Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women.

OBJECTIVE: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. METHODS: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. RESULTS: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. CONCLUSION: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease. BACKGROUND: ▪ Sitting time increased in 73.9% of women and 84.9% of men at the onset of the pandemic. BACKGROUND: ▪ Physical activity was practiced by 23.9% of women and 39.6% of men at the onset of the pandemic. BACKGROUND: ▪ The prevalence of both women and men reporting physical mobility difficulties increased at follow-up. BACKGROUND: ▪ Hospitalization rates for reasons unrelated to COVID-19 have increased in both women and. BACKGROUND: While women experience more consequences related to peripheral artery disease than men, such as worse functional capacity and higher morbidity, there was a similar increase in physical mobility difficulty and frequency of hospitalization for reasons other than COVID-19 one year after the onset of the pandemic.

Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease.

Impact of physical activity on self-reported health parameters in peripheral artery disease in two periods of the COVID-19 pandemic.

BACKGROUND: Prolonged social isolation intended to mitigate the spread of Coronavirus 2019 (COVID-19), may potentially affect the physical activity level and health of patients with peripheral artery disease (PAD). OBJECTIVES: To analyze the impact of physical activity practice on longitudinal changes in self-reported health parameters during the COVID-19 pandemic in patients with PAD. DESIGN: Longitudinal study. SETTING: The database of studies developed by our group involving patients with PAD from public hospitals in São Paulo, Brazil. METHODS: In this longitudinal study, 99 patients with PAD were evaluated in two periods during the COVID-19 pandemic (i.e., May to August 2020 and May to August 2021). Patients were interviewed by telephone, and information was obtained regarding physical activity practice and self-reported health (i.e., current global, physical, and mental health). Patients were divided into two groups: the physically inactive group (patients who were or became physically inactive, n=76, 51.3% male, 67±10 years old, 8±7 years of disease duration) and the physically active group (patients who started or continued practicing physical activity, n=23, 65.2% male, 71±8years old, 7±6 years of disease). RESULTS: The physically inactive group more frequently self-reported their current health as poor (6.6 vs. 17.1%, P=0.045) and were more frequently hospitalized for reasons other than COVID-19 (6.6 vs. 27.6%, P=0.001) between the two periods evaluated during the COVID-19 pandemic. The physically active group self-reported lower declines in walking capacity (13.0 vs. 43.5%, P=0.022) between the two periods evaluated. We did not observe any differences in other parameters in either group between the two periods evaluated (p>0.05). CONCLUSIONS: The practice of physical activity during the COVID-19 pandemic can help maintain or mitigate the negative impacts on self-reported global and physical health parameters in patients with PAD.

Impacto do câncer em pacientes com doença arterial periférica / Impact of cancer in patients with peripheral artery disease

Introdução e Objetivo: O impacto do câncer em pacientes com DAP sobre nível de atividade física diária, capacidade funcional, função cardiovascular e qualidade de vida ainda não é conhecido, sendo, portanto, o objetivo deste presente estudo. Métodos: Estudo transversal com 299 pacientes. Nível de Atividade física (acelerômetro), capacidade funcional (teste de caminhada de 6 minutos, Handgrip, Short Physical Performance Battery, Walking Impairment Questionnaire-WIQ e o Walking Estimated-Limitation Calculated by History), função cardiovascular (pressão arterial braquial, variabilidade da frequência cardíaca e rigidez arterial) e qualidade de vida (WHOQOL-bref) foram comparados entre os pacientes com DAP com e sem histórico de câncer. Resultados: Pacientes com DAP e câncer (N=27) apresentaram melhor desempenho no domínio da distância e da velocidade do WIQ (21±37 vs 14±26, p=0.036; 29±18 vs 22±15, p=0.022, respectivamente) comparado aos pacientes com DP sem câncer. Os outros parâmetros foram similares entre os grupos. Conclusão: Os pacientes com DAP e câncer apresentaram

Introduction and Objective: The impact of cancer in patients with PAD on the level of daily physical activity, functional capacity, cardiovascular function and quality of life is not yet known, thus being the objective of this present study. Methods: Cross-sectional study with 299 patients. Physical activity level (accelerometer), functional capacity (6-minute walk test, Handgrip, Short Physical Performance Battery, Walking Impairment Questionnaire-WIQ and the Walking Estimated-Limitation Calculated by History), cardiovascular function (brachial blood pressure, variability of heart rate and arterial stiffness) and quality of life (WHOQOL-bref) were compared between patients with PAD with and without a history of cancer. Results: Patients with PAD and cancer (N=27) performed better in the distance and speed domains of the WIQ (21±37 vs 14±26, p=0.036; 29±18 vs 22±15, p=0.022, respectively) compared to PD patients without cancer. The other parameters were similar between groups. Conclusion: Patients with PAD and cancer had better results for subjectively assessed functional capacity.

Association between mental health and sleep quality in peripheral artery disease patients: a longitudinal study / Associação entre saúde mental e qualidade do sono em pacientes com doença arterial periférica: estudo longitudinal

Objective: To analyze the longitudinal association between mental health and sleep quality in peripheral artery disease (PAD) patients in two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 PAD patients were evaluated in two years of COVID-19 pandemic (2020 and 2021). Patients were interviewed by telephone call, and information regarding mental health (anxiety, unhappiness, stress and depression) and sleep quality (sleep change, difficulty to sleep and sleep improvement) were obtained. Patients were divided into: no symptoms (patients that reported no mental health symptoms, n=31, 68.2±9.4 y.o.) and one or more symptoms (patients with at least one mental health symptom, n=68, 68.1±9.4 y.o.). Results: In 2020, mental health symptoms were associated with sleep change (OR=5.018; p=0.020), difficulty to sleep (OR=12.250; p=0.003) and sleep improvement (OR=0.104; p=0.003). In 2021, mental health was associated only with sleep change (OR=3.522; p=0.035). Conclusion: The impact of mental health symptoms on sleep quality of PAD patients was attenuated along the coronavirus pandemic.

Objetivo: Analisar a associação longitudinal entre saúde mental e qualidade do sono em pacientes com doença arterial periférica (DAP) em dois períodos da pandemia de COVID-19. Métodos: Neste estudo longitudinal, 99 pacientes com DAP foram avaliados em dois anos de pandemia de COVID-19 (2020 e 2021). Os pacientes foram entrevistados por telefone, obtendo-se informações sobre saúde mental (ansiedade, infelicidade, estresse e depressão) e qualidade do sono (alteração do sono, dificuldade para dormir e melhora do sono). Os pacientes foram divididos em: sem sintomas (pacientes que não relataram sintomas de saúde mental, n=31, 68,2±9,4 anos) e um ou mais sintomas (com pelo menos um sintoma de saúde mental, n=68, 68,1±9,4 anos). Resultados: Em 2020, os sintomas de saúde mental foram associados à alteração do sono (OR=5,018; p=0,020), dificuldade para dormir (OR=12,250; p=0,003) e melhora do sono (OR=0,104; p=0,003). Em 2021, a saúde mental esteve associada apenas à alteração do sono (OR=3,522; p=0,035). Conclusão: O impacto dos sintomas de saúde mental na qualidade do sono de pacientes com DAP foi atenuado durante a pandemia de coronavírus.

Effects of Breaking Up Prolonged Sitting on Cardiovascular Parameters: A systematic Review.

The aim of this systematic review was to analyze the acute and chronic effects of sitting breaks on cardiovascular parameters. PubMed and Web of Science databases were searched by two independent researchers for relevant studies published until February 2020. Acute or chronic studies reporting the effects of sitting breaks or reduction in sitting time on cardiovascular parameters were examined. The eligibility criteria followed PICOS: Population - Humans ≥ 18 years old; Interventions - Sitting break strategies; Comparisons - Uninterrupted sitting; Outcomes - Cardiovascular parameters (blood pressure, heart rate, ambulatory blood pressure, vascular function, pulse-wave velocity, cerebral blood flow and biomarkers); Study design - Randomized controlled trials, non-randomized non-controlled trials and randomized crossover trials. Forty-five studies were included, where 35 investigated the acute and 10 the chronic effects of sitting breaks or reductions in sitting time. Walking was the main acute study strategy, used in different volumes (1 min 30 s to 30 min), intensities (light to vigorous) and frequencies (every 20 min to every 2 h). Acute studies found improvements on cardiovascular parameters, especially blood pressure, flow-mediated dilation, and biomarkers, whereas chronic studies found improvements mostly on blood pressure. Breaking up or reducing sitting time improves cardiovascular parameters, especially with walking.

Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial

ABSTRACT BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P < 0.05; control: 126 ± 4 versus 126 ± 3 mmHg, P > 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317.

Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial.

BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P < 0.05; control: 126 ± 4 versus 126 ± 3 mmHg, P > 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317.

Are Vascular Parameters Associated with Walking Impairment in Patients with Claudication?

BACKGROUND: The mechanisms underlying functional impairments in symptomatic PAD patients are controversial and poorly understood. Endothelial dysfunction and arterial stiffness have been proposed as potential mechanisms related to functional impairment in symptomatic PAD patients, however, more studies are needed to confirm these associations. OBJECTIVE: To analyze the association between vascular function and walking impairment in patients with peripheral arterial disease (PAD) and symptoms of claudication. METHODS: This was a cross-sectional study that included 68 patients with symptomatic PAD. All patients underwent an objective (Six-minute walk test [6MWT], 4-meter walk test) and a subjective (Walking Impairment Questionnaire [WIQ]) measurement of walking impairment. Vascular parameters measured were pulse-wave velocity (PWV) and flow-mediated dilation (FMD). Multiple linear regression was performed to investigate the association among walking impairment variables with vascular function parameters. RESULTS: No significant associations between the claudication onset distance (PWV: b=.060, P = 0.842; FMD: b=-.192, P = 0.456), 6MWT (PWV: b=.007, P = 0..975; FMD: b=.090, P = 0.725), WIQ distance (PWV: b=.337, P = 0.117; FMD: b=-.025, P = 0.895) WIQ speed (PWV: b=.320, P = 0.181; FMD: b=-.028, P = 0.497), WIQ stairs (PWV: b=.256, P = 0.204; FMD: b=-.228, P = 0.230), 4-meter usual walk (PWV: b=-.421, P = 0.107; FMD: b=-.338, P = 0.112), 4-meter fast walk (PWV: b=-.496, P = 0.063; FMD: b=-.371, P = 0.086) and vascular function were found. CONCLUSIONS: In symptomatic PAD patients, vascular function is not associated to walking impairment, even when adjusting for comorbid conditions and diabetes.

In peripheral artery disease, diabetes is associated with reduced physical activity level and physical function and impaired cardiac autonomic control: A cross-sectional study.

BACKGROUND: Diabetes has been considered a major risk factor for peripheral artery disease (PAD). The effect of diabetes on daily physical activity level and cardiovascular function in PAD patients is poorly known. OBJECTIVE: To analyze the effect of diabetes on physical activity level, physical function and cardiovascular health parameters in patients with PAD and claudication symptoms. METHODS: Cross-sectional study of 267 PAD patients, 146 without and 121 with diabetes. Physical activity levels were objectively measured by using an accelerometer, and time spent in sedentary (0-100 counts/min), light (101-1040 counts/min) and moderate to vigorous (≥1041 counts/min) physical activity was obtained. Physical function assessment included the 6-min walk test, handgrip strength test and short physical performance battery. Cardiovascular health parameters measured were brachial blood pressure, heart rate variability, and arterial stiffness. RESULTS: Diabetic PAD patients spent more time in sedentary behavior (P=0.001, effect size [ES] 0.234) and less time in light (P=0.003, ES=0.206) and moderate-to-vigorous physical activity (P<0.001, ES=0.258) than non-diabetic PAD patients. Diabetic PAD patients presented lower 6-min walk distance (P=0.005, ES=0.194) and impaired cardiac autonomic modulation (standard deviation of all NN intervals [SDNN], P<0.001, ES=0.357; square root of the mean of the sum of the squares of differences between adjacent NN intervals [RMSSD], P<0.001, ES=0.280; and NN50 count divided by the total number of all NN intervals [pNN50], P<0.001, ES=0.291) as compared with non-diabetic PAD patients. After adjustment for confounders, diabetes remained associated with sedentary behavior (P=0.011), light (P=0.020) and moderate-to-vigorous physical activity (P=0.008), 6-min walk distance (P=0.030), SDNN (P<0.001), RMSSD (P=0.004), and PNN50 (P=0.004). CONCLUSION: Diabetic PAD patients presented lower physical activity level, reduced physical function and impaired autonomic modulation as compared with non-diabetic PAD patients.

Isometric handgrip training does not improve quality of life in hypertensives / Treinamento isométrico com handgrip não melhora qualidade de vida em hipertensos

Hypertensive patients have high blood pressure and poor cardiovascular health and it is known that hypertension negatively affects people's health-related quality of life. Meta-analyses have shown that isometric handgrip training (IHT) reduces blood pressure in hypertensives, but the effects of IHT on health-related quality of life is unknown. Therefore, we tested the hypotheses that the IHT improves health-related quality of life in hypertensives. In this randomized controlled trial, 48 hypertensive individuals were randomly assigned to two groups: IHT and control. IHT was completed thrice weekly (4 × 2 min at 30% of maximal voluntary contraction). Before and after 12 weeks healthrelated quality of life was assessment through Medical Outcomes Study Questionnaire Short Form 36 (SF36). No significant effect was observed for physical function (IHT: 85.6±4.6 vs. 81.1±7.2; Control: 78.6±76.7±4.9), physical problems (IHT: 71.4±10.1vs. 83.9±8.1; Control: 73.8±8.2 vs. 64.3±8.0), general health (IHT: 56.1±3.7 vs. 57.1±1.9; Control: 54.3±1.6 vs. 57.6±2.1), pain (IHT: 23.6±4.6 vs. 30.7±5.8; Control: 32.9±4.5 vs. 31.9±4.3), social aspects (IHT: 46.4±3.6 vs. 50.0±2.3; Control: 48.8±2.7 vs. 48.8±1.7), emotional problems (IHT: 85.7±8.4 vs. 92.9±5.2; Control: 79.4±7.8 vs. 71.4±6.6), mental health (IHT: 61.7±2.8 vs. 58.0±2.5; Control: 54.5±2.4 ± 55.6±1.9), and vitality (IHT: 60.0±4.3 vs. 58.6±4.0; Control: 50.7±2.9 vs. 53.6±3.0) after 12-weeks of supervised IHT (p>0.05 for all). In conclusion, 12-weeks of IHT does not improve health-related quality of life in hypertensives. Therefore, in order to improve quality of life, other exercises should be an indicated for hypertensive patients...(AU)

Pacientes hipertensos têm pressão arterial elevada e saúde cardiovascular prejudicada, e, sabese que a hipertensão também afeta negativamente a qualidade de vida relacionada a saúde. Meta-análises têm demonstrado que o treinamento de exercício isométrico com handgrip (IHT) reduz pressão arterial, mas os efeitos do IHT na qualidade de vida relacionada a saúde são esconhecidos. Portanto, foi testado a hipótese que o IHT melhora a qualidade de vida relacionada a saúde em hipertensos. Nesse ensaio clínico controlado randomizado, 48 hipertensos foram randomizados em IHT e controle. IHT foi realizado três vezes semanais (4 x 2 minutos a 30% da contração voluntária máxima). Antes e após 12 semanas, a qualidade de vida relacionada a saúde foi avaliada pelo Medical Outcomes Study Questionnaire Short Form 36. Nenhum efeito significante foi observado para função física (IHT: 85,6±4,6 vs. 81,1±7,2; Controle: 78,6±76,7±4,9), problemas físicos (IHT: 71,4±10,1 vs. 83,9±8,1; Controle: 73,8±8,2 vs. 64,3±8,0), estado geral de saúde (IHT: 56,1±3,7 vs. 57,1±1,9; Controle: 54,3±1,6 vs. 57,6±2,1), dor (IHT: 23,6±4,6 vs. 30,7±5,8; Controle: 32,9±4,5 vs. 31,9±4,3), aspectos sociais (IHT: 46,4±3,6 vs. 50,0±2,3; Controle: 48,8±2,7 vs. 48,8±1,7), problemas emocionais (IHT: 85,7±8,4 vs. 92,9±5,2; Controle: 79,4±7,8 vs. 71,4±6,6), saúde mental (IHT: 61,7±2,8 vs. 58,0±2,5; Controle: 54,5±2,4 ± 55,6±1,9), e vitalidade (IHT: 60,0±4,3 vs. 58,6±4,0; Controle: 50,7±2,9 vs. 53,6±3,0) após 12 semanas de IHT (p>0.05 para todos). Em conclusão, 12 semanas de IHT não melhora a qualidade de vida relacionada a saúde em hipertensos. Portanto, para melhorar a qualidade de vida, outras modalidades de exercício deveriam ser indicadas para pacientes hipertensos...(AU)

Association between handgrip strength and vascular function in patients with hypertension.

Background: Increased handgrip strength has been associated with lower cardiovascular and non-cardiovascular mortality in different populations. In patients with hypertension, arterial stiffness relates to cardiovascular mortality. However, whether muscle strength is associated with arterial stiffness in hypertensives is unknown. Thus, the objective of this study was to analyze the association between handgrip strength and arterial stiffness parameters in hypertensive patients. Methods: Seventy-two hypertensive patients completed all evaluations and were included in the analysis. The ambulatory arterial stiffness index (AASI) was obtained based on 24-h ambulatory blood pressure monitoring. Carotid-femoral pulse wave velocity (cfPWV), and reflected wave indicator (AIx and AIx@75) were estimated using applanation tonometry technique, whereas handgrip strength test was performed using a digital dynamometer. Crude and adjusted linear regression models were performed. Results: The crude analysis revealed a negative association between handgrip strength and AASI (b = -0.41, p = 0.002) and AIx (b = -0.49, p < 0.001), and AIx@75 (b = -0.54, p < 0.001) which remained significant after adjustments for age, sex, and body mass index, mean blood pressure, and heart rate only for AASI (b = -0.46, p = 0.028) and AIx@75 (b = -0.24, p- = 0.040). Handgrip strength was not associated with cfPWV (p > 0.05). Conclusion: Handgrip strength is negatively associated with AASI and AIx@75, but not with AIx and cfPWV in hypertensive patients.