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.

Comparação entre os métodos subjetivo e objetivo para avaliação da capacidade funcional durante tratamento clínico em pacientes com claudicação intermitente / Comparison between subjective and objective methods to assess functional capacity during clinical treatment in patients with intermittent claudication

OBJETIVO: Verificar se há relação entre a medida da capacidade funcional avaliada subjetiva e objetivamente em relação ao estado atual e após tratamento clínico em pacientes com claudicação intermitente. MÉTODOS: Foram recrutados 500 pacientes com claudicação intermitente. Todos realizaram exame clínico e foram submetidos a uma avaliação funcional por meio do método subjetivo (consulta clínica) e objetivo (teste de esteira). Adicionalmente, 50 pacientes foram selecionados para se avaliar o efeito do tratamento clínico, pelos métodos subjetivo e objetivo, em relação à capacidade funcional. RESULTADOS: Dos 500 pacientes selecionados, somente 60 (12,0%) apresentaram valores referidos e observados similares. Os demais pacientes, ou seja, 440 (88,0%) apresentaram valores relatados discordantes em relação àqueles obtidos no teste de esforço. Com relação ao efeito do tratamento clínico em relação à capacidade funcional, os resultados foram similares entre ambos os métodos (χ²=1,7; p=0,427). CONCLUSÃO: Apesar de o método subjetivo superestimar os valores de capacidade funcional, quando comparados ao método objetivo, não foram observadas diferenças significantes entre ambos os métodos, quando se analisou o efeito do tratamento clínico. Assim, o método subjetivo fornece informações similares em comparação à medida objetiva no acompanhamento do tratamento clínico de pacientes com claudicação intermitente.

OBJECTIVE: To analyze if there is any relation between functional capacity assessed by subjective and objective methods regarding the current state and after clinical treatment in patients with intermittent claudication. METHODS: A total of 500 patients with intermittent claudication were enrolled. All patients underwent clinical examination and a functional evaluation by subjective (clinical visit) and objective method (treadmill test). Additionally, 50 patients were selected to evaluate the effect of clinical treatment by subjective and objective methods in relation to functional capacity. RESULTS: Out of 500 patients, only 60 (12.0%) had similar results in both methods. The remaining, that is 440 patients (88.0%) had subject values in disagreement with stress test findings. Regarding the clinical effect of the treatment on the functional outcomes, results were similar in both methods (χ²=1.7; p=0.427). CONCLUSION: Although the subjective method overestimates the functional capacity when compared to the objective method, no significant differences were observed between both methods when analyzing the effect of clinical treatment. Thus, the subjective method provides similar information as compared with objective method, in monitoring the clinical treatment of patients with intermittent claudication.

Remote ischemic preconditioning in patients with intermittent claudication

OBJECTIVE: Remote ischemic preconditioning (RIPC) is a phenomenon in which a short period of sub-lethal ischemia in one organ protects against subsequent bouts of ischemia in another organ. We hypothesized that RIPC in patients with intermittent claudication would increase muscle tissue resistance to ischemia, thereby resulting in an increased ability to walk. METHODS: In a claudication clinic, 52 ambulatory patients who presented with complaints of intermittent claudication in the lower limbs associated with an absent or reduced arterial pulse in the symptomatic limb and/or an ankle-brachial index <0.90 were recruited for this study. The patients were randomly divided into three groups (A, B and C). All of the patients underwent two tests on a treadmill according to the Gardener protocol. Group A was tested first without RIPC. Group A was subjected to RIPC prior to the second treadmill test. Group B was subjected to RIPC prior to the first treadmill test and then was subjected to a treadmill test without RIPC. In Group C (control group), both treadmill tests were performed without RIPC. The first and second tests were conducted seven days apart. Brazilian Clinical Trials: RBR-7TF6TM. RESULTS: Group A showed a significant increase in the initial claudication distance in the second test compared to the first test. CONCLUSION: RIPC increased the initial claudication distance in patients with intermittent claudication; however, RIPC did not affect the total walking distance of the patients. .