 21,54±1,35 kg/m2), estos realizaron en dos días separados por 48 horas una prueba maximal e incremental cardiorrespiratoria (Course-Navette) y el WOD Pukie (150 burpees en el menor tiempo posible). Se registró la frecuencia cardiaca máxima, frecuencia cardiaca de la sesión, frecuencia cardiaca de recuperación (1, 2 y 3 minutos). Se aplicaron la prueba de normalidad de Shapiro-Wilk y el coeficiente correlacional de Pearson (95 % de confianza y un p-valor de 0,05). Resultados: el consumo máximo de oxígeno no se relacionó significativamente en hombres (p>0,05), en el caso de las mujeres fue positivo con la frecuencia cardiaca de recuperación en todos los lapsos, pero con significación en 1 minuto (r = 0,81; p<0,05) y 3 minutos (r = 0,93; p<0,01). Conclusiones: el consumo máximo de oxígeno se relacionó positiva y significativamente con la frecuencia cardiaca de recuperación en una sesión de functional fitness en mujeres físicamente activas.

Foundation: the recovery heart rate in physical efforts is a relevant indicator for health and sports professionals. Objective: to relate the acute recovery of the heart rate in a submaximal functional fitness session with the maximum oxygen consumption in physically active subjects. Methods: descriptive study with a quantitative approach with a convenience sample made up of 14 men (age 21.32±4.36 years; body mass 71.42±14.68 kg; height 1.75±0.17 m; BMI 23 01±3.61 kg/m2) and 5 women (age 22.81±3.48 years; body mass 65.82±8.45 kg; height 1.56±0.21 m; BMI 21.54± 1.35 kg/m2), they performed a maximal and incremental cardiorespiratory test (Course-Navette) and the WOD Pukie (150 burpees in the shortest possible time) on two days separated by 48 hours. Maximum heart rate, session heart rate, and recovery heart rate (1, 2, and 3 minutes) were recorded. The Shapiro-Wilk normality test and the Pearson correlation coefficient (95% confidence and a p-value of 0.05) were applied. Results: the maximum oxygen consumption was not significantly related in men (p>0.05), in the case of women it was positive with the recovery heart rate in all periods, but with significance in 1 minute (r = 0 .81; p<0.05) and 3 minutes (r = 0.93; p<0.01). Conclusions: maximal oxygen consumption was positively and significantly related to recovery heart rate in a functional fitness session in physically active women.

Reactividad Cardiaca ante Evocación de Eventos Estresantes en Población Universitaria / Cardiac Reactivity to Evocation of Stressful Events in a University Population

Resumen La variabilidad de la frecuencia cardiaca (VFC) se utiliza como una señal fisiológica para evaluar la reactividad psicofisiológica al estrés. El análisis en el dominio de la frecuencia de esta señal se ha usado para describir el papel del sistema nervioso autónomo en los procesos de adaptación al estrés. Sin embargo, el uso de medidas de tendencia central para reportar los resultados de distintas poblaciones desestima las diferencias individuales en la reacción frente al estrés. El objetivo de esta investigación fue caracterizar la reactividad cardiaca ante la evocación de eventos estresantes en población universitaria. Participaron 94 estudiantes de nuevo ingreso a la carrera de psicología, de dos universidades de México. Los resultados indican un decremento consistente en la banda de alta frecuencia ante la evocación de eventos estresantes, en comparación con la banda de baja frecuencia. La caracterización de la respuesta autonómica al estrés presenta dos subgrupos acoplados (co-activación y co-inhibición); y uno desacoplado. Nuestros hallazgos, ratifican la viabilidad de la banda de frecuencia alta de la VFC como un indicador estable de reactividad al estrés, y resaltan la importancia de las diferencias específicas de la actividad autonómica en la caracterización de la respuesta fisiológica al estrés.

Abstract Heart rate variability (HRV) is used as a reliable physiological signal to assess psychophysiological reactivity to stress. Frequency-domain mathematical analysis of the HRV signal provides metrics that are associated with the performance of the autonomic nervous system. However, the use of measures of central tendency to report global results in different populations underestimates individual differences in the way people react to stress and the clinical importance of this response. The objective of this research was to characterize cardiac reactivity to the evocation of stressful events in a university population. The participants were 94 new psychology students from two universities in Mexico. A psychophysiological stress assessment was performed to estimate cardiac reactivity; the evaluation consisted of the following conditions: 1) Baseline; 2) Evocation of stress; and 3) Recovery. The participants were sitting with their eyes closed and without moving during every single one of the conditions. Four subgroups were created depending on the type of cardiac reactivity to stress. The results indicate a significant consistent decrease in the high-frequency band when evoking stressful events, compared to the low-frequency band. Similar responses were observed between the low-frequency band and the high-frequency band in 60.6% of the cases, suggesting that the antagonistic autonomic balance between the two divisions of the ANS was scarce. According to the autonomic space model and the type of stress reactivity of each student, there were two subgroups characterized by co-activation and co-inhibition modes; and one subgroup characterized by uncoupled response mode. Our findings confirm the viability of the high-frequency band of HRV as a stable indicator of stress reactivity. Likewise, evidence is generated in favor of using evocative stress stimuli to assess physiological reactivity like more personal stressors. Lastly, the importance of specific differences in autonomic activity to characterize the physiological response to stress and its possible clinical utility to propose interventions and select techniques that most effectively benefit vulnerable populations are highlighted.

Heart rate recovery at 1st min after graded exercise an indicator of parasympathetic function in healthy obese young adults

Background: Heart rate recovery at 1st min (HRR 1 min) after graded treadmill exercise (GTX) is a predictor of parasympathetic function. Impaired HRR 1 min and obesity are strong predictors of metabolic syndrome and cardiovascular disorders. This study is done to asses HRR 1 min on apparently healthy obese young adults with body mass index (BMI) ?30, without any other metabolic syndrome components. Aims and Objectives: The objective of this study was to assess the parasympathetic function by estimating HRR 1 min after exercise in apparently healthy obese young adults of 18–30 years of age without any metabolic syndrome components and is compared with age- and gender-matched controls with normal BMI. Materials and Methods: Fifty obese young adults with BMI ?30 without any other metabolic syndrome component and 50 age- and gender-matched controls with BMI ?24.9 were selected and subjected to GTX according to modified Bruce protocol. Maximum heart rate reached during exercise (HRmax) and heart rate at 1st min of recovery phase (HR1min) were recorded. HRR 1 min was calculated as HRmax-HR1min and was analyzed. Results: This study showed significantly attenuated HRR 1 min in obese young adults compared to age- and gender-matched controls (mean 24.02 ± 8.87 vs. 42.42 ± 5.3, P < 0.001). Conclusion: HRR 1 min was significantly decreased in obese young adults, indicating attenuated parasympathetic function, who are at higher risk of developing chronic cardiovascular and other metabolic disorders.

Exponential modelling of heart rate recovery after a maximal exercise

Objectives: Heart rate recovery (HRR) after exercise is clinically important as a predictor of mortality. In addition, HRR is an indicator of cardiac autonomic activity, since increased vagal activity and diminished sympathetic activity return the heart rate to resting conditions after exercise. The previous attempts to model HRR using polynomial, first-order and second-order modelling have produced mixed results. In this study, we hypothesised that the double-exponential fit would model the HRR more accurately than the single-exponential fit as it would capture the activity of both autonomic arms responsible for heart rate decay and investigated the outcome of these two models on the HRR data following a maximal exercise. Materials and Methods: Exponential curve fitting was done on a set of previously published data from our laboratory. The HRR data were acquired from 40 male participants (19–38 years) after a maximal treadmill exercise. The normalised HRR data from a 5-min time window from maximal heart rate were fitted using single and double-exponential curves, to obtain, respectively, the time constants Tau and, Tau 1 and Tau 2. The goodness-of-fit of the model was assessed with Chi-square values computed for each participant data set with both models. Considering that Chi-square of zero is a perfect fit, and therefore, smaller Chi-square values indicate a better fit than larger values, we computed the difference in the Chi-square values (??2 ) between the models by subtracting the Chi-square value of the double-exponential fit from the Chi-square value of the singleexponential fit. This was based on the premise that if the calculated ??2 is positive, it would indicate a better fit with double-exponential than single-exponential decay model. The data are presented as mean ± standard deviation. Comparisons were made with Student’s t-test. Results: Data from four participants were excluded for technical reasons. The Tau of the single-exponential fit was 65.50 ± 12.13 s, while Tau 1 and Tau 2 of the double-exponential fit were 43.75 ± 18.96 s and 120.30 ± 91.32 s, respectively, the Tau 1 value being significantly lower than the Tau 2 value (P < 0.0001). Remarkably among the 36 participants, the difference in the Chi-square value was positive (127.2 ± 171.04) in 22 subjects and zero or marginally negative (?0.17 ± 0.31) in 14 subjects. Conclusion: Our results indicate that the double-exponential model fitted the HRR data better than the single-exponential model in almost two-thirds (61%) of our study population. In the remaining participants, the goodness-of-fit was nearly equivalent for both fits with no evidence of superior modelling with the singleexponential fit. Our data show that while the single-exponential fit is sufficient for modelling the HRR of 14 subjects, it was less efficient for fitting the data of most participants. In comparison, the double-exponential curve fit effectively modelled 100% of our study population. Given our findings, we conclude that the doubleexponential model is more inclusive and better represented the HRR data of our study population than the singleexponential model.

Predictors of Rehospitalization in Patients with Chronic Heart Failure a Single Center Study in Moroccan Patients

Chronic heart failure (HF) is a major problem of public health in Morocco with few studies exploring HF particularities in this country where the prevalence of HF is estimated to be around 2.2%. Objective: The aim of this study was to evaluate the correlation between frequency of rehospitalization in our population with age, left ventricular ejection fraction (LVEF), heart rate (HR), and QRS duration, Since the number of rehospitalizations is strongly correlated to mortality as shown by many studies. Materials and Methods: Patients with HF were enrolled in this retrospective case control study regardless of their LVEF, patients with recent (<3months) myocardial infarction were excluded. They were all examined and questioned in the heart failure unit of our hospital between the period of October 2022 and December 2022. The correlations were calculated by PEARSON index using R Statistical Software. Results: 224 patients were included. The mean patient age was 59 years (57.2-63;IC 95%) with a male predominance of 60.1 % (56.8-71; IC 95%). 35.5% and 32.2% of patients were treated for hypertension and diabetes respectively. The mean LVEF was 35.2% (33.96-36.91;IC 95%). A positive correlation was found between rehospitalization frequency and age and high heart rate (+ 0.42 p = 0,04;+0.322, p<0.005) respectively . Conversely a negative correlation was found with LVEF (-0.312, p<0.005) while there was a positive correlation with QRS duration but without significance (+0.162 , p=0.03). Conclusion: This study shows strong correlation between rehospitalization and advanced age, higher HR and lower LVEF.

Intervención Psicofisiológica basada en la Teoría Polivagal para Manejo del Dolor Lumbar Crónico / Psychophysiological Intervention based on the Polyvagal Theory for the Management of Chronic Low Back Pain

Resumen El dolor lumbar crónico es un padecimiento común asociado a problemas físicos y afectivos. Recientemente, Dana (2019) sugirió un conjunto de estrategias psicológicas breves, basadas en los principios de la Teoría Polivagal, para el manejo del estrés, sin embargo, su uso no se ha aplicado en el campo del dolor. El presente estudio evaluó la eficacia de un plan de tratamiento en regulación autonómica del complejo vagal ventral para la disminución de la intensidad e interferencia del dolor, así como el efecto sobre la ansiedad, la depresión y catastrofización. Mediante un estudio pre experimental, con un muestreo no probabilístico, se utilizó un diseño de medidas repetidas para evaluar los efectos de un programa breve en pacientes con lumbalgia, sobre medidas psicométricas de dolor, ansiedad, depresión y catastrofización, así como la regulación fisiológica autonómica de la Frecuencia Cardiaca y la Temperatura Periférica. Los resultados revelaron una disminución significativa (p < .05) de la interferencia del dolor del estado anímico, el trabajo, la ansiedad, depresión y la catastrofización; así como un incremento en la temperatura periférica. Esto sugiere que el tratamiento fue eficaz para el manejo de problemas afectivos de estos pacientes, y consistente con los niveles de activación fisiológica propuestos por la Teoría Polivagal.

Abstract Chronic low back pain is a common chronic pain condition, associated with physical and emotional problems. Recently, Dana (2019) suggested a set of brief psychological strategies, based on the principles of the Polyvagal Theory, for stress management in people with chronic affective problems; however, no use has not been applied in the field of pain. The purpose of this study was to evaluate the efficacy of a treatment plan based on the autonomic regulation of the ventral vagal complex for the reduction of pain intensity, mood, behavioral and social interference, as well as the effect on anxiety, depression, and catastrophizing associated with pain. Through a pre-experimental study, with a non-probabilistic demonstration, a repeated measures design was obtained to evaluate the effects of a brief program in patients with low back pain, on validated psychometric measures of pain, anxiety, depression, and catastrophizing, as well as autonomic physiological regulation. Heart rate and peripheral temperature. Results revealed a significant (p < .05) decrease in pain interference from mood, work, anxiety, depression, and catastrophizing, as well as an increase in peripheral temperature. This suggests that the treatment was effective in managing the affective problems of these patients, and consistent with the levels of physiological activation proposed by the Polyvagal Theory on the affective state.

Study of heart rate variability to assess autonomic dysfunction in patients with chronic obstructive pulmonary disease of a tertiary care hospital of West Bengal: A cross-sectional comparative study

Background: Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality throughout the world. COPD and its complications also lead to a large number of deaths every year in our country. Cardiac arrhythmias and sudden cardiac death are the major complications of COPD leading to death and disability. Such cardiac complications are often a result of autonomic dysfunction. Aims and Objectives: This study aims to find out the autonomic dysfunction in moderate COPD patients by comparing their heart rate variability (HRV) parameters with age and sex matched healthy controls. Materials and Methods: After obtaining approval from the Institutional Ethics Committee, 48 patients of moderate COPD and 54 healthy subjects were assessed and compared with respect to their HRV parameters which included Mean RR, Mean HR, SDNN, NN50, pNN50, root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF), LF/HF ratio, and SD2/SD1 ratio. Results: It was found that in comparison to healthy controls, patients of moderate COPD had significant alteration in the following HRV parameters – Mean HR (P: 0.001), RMSSD (P: 0.002), SDNN (P: 0.015), NN50 (P: 0.001), pNN50 (P: 0.000), HF (NU/normalized unit) [P: 0.033], HF (%) [P: 0.002], LF (NU/normalized unit) [P: 0.033], LF (%) [P: 0.012], and LF/HF (P: 0.033). Conclusion: As there is a significant alteration of several HRV parameters in moderate COPD patients, we conclude that HRV measurement may subserve as a simple and non-invasive tool to assess autonomic dysfunction in patients of COPD at the earliest.

A comparative study of cardiovascular responses to exercise in trained and untrained individuals

Background: This experiment has been designed for you to learn more about the way the cardiovascular system how it respond toward exercise. The prevalence of cardiovascular disease and its resultant debilitation of cardiac performance are expected to increase in the future generation. Eelier research on cardiovascular adaptations to endurance training has primarily focused on young generation. Recent work on the present study indicates that the basis of trained older male’s increased aerobic power is their superior ability to increase stroke volume during exercise, which, in turn, allows them to marked increase in cardiac output. Aims and Objectives: The aim of the study was to assess the differences in cardiovascular responses to exercise in trained and untrained individuals. Materials and Methods: In this, 100 subjects were included and divided into trained (50) and untrained (50) for a minimum of 1 year duration by the time of study and 50 untrained individuals acted as controls. Institution ethics committee permission obtained and the subjects performed four exercise sessions per week for a minimum of 1 year duration by the time of study; supervised by the personal trainers at gym center, according to instructions. Results: The mean resting heart rate (HR) of strength trained was lesser when compared to mean resting HR of untrained. Conclusion: Regular strength training exercise results in a decrease in weight, body fat, resistance of insulin, triglycerides, and an increase in excess good cholesterol levels. Regular strength training exercise if performed within normal limits decreases cardiovascular risk factors.

A correlation study of arterial stiffness, cardiac autonomic neuropathy and lipid profile in type 2 diabetes mellitus patients

Objectives: Micro and macrovasculopathy are common complications of undertreated or undiagnosed type 2 diabetes mellitus (T2DM) patients. One of the underlying factors of macrovasculopathy is arterial stiffness, which may lead to cardiovascular and cerebrovascular diseases. Understandably, diabetic micro and macrovasculopathy affect vital functions, which may affect the well-being of the individual. However, few studies have attempted to determine arterial stiffness, cardiac autonomic neuropathy (CAN) and lipid profile separately in South Asian population and examined its associations with T2DM. Moreover, there is a need to understand the mechanistic links among cardiovascular risk factors. This forms the basis of the present study. Materials and Methods: T2DM patients of 53–62 years and age- and gender-matched healthy control subjects were recruited in the cross-sectional and observational study (n = 30 each, eight women). Anthropometric measurements, physiological parameters such as resting heart rate, peripheral blood pressure (PBP), central blood pressure (CBP), augmentation index% (AIx%), brachial-ankle pulse wave velocity and lead II ECG for analysis of heart rate variability parameters were recorded after obtaining the consent of the study participants. The lipid profile and fasting blood glucose were also analysed. Results: Peripheral systolic blood pressure was significantly higher (P = 0.05) in T2DM patients. Dyslipidaemia was evident in T2DM patients. Atherogenic index of plasma (AIP) was also significantly higher in T2DM patients. Correlation analysis revealed a positive association between AIx% with PBP and CBP as well as between AIP index and central systolic blood pressure, serum triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) levels. AIP index was found to be negatively associated with HF (nu). Serum TG, high-density lipoprotein cholesterol (HDL-C) levels and AIP index have emerged as significant independent predictors of T2DM vasculopathy by multiple regression analysis. Conclusion: In the present study, atherogenic dyslipidaemia was observed in T2DM patients in combination with increased serum levels of TG, VLDL-C and decreased serum levels of HDL-C. Moreover, AIP index, a predictor cardiovascular risk, was found to be significantly higher in T2DM patients. Dyslipidaemia was found to be associated with dysregulation of autonomic nervous system in those patients. A positive association between noninvasive, surrogate markers of arterial stiffness with PBP and CBP indicates that enhanced arterial stiffness may elevate systemic arterial pressure. Therefore, early screening of T2DM patients for the estimation of serum lipid profile, arterial stiffness and cardiac autonomic neuropathy may be performed to unravel diabetic vasculopathy.

Heart rate variability in patients presenting with anginal symptoms in absence of cardiac and other diseases

Objectives: Angina is a symptom of coronary artery disease (CAD). Modulation of cardiac autonomic tone as assessed by heart rate (HR) variability (HRV) is found reduced in patients with CAD; myocardial ischemia, myocardial infarction and some other cardiovascular diseases. Reduced HRV has been found associated with sudden cardiac death in these CAD patients. Several patients present with anginal symptoms clinically in absence of CAD or other diseases. The status of HRV is not much clear in these patients. Thus, we aimed to assess HRV in patients with angina with and without myocardial ischemia and compare it with HRV of healthy subjects of similar age groups and follow-up patients for 1 year for cardiac/health events. Materials and Methods: The study included 61 consecutive male patients clinically presenting with angina and 30 healthy subjects. Based on Thallium-201 myocardial perfusion Single-photon emission computerized tomography (SPECT) imaging, patients were divided into two groups; patients with myocardial perfusion defects (MPD), (n = 33, age 54.91 ± 7.43 years) and patients with no MPD (NMPD), NMPD (n = 28, age 53.04 ± 8.50 years). Short-term HRV was assessed in all patients and subjects in resting supine position following standard protocol. All MPD and 25 NMPD patients could be followed up for 1 year for cardiac/health events. Results: Surprisingly, the NMPD patients showed significantly reduced HRV, Standard deviation of the N-N intervals, The square root of the mean squared differences of successive N-N intervals, Percentage of the number of interval differences of successive N-N intervals greater than >50 ms divided by total number of R-R intervals, low frequency (LF) power, High Frequency (HF) power and total power as compared to both MPD patients and healthy subjects. (Total power [NMPD vs. MPD]: 610.1 [379.9–1072.8] vs. 1508.0 [748.4–2339.4] millisecond squares (ms2 ), P = 0.001), healthy subjects (Total power: 1414.6 [1104.6-2141.5] ms2 , P = 0.001). The markers of sympathetic tone; LF (normalised unit) and LF/HF ratio were higher in NMPD patients as compared to MPD patients resulting in an altered sympathovagal balance. During a 1-year follow-up, sudden death was seen in one MPD patient (3.1%) and two NMPD patients (8%). Conclusion: The NMPD patients showed significantly reduced HRV as compared to both MPD patients and Healthy subjects with an altered sympathovagal balance. Sudden death was also seen in NMPD patients as MPD patients.

Effect of acupuncture on heart rate variability in individuals with multiple sclerosis: a protocol for a double-blinded randomized controlled trial / Efeito da acupuntura na variabilidade da frequência cardíaca em indivíduos com esclerose múltipla: um protocolo para ensaio randomizado controlado duplo cego

Introdução: o crescimento de pacientes com esclerose múltipla que procuram tratamento com acupuntura é baseado em relatos clínicos de melhora dos sintomas. Considerando que o comprometimento autonômico, incluindo a disfunção autonômica cardiovascular, não é incomum em pacientes com EM a neuromodulação com acupuntura pode ser uma ferramenta interessante para alterar a variabilidade da frequência cardíaca nessa população.Objetivo: avaliar a variabilidade da frequência cardíaca em pacientes com esclerose múltipla, durante a aplicação da Acupuntura, a fim de analisar o comportamento do sistema nervoso autônomo antes, durante e após a terapia e as mudanças na condição após uma intervenção longitudinal.Métodos: será realizado um ensaio clínico cruzado, randomizado, placebo-controlado, duplo-cego, com proporção de alocação de 1:1, com 40 indivíduos sem doença prévia, que constituirão o grupo controle, e 40 indivíduos com Esclerose Múltipla, que constituirão o grupo experimental. grupo, pareado por idade e sexo. Todos os participantes realizarão sessões de acupuntura ativas ou simuladas.Discussão: de acordo com os estudos encontrados, é esperada disfunção autonômica cardiovascular, com alterações na variabilidade da frequência cardíaca. Embora a neuromodulação com acupuntura possa controlar a dor e a inflamação, ainda há dificuldades em afirmar se o equilíbrio entre os sistemas simpático e parassimpático pode ser alterado pela acupuntura.

Backgroung: the growing of patients with multiple sclerosis seeking acupuncture treatment is based on clinical reports of improvements in symptoms. Considering that autonomic impairment, including cardiovascular autonomic dysfunction, is not uncommon in patients with MS, neuromodulation with acupuncture could be an interesting tool to change heart rate variability in this population.Objective: to evaluate heart rate variability in patients with multiple sclerosis, during the application of acupuncture, in order to analyze the behavior of the autonomic nervous system before, during and after therapy and changes in condition after a longitudinal intervention.Methods: a double-blinded randomized sham-controlled crossover trial with a 1:1 allocation ratio will be conducted, with 40 individuals without a previous illness, who will constitute the control group, and 40 individuals with Multiple Sclerosis, who will constitute the experimental group, paired by age and sex. All participants will undertake active or sham acupuncture sessions.Discussion: according to the studies found, cardiovascular autonomic dysfunction is expected, with alterations in heart rate variability. Although neuromodulation with acupuncture can control pain and inflammation, there are still difficulties in affirming whether the balance between the sympathetic and parasympathetic systems can be changed by acupuncture

Is there a link between heart rate variability and cognitive decline? A cross-sectional study on patients with mild cognitive impairment and cognitively healthy controls / Existe uma ligação entre a variabilidade da frequência cardíaca e o declínio cognitivo? Um estudo transversal em pacientes com deficiência cognitiva leve e controles cognitivos saudáveis

Abstract Background Given that, up to date, there is no effective strategy to treat dementia, a timely start of interventions in a prodromal stage such as mild cognitive impairment (MCI) is considered an important option to lower the overall societal burden. Although autonomic functions have been related to cognitive performance, both aspects have rarely been studied simultaneously in MCI. Objective The aim of the present study was to investigate cardiac autonomic control in older adults with and without MCI. Methods Cardiac autonomic control was assessed by means of heart rate variability (HRV) at resting state and during cognitive tasks in 22 older adults with MCI and 29 healthy controls (HCs). Resting HRV measurement was performed for 5 minutes during a sitting position. Afterwards, participants performed three PC-based tasks to probe performance in executive functions and language abilities (i.e., Stroop, N-back, and a verbal fluency task). Results Participants with MCI showed a significant reduction of HRV in the frequency-domain (high frequency power) and nonlinear indices (SD2, D2, and DFA1) during resting state compared to HCs. Older individuals with MCI exhibited decreases in RMSSD and increases in DFA1 from resting state to Stroop and N-back tasks, reflecting strong vagal withdrawal, while this parameter remained stable in HCs. Conclusion The results support the presence of autonomic dysfunction at the early stage of cognitive impairment. Heart rate variability could help in the prediction of cognitive decline as a noninvasive biomarker or as a tool to monitor the effectiveness of therapy and prevention of neurodegenerative diseases.

Resumo Antecedentes Como não existe até o momento uma estratégia eficaz para tratar a demência de comprometimento cognitivo leve (MCI, na sigla em inglês), as intervenções em um estágio prodrômico são consideradas uma opção. Embora as funções autonômicas tenham sido relacionadas ao desempenho cognitivo, ambos os aspectos raramente foram estudados simultaneamente no MCI. Objetivo Investigar o controle autonômico cardíaco em idosos com e sem MCI. Métodos O controle autonômico cardíaco foi avaliado por meio da variabilidade da frequência cardíaca (HRV, na sigla em inglês) em repouso e durante tarefas cognitivas, em 22 idosos com MCI e 29 controles saudáveis (HCs, na sigla em inglês). A medida da HRV de repouso foi realizada por 5 minutos na posição sentada. Os participantes realizaram três tarefas executadas em computador para testar o desempenho em funções executivas e habilidades de linguagem (o teste de cores e palavras - Stroop, Tarefa N-back auditiva e uma tarefa de fluência verbal). Resultados Em pacientes com MCI, observou-se uma redução significativa da HRV no domínio da frequência (potência de alta frequência) e índices não lineares (SD2, D2 e DFA1) durante o estado de repouso em comparação com os HCs. Indivíduos mais velhos com MCI exibiram diminuições em RMSSD e aumentos em DFA1 do estado de repouso para Stroop e tarefas N-back, refletindo forte recessão vagal, enquanto este parâmetro permaneceu estável em HC. Conclusão Observou-se disfunção autonômica na fase inicial da neurodegeneração. A HRV pode ajudar na previsão do declínio cognitivo, como um biomarcador não invasivo, ou como uma ferramenta para monitorar a eficácia da terapia e prevenção de doenças neurodegenerativas.

Effects of face mask on pulse rate and blood oxygenation

ABSTRACT Objective The World Health Organization and Centers for Disease Control and Prevention recommend the use of face masks in public. This study aimed to evaluate the effects of face masks on pulse rate and partial blood oxygen saturation in patients without cardiorespiratory disorders. Methods A total of 150 volunteers of both sexes were divided into three groups (n=50) according to age (children, young adults, and older adults). The partial blood oxygen saturation and pulse rate were measured for each volunteer using a digital oximeter while wearing a facial mask and remaining at rest. The masks were removed for two minutes, and partial blood oxygen saturation and pulse rate were remeasured. The materials and types of masks used were recorded. The t -test for paired samples was used to compare the mean values obtained before and after removing the masks. Results The most frequently used mask was a two-layered cloth (64.7%). A decrease in pulse rate was observed after removing the face mask in males, particularly in children (p=0.006) and young adults (p=0.034). Partial blood oxygen saturation levels increased in young adult males after mask removal (p=0.01). Conclusion The two-layer cotton tissue face masks are associated with a higher pulse rate and reduced arterial blood oxygen saturation without associated clinical disorders, mainly in adult men with a lower tolerance to breathing and ear discomfort.

Modelo Preditivo de Mortalidade por Todas as Causas em Pacientes com Insuficiência Cardíaca Usando a Variabilidade da Frequência Cardíaca / Predictive Model of All-Cause Death in Patients with Heart Failure using Heart Rate Variability

Resumo Fundamento Dados de curto e de longo prazo da variabilidade da frequência cardíaca (VFC) poderiam identificar preditores de mortalidade por todas as causas em pacientes com insuficiência cardíaca (IC). Objetivos Construir um modelo preditivo de mortalidade por todas as causas em pacientes com IC usando a VFC. Métodos Estudo retrospectivo incluindo pacientes com suspeita ou diagnóstico confirmado de IC internados por IC descompensada ou síncope e que realizaram exame de Holter 24 horas. Na análise do tônus simpático aumentado, nós avaliamos a VFC mais baixa em períodos de 10 minutos não sobrepostos em um registro contínuo de sinal eletrocardiográfico por 24 horas (VFC de curta duração). As variáveis com p<0,01 foram incluídas no modelo de regressão multivariada de Cox para determinar a ocorrência da mortalidade por todas as causas. As variáveis com significância estatística na regressão de Cox foram escolhidas para construir o modelo preditivo. Um p<0,05 foi considerado estatisticamente significativo. Resultados Um total de 116 pacientes foram incluídos, com idade média de 71,9±16,3 anos, 45,7% eram do sexo masculino. O tempo médio de acompanhamento foi de 2,83 ± 1,27 anos. Trinta e nove (33,6%) óbitos ocorreram. Na comparação de sobreviventes e não sobreviventes, as variáveis que mostraram significância estatística foram menor SDNN, menor rMSSD, idade e fração de ejeção ventricular esquerda (FEVE). Na regressão Cox, os preditores independentes de mortalidade por todas as causas foram: idade > 69 anos (HR 3,95, IC95% 1,64-9,52); FEVE≤57% (HR 4,70, IC95% 2,38-9,28) e menor rMSSD ≤12ms (HR 5,54; IC 95% 2,04-15,08). Um valor inteiro foi atribuído para cada variável. Este escore < 3 apresentou uma área sob a curva de 0,802 (IC95% 0,72-0,87). Conclusão Em pacientes com IC internados por IC descompensada ou síncope, preditores de longo prazo de mortalidade por todas as causas foram idade, FEVE, e rMSSD em 10 minutos. Esses achados indicam que mesmo breves momentos de tônus simpático elevado podem ter impacto na sobrevida, principalmente em idosos e pacientes com IC e fração de ejeção reduzida.

Abstract Background Short and long-duration heart rate variability (HRV) data from Holter monitoring could identify predictors of all-cause death in heart failure (HF) patients. Objectives To build a predictive model of all-cause death in patients with HF using HRV. Methods Retrospective study including patients with suspected or confirmed HF who were admitted for decompensated HF or syncope that underwent Holter monitoring. In analysis of augmented sympathetic tonus, we evaluated the lowest HRV in nonoverlapping 10-minutes periods throughout 24h continuous electrocardiographic signal recording (short HRV variables). Variables with p<0.01 were included in a multivariate Cox regression model to determine the occurrence of the all-cause death. Variables with statistical significance in Cox regression were chosen to build the predictive model. P<0.05 was considered significant. Results A total of 116 patients were included, mean age of 71.9±16.3 years, 45.7% men, mean follow-up of 2.83±1.27 years. Thirty-nine deaths occurred (33.6%). By comparing survivors vs. non-survivors, the variables that showed statistical significance were lowest SDNN, lowest rMSSD, age and left ventricular ejection fraction (LVEF). In Cox regression, independent predictors of all-cause death were: age>69 years (HR 3.95, 95%CI 1.64-9.52); LVEF≤57% (HR 4.70, 95%CI 2.38-9.28) and lowest rMSSD≤12ms (HR 5.54, 95%CI 2.04-15.08). An integer value was assigned to each variable. Score<3 showed AUC=0.802 (95%CI 0.72-0.87). Conclusion In HF patients hospitalized for decompensated HF or syncope, independent long-term predictors of all-cause death were age, LVEF, and 10-minutes rMSSD. These findings indicate that even brief moments of high sympathetic tone can impact survival, specifically in the elderly and patients with HF with reduced ejection fraction.

Physiological responses during walking in men and women with intermittent claudication

ABSTRACT Objective Peak oxygen consumption (VO2peak), anaerobic threshold, walking economy, and cardiovascular responses during walking are used to guide and monitor walking training in patients with peripheral artery disease and intermittent claudication. Women with peripheral artery disease and intermittent claudication present greater impairments than men, and evaluating training markers according to sex for decisions regarding walking prescription in this population is important. This study aimed to compare VO2peak, walking economy, anaerobic threshold, and cardiovascular responses during walking in men and women with peripheral artery disease and intermittent claudication. Methods Forty patients (20 men and 20 women with similar baseline characteristics) underwent a cardiopulmonary treadmill test (3.2km/h and 2% increase in slope every 2 minutes until maximal leg pain). The VO2 and rate-pressure product were assessed. Data from men and women were compared using t-tests. Results There were no significant differences between men and women (VO2peak: 15.0±4.8 versus 13.9±2.9mL∙kg-1∙min-1, p=0.38; walking economy: 9.6±2.7 versus 8.4±1.6mL∙kg-1∙min-1, p=0.09; anaerobic threshold: 10.5±3.2 versus 10.5±2.2mL∙kg-1∙min-1, p=0.98; rate pressure product at 1st stage: 13,465± 2,910 versus 14,445±4,379bpm∙mmHg, p=0.41; and rate pressure product at anaerobic threshold:13,673±3,100 versus 16,390±5,870bpm∙mmHg, p=0.08 and rate pressure product at peak exercise: 21,253±6,141 versus 21,923±7,414bpm∙mmHg, p=0.76, respectively). Conclusion Men and women with peripheral artery disease and similar baseline characteristics presented similar responses to walking, suggesting that decisions regarding walking prescription and monitoring can be made regardless of sex in this specific population.