Acute Effects of Breaking up Sitting Time With Isometric Wall Squat Exercise on Vascular Function and Blood Pressure in Sedentary Adults: Randomized Crossover Trial.

PURPOSE: The World Health Organization has recommended breaking up sitting time to improve cardiovascular health. However, whether isometric exercise can be effectively used as a strategy to break up sitting time remains unclear. Thus, the aim of this study was to analyze the acute effects of breaking up prolonged sitting with isometric wall squat exercise (IWSE) on vascular function and blood pressure (BP) in sedentary adults. METHODS: This randomized crossover trial included 17 adults (53% male, 26 ± 6 yr, 22.4 ± 3.6 kg/m2) with high sedentary behavior (≥ 6 hr/d). The participants completed 2 experimental sessions in a randomized order, both sharing a common sitting period of 180 min: Breaks (2-min breaks were incorporated into the IWSE, with participants maintaining their knees at the angle determined by the incremental test, which occurred every 30 min) and Control (sitting for 180 min continuously). Popliteal artery flow-mediated dilation (FMD) and brachial BP were measured before and at 10 and 30 min after the experimental sessions. RESULTS: The results did not indicate significant session vs time interaction effects on popliteal FMD and brachial BP (P > .05). A subanalysis including only participants with popliteal FMD reduction after the Control session (n = 11) revealed that Breaks enhanced popliteal FMD after 10 min (1.38 ± 6.45% vs -4.87 ± 2.95%, P= .002) and 30 min (-0.43 ± 2.48% vs -2.11 ± 5.22%, P= .047). CONCLUSION: Breaking up prolonged sitting with IWSE mitigates impaired vascular function resulting from prolonged sitting but has no effect on BP in sedentary adults.

Characteristics associated with responsiveness to isometric handgrip training in medicated hypertensive patients: secondary data analysis.

OBJECTIVE: Isometric handgrip training (IHT) has been shown to reduce blood pressure (BP) in hypertensive patients. However, factors that predict responsiveness to IHT are largely unknown. The aim of this study was to investigate the patient characteristics associated with the antihypertensive response to IHT using a recommended statistical approach for evaluating interindividual responses. METHODS: Data from four randomized controlled trials were combined, totaling 81 patients undergoing IHT (48.8% women; 60 ±â€Š11 years) and 90 control patients (45.6% women; 62 ±â€Š12 years). IHT consisted of 4 × 2 min isometric contractions at 30% of maximal voluntary contraction, performed three times/week for 8-12 weeks. BP was measured at baseline and following IHT and control interventions. The interindividual variation was assessed by the standard deviation of the individual responses (SD ir ), and linear regression analyses were conducted to explore response predictors. RESULTS: IHT significantly decreased both SBP (-5.4; 95% confidence interval (CI) -9.5 to -1.3 mmHg) and DBP (-2.8; 95% CI -5.1 to -0.6 mmHg). The interindividual variation of BP change was moderate for systolic (SD ir  = 5.2 mmHg, 0.30 standardized units) and low for diastolic (SD ir  = 1.7 mmHg, 0.15 standardized units). Sex, age, and BMI were not associated with the antihypertensive effect of IHT. However, a higher baseline SBP ( b  = -0.467, P  < 0.001) and absence of dihydropyridine calcium channel blockers use ( b  = 0.340, P  = 0.001) were associated with greater BP reductions. CONCLUSION: IHT reduced BP in medicated hypertensive patients regardless of age, sex, and BMI. Patients with a higher baseline SBP and those not prescribed dihydropyridine calcium channel blockers were more responsive to IHT.

Do Sociodemographic, Behavioral, Clinical, and Anthropometric Factors Influence the Association Between Sex and Functional Capacity in Patients with Peripheral Arterial Disease?

BACKGROUND: To explore the influence of sociodemographic, behavioral, clinical, and anthropometric factors on the association between sex and functional capacity in patients with peripheral arterial disease. METHODS: A cross-sectional study was conducted with patients aged more than 45 years, diagnosed with peripheral artery disease (PAD), from 2 Brazilian hospitals. Data on sociodemographic characteristics, behavioral risk factors, clinical profile, and anthropometric measurements were collected. Functional capacity was assessed using the 6-min walk test and the Walking Impairment Questionnaire. Statistical analyses, including t-tests, chi-square tests, and logistic regression, were performed to assess the relationships between sex, functional capacity, and potential influencing factors. RESULTS: Among the 262 patients with PAD, 67 were women and 113 were men. Women exhibited lower absolute functional capacity and lower Walking Impairment Questionnaire scores compared to men, even after adjusting for potential confounders. However, relative functional capacity did not significantly differ between sexes after adjusting for variables. Pain-free walking distance was also lower in women compared to that in men, but this association lost significance after adjusting for sociodemographic factors. CONCLUSIONS: Women with PAD had lower absolute functional capacity compared to men, influenced by various factors such as sociodemographic, behavioral, clinical, and anthropometric factors. However, the relative functional capacity was similar between genders, being influenced only by behavioral factors, while for the distance walked until pain, the association was lost after adjustments for sociodemographic factors.

Is the Walking Impairment Questionnaire a surrogate marker of 6-minute walking test performance in patients with peripheral artery disease with different degrees of claudication symptoms?

AIM: To analyze the associations between the Walking Impairment Questionnaire (WIQ) and 6-minute walk test (6MWT) in absolute or relative performance in patients with peripheral artery disease (PAD) and different degrees of claudication symptoms. METHODS: Two hundred and sixty-seven patients with PAD and claudication symptoms participated in the study. All patients underwent 6MWT and WIQ tests. Patients were divided into tertile groups according to their 6MWT performance (1st tertile = severe, 2nd = moderate, 3rd = mild). Multiple linear regression was performed to investigate the association between WIQ scores and the achievement of expected performance in the 6MWT. RESULTS: Claudication onset distance and time, total walking distance, and the percentage of the predicted values had a significant weak correlation ( P  < 0.01) with WIQ scores (distance, speed, and stair-climbing capacity). The correlations for almost all variables were slightly higher in the 1st tertile compared with the 2nd and 3rd tertiles (i.e. WIQ-distance and Claudication onset time, r  = 0.25 and 0.12, WIQ-distance and Claudication onset distance, r  = 0.34 and 0.18; WIQ-distance and total walking distance, r  = 0.23 and 0.18, respectively). Multilinear regression confirmed a slightly superior relationship in the 1st tertile compared with the 2nd tertile (i.e. WIQ-distance and Claudication onset time, R2  = 0.24 and R2  = 0.01; WIQ-distance and Claudication onset distance, R2  = 0.25 and R2  = 0.03, respectively). CONCLUSIONS: WIQ is weakly associated with absolute and relative 6MWT performance in patients with PAD. Despite slightly better correlations in patients with severe claudication symptoms, WIQ scores must be used with care as a surrogate marker of 6MWT performance in this group.

Patterns of sedentary behavior in adults: A cross-sectional study.

Introduction: Sedentary behavior (SB) has been associated with adverse health outcomes, however, it is not completely clear whether total time in SB during the day or prolonged uninterrupted SB are interrelated. The aim of the current study was to describe the different patterns of SB of adults, their relationships, and associated factors. Methods: The sample included 184 adults aged ranging from 18 to 59 years old. SB was objectively measured by an accelerometer and the following SB pattern parameters were obtained: total time in sedentary bouts, mean time of sedentary bouts, and total time in sedentary breaks. Demographic data (age and sex), anthropometry [weight, height, body mass index (BMI)], blood pressure (BP), medical history (self-reported comorbid conditions), and cardiac autonomic modulation, were assessed to identify factors associated with SB. Multiple linear regressions were used to analyze the relationship between SB parameters and the associated factors. Results: The parameters of SB indicated 2.4 (0.9) h/day for total time in sedentary bouts, 36.4 (7.9) min for the mean time of sedentary bouts, and 9.1 (1.9) h/day for the total time in sedentary breaks. Multiple adjusted regression indicated that age was the only factor associated with SB patterns (p < 0.05) after adjustment for confounding variables (sex, age, BMI, dyslipidemia, systolic and diastolic BP). Young adults (18-39 years old) spent more time in sedentary bouts and less time in uninterrupted sedentary bouts compared to middle-aged adults (40-59 years old) (2.58 (0.88) h/day vs. 2.13 (0.90) h/day, respectively; p = 0.001 and 34.5 (5.8) min 18-39 years old vs. 38.8 (9.6) min 40-59 years old; p ≤ 0.001; respectively). The total time in sedentary breaks was similar between age groups (p = 0.465). The total time in sedentary bouts was significantly correlated with the mean time of sedentary bouts (r = -0.58; p ≤ 0.001), and with the total time in sedentary breaks (r = -0.20; p = 0.006). The mean time of sedentary bouts was significantly related to the total time in sedentary breaks (r -= 0.19; p = 0.007). Discussion and Conclusion: In conclusion, age seems to be a relevant factor associated with sedentary behavior with young adults spending more time in SB and accumulating this behavior in a higher amount of sedentary bouts compared to middle-aged adults.

Anxiety is more related to inadequate eating habits in inactive than in physically active adults during COVID-19 quarantine.

BACKGROUND & AIMS: Anxiety can be related to reduced diet quality during pandemics such as COVID-19. However, it is not clear whether these relationships would be similar in inactive and physically active participants. The aim of this study was to analyze associations between anxiety and eating habits in physically active and inactive individuals during the COVID-19 pandemic. METHODS: The sample consisted of 1826 adults (58.5% women) who were invited through social media to answer an online questionnaire. The instrument included questions related to physical activity, eating habits, health behavior, mental health (anxiety, depression, self-esteem, sadness and stress) and overall health. Anxiety, food habits (high food habits consumption ≥5 times per week) and physical activity (≥150 min per week) were assessed during the COVID-19 pandemic. The relationship between anxiety and eating habits according to levels of physical activity (inactive vs. active) was assessed using binary logistic regression adjusted for sex, age, education level, social isolation, and body mass index. RESULTS: Among the inactive participants, anxiety was related with high consumption of sweets (OR = 1.43; 95% CI = 1.11-1.83) and fast foods (OR = 2.23; 95% CI = 1.05-4.74) while quarantining during the COVID-19 pandemic. No relationship was observed between anxiety and food consumption among physically active participants in the final model. CONCLUSION: Anxiety was associated with less desirable eating habits among physically inactive adults during the COVID-19 pandemic.

Association between the risk of malnutrition and functional capacity in patients with peripheral arterial disease: A cross-sectional study.

INTRODUCTION: The risk of malnutrition is an important predictor of functional capacity in the elderly population. However, whether malnutrition is associated with functional capacity in patients with peripheral artery disease (PAD) is poorly known. PURPOSE: To analyse the association between the risk of malnutrition and functional capacity in patients with PAD. METHODS: This cross-sectional study included 135 patients with PAD of both genders, ≥50 years old, with symptomatic PAD (Rutherford stage I to III) in one or both limbs and with ankle-brachial index ≤0.90. The risk of malnutrition was assessed by the short form of the Mini Nutritional Assessment-Short Form and patients were classified as having normal nutritional status (n = 92) and at risk of malnutrition (n = 43). Functional capacity was objectively assessed using the six-minute walking test (6MWT, absolute maximal distance and relativized and expressed as a percentage of health subjects), short-physical performance battery (SPPB, balance, gait speed and the sit and stand test) and the handgrip test, and subjectively, using the Walking Impairment Questionnaire and Walking Estimated-Limitation Calculated by History. The association between the risk of malnutrition and functional capacity was analysed using bivariate and multivariate logistic regression adjustments for gender, age, ankle-brachial index, body mass index, use of statins, coronary arterial disease and stroke. For all statistical analyses, significance was accepted at p<0.05. RESULTS: Thirty-two per cent of our patients were classified with a risk of malnutrition. The risk of malnutrition was associated with the absolute 6MWT total distance (OR = 0.994, P = 0.031) relative 6MWT total distance (OR = 0.971, P = 0.038), lowest SPPB total score (OR = 0.682, P = 0.011), sit and stand (OR = 1.173, P = 0.003) and usual 4-meter walk test (OR = 1.757, P = 0.034). CONCLUSION: In patients with PAD, the risk of malnutrition was associated with objective measurements of functional capacity.

Impact of COVID-19 pandemic on physical activity level and screen time is associated with decreased mental health in Brazillian adults: A cross-sectional epidemiological study.

The objective was to verify whether the impact of COVID-19 on physical activity and screen time was associated with the impact on quality of life and symptoms of anxiety and depression in a sample of Brazilian adults. The invitation was made through social networks and the collection was carried out through electronic research. There was a decrease in quality of life and physical activity, and an increase in symptoms of anxiety and depression and screen time. These findings are important for new strategies that promote physically active habits during the pandemic .

Depressive Symptoms Associated With Musculoskeletal Pain in Inactive Adults During COVID-19 Quarantine.

BACKGROUND: Depression has been associated with episodes of musculoskeletal pain. However, it is not clear whether such relationships could be mitigated according to the physical activity level. AIM: To describe, during the COVID-19 pandemic, the relationship between depression and musculoskeletal pain according to the physical activity levels. DESIGN: Cross-sectional study. METHODS: This research was conducted in Brazil between May 5 and March 17, 2020. Participants (N = 1872; 58% women) were invited through social media to answer a structured online questionnaire. Depressive symptoms were assessed through self-report of perception of depression during quarantine. Musculoskeletal pain was assessed based on the Nordic questionnaire identifying nine possible pain points in the body. Physical activity was assessed based on the weekly frequency, intensity, and duration of each session of physical activity the participants engaged in during COVID-19. The logistic binary regression analyzed the associations between depressive symptoms and musculoskeletal pain according to the participants' level of physical activity. RESULTS: Depressive symptoms were associated with pain in six different regions of the body in physically inactive participants. In physically inactive participants, those with depressive symptoms 1.51 (95% CI = 1.04-2.19) and 2.78 (95% CI = 1.81-4.26) times more likely to have pain in one or two and ≥three regions body regions, respectively. In active participants, depressive symptoms were not associated with pain. CONCLUSION: During the COVID-19 pandemic, depression was associated with musculoskeletal pain in physically inactive participants.

Acute effects of breaking up sitting time with isometric exercise on cardiovascular health: Randomized crossover trial.

The objective of this study was to analyze the acute effects of breaking up prolonged sitting with isometric exercise on the cardiovascular health of sedentary adults. This is a three-condition randomized crossover trial. The sample was comprised of 17 subjects (11 women; 29 ± 10 years old; 25,1 ± 5,1 kg/m2 ). The participants completed, in randomized order, three experimental conditions (control, breaks with isometric leg extension exercise, and breaks with walking), with the order of the conditions determined through simple automatic randomization. All the conditions had in common a sitting period of 3 h. During the conditions with isometric exercise and walking breaks the participants performed breaks with isometric leg extension exercise and with walking every 30 min, while in the control condition they remained seated with no breaks. Before and after this period, vascular function (primary outcome), blood pressure, and cardiac autonomic modulation (secondary outcomes) were measured. Generalized estimated equations were used to analyze the data. The results did not indicate significant interaction effects for vascular function among experimental conditions (p > 0,05 for all). We also did not find significant interaction effects for systolic or diastolic blood pressure among the conditions (p > 0,05 for all). The heart rate variability parameters did not present significant interaction effects among conditions (p > 0,05 for all). In conclusion, breaking up sitting with isometric exercise does not seem to lead to significant effects on the cardiovascular health of sedentary adults.

Effect of Sex on Vascular Adaptations to Isometric Handgrip Training in Elderly Patients with Peripheral Artery Disease: A Randomized Controlled Trial.

BACKGROUND: Isometric handgrip training (IHT) promotes vascular adaptations in different populations. AIMS: We assessed the sex differences in vascular adaptations of IHT in a sample of older adults with symptomatic peripheral artery disease (PAD). METHODS: Fifty-three older patients with symptomatic PAD (6 women and 13 men in IHT and 13 women and 21 men in the control group) participated in this study. The IHT group performed 3 sessions per week, for 8 weeks, consisting of 4 sets of isometric contractions for 2 min at 30% of maximum voluntary contraction and a 4-min interval between sets. The control group received a compression ball in order to minimize the placebo effects, representing sham training. Blood flow and brachial flow-mediated dilation were analyzed at before and after 8 weeks of intervention. We compared the responses (Δ = post-pre values) of each group (women control, women IHT, men control, and men IHT) with a Kruskal-Wallis test. RESULTS: There were no differences in all groups after 8 weeks of IHT in Δ brachial diameter (p = 0.850), Δ flow-mediated dilation (p = 0.241), Δ time to peak diameter (p = 0.528), and Δ FMD/AUC (p = 0.397). CONCLUSIONS: There are no effects of sex on vascular adaptation after 8 weeks of IHT in older adults with symptomatic PAD.

Physical Activity Is Associated With Improved Eating Habits During the COVID-19 Pandemic.

The aim of this study was to analyze the association between physical activity and eating habits during the COVID-19 pandemic among Brazilian adults. A sample of 1,929 participants answered an online survey, however 1,874 were included in the analysis. The impact of the COVID-19 pandemic on eating habits was assessed inquiring about participants' intake of fruits, vegetables, fried foods, and sweets during the pandemic. Physical activity was assessed by asking participants about their weekly frequency, intensity and number of minutes/hours engaging in structured physical activities per week. Participants were then stratified into categories based on moderate-to-vigorous intensity (0-30; 31-90; 91-150; 151-300; and >300 min/week) and into active (≥150 min) or inactive (<150 min). Increased sweets consumption was the most commonly reported change to eating habits (42.5%), followed by an increase in the consumption of vegetables (26.6%), fruits (25.9%), and fried foods (17.9%). Physical activity practice was related to lower consumption of fried foods (OR = 0.60; p < 0.001) and sweets (OR = 0.53; p < 0.001). A cluster analysis revealed subjects with higher the level of physical activity was more likely to follow a healthy diet (p < 0.001). Thus, physical activity was positively associated with healthier eating habits. Health authorities must recommend regular physical as a strategy to improve overall health during the COVID-19 pandemic. Future studies should address the physical activity interventions to improve health status during a pandemic.

The same storm but not the same boat: Effects of COVID-19 stay-at-home order on mental health in individuals with overweight.

OBJECTIVE: To describe the effects of stay-at-home orders and social distancing during the coronavirus disease (COVID-19) outbreak on mental health and to compare these outcomes between individuals with normal weight and overweight. METHODS: This cross-sectional study included 1857 Brazilian adults, who were invited through social media to answer an online questionnaire from 5 May 2020 to 17 May 2020. The instrument included questions related to health behaviour, mental health (anxiety, depression, self-esteem, sadness and stress) and overall health. Overweight was defined as body mass index (BMI) ≥ 25 Kg/m2 . Multiple logistic regression was conducted to identify whether overweight is associated with mental health variables. RESULTS: Women reported increased anxiety (36.5% vs 22.2%, P < .01), depression (16.2% vs 8.8%, P < .01), low self-esteem (19.8% vs 10.6%, P < .01), sadness (17.7% vs 10.2%, P < .01), and stress (29.5% vs 19.3%, P < .01) relative to men. Women with overweight are more likely to report higher feeling of anxiety (OR 1.62, CI 95% 1.22-2.14), depression (OR 1.79, CI 95% 1.25-2.55), low self-esteem (OR 1.82, CI95% 1.28-2.58) and sadness (OR 1.51, CI 95% 1.08-2.10), adjusted for age, social isolation days, educational level, chronic diseases, smoke, alcohol intake and physical activity. CONCLUSION: Women, specially those with overweight are more vulnerable to the deleterious effects of stay-at-home orders on mental health during the COVID-19 pandemic.

Impact of obesity on walking capacity and cardiovascular parameters in patients with peripheral artery disease: A cross-sectional study.

BACKGROUND: Patients with peripheral artery disease (PAD) present a high prevalence of obesity and metabolic syndrome, as well as diseases related to cardiovascular dysfunction. However, whether obesity influences walking capacity and cardiovascular function in patients with PAD is poorly understood. OBJECTIVES: The objective of this study was to analyze the impact of obesity on walking capacity and cardiovascular parameters in patients with PAD. DESIGN: This is a cross-sectional study. SETTING: Patients were recruited from public hospitals of São Paulo. METHODS: One-hundred two patients with PAD and symptoms of intermittent claudication were recruited and divided into 2 groups according to their body mass index: normal weight (<25 kg/m2) and overweight/obese (≥25 kg/m2). Patients were submitted to objective (6-minute walk test) and subjective measurements of walking capacity (Walking Impairment Questionnaire). In addition, cardiovascular parameters (office blood pressure, resting heart rate, arterial stiffness, vascular function, and heart rate variability) were obtained. RESULTS: The speed domain of the Walking Impairment Questionnaire was lower in the overweight/obese group compared to the normal weight group (32 ± 20 vs 21 ± 16, respectively, P < .01). Resting heart rate was higher in overweight/obese patients (61 ± 10 vs 70 ± 12, respectively, P < .01). However, no other walking capacity or cardiovascular parameter variables were related to obesity in patients with PAD. CONCLUSION: Obesity influences resting heart rate and walking speed in patients with PAD.

Are cardiovascular function and habitual physical activity levels similar in patients with classic and atypical claudication symptoms? A cross-sectional study.

OBJECTIVE: To analyze the impact of the different types of exertional leg pain on cardiovascular function, functional capacity, and habitual physical activity levels in patients with peripheral arterial disease. METHODS: In this cross-sectional study, 124 patients with symptomatic peripheral arterial disease were included. Exertional leg pain was evaluated using the San Diego Claudication Questionnaire. Subsequently, patients were categorized into two groups according to their exertional leg pain: atypical leg pain (non-calf pain and atypical calf pain, n = 31) and intermittent claudication (classic intermittent claudication symptoms, n = 93). Cardiovascular function (blood pressure, heart rate, arterial stiffness, and heart rate variability), functional capacity (6-min walk distance, handgrip strength, and short physical performance battery), and habitual physical activity levels were measured. RESULTS: Functional capacity and physical activity levels were similar between patients with atypical leg pain and symptoms of intermittent claudication. However, patients with classic intermittent claudication symptoms presented higher central systolic blood pressure (P = 0.028) and arterial stiffness (augmentation index and pulse pressure; P ≤ 0.001 and 0.019, respectively) compared to patients with atypical leg pain. CONCLUSION: The type of exertional leg pain does not influence functional capacity and habitual physical activity levels in patients with peripheral arterial disease. However, patients with classic intermittent claudication symptoms present impaired cardiovascular function compared to patients with atypical leg pain.

Effects of isometric handgrip training on cardiac autonomic profile: A systematic review and meta-analysis study.

Meta-analyses have shown that isometric handgrip training reduces blood pressure in normotensive and hypertensive subjects. However, the effects on cardiac autonomic modulation are still controversial. Thus, the aim of this systematic review and meta-analysis was to analyse the effects of isometric handgrip training on cardiac autonomic modulation in normotensive and hypertensive subjects. For this, Medline, Cinhal, Embase, Spordiscus and PEdro were searched for relevant studies published until December 2018. Randomized controlled trials investigating the effect of isometric handgrip training on heart rate variability parameters were considered eligible. Parameters were obtained in time (standard deviation of all the RR intervals-SDNN, root mean square of successive differences between the normal adjacent RR intervals-RMSSD and the percentage of adjacent intervals with more than 50 ms-PNN50) and frequency domain (low frequency-LF, high frequency-HF and sympathovagal balance-LF/HF). Mean difference (MD) and 95% confidence interval (95% CI) were calculated using an inverse variance method with a random effects model. Seven trials were included in the systematic review and meta-analysis, totalling 86 participants. No significant effect was observed in heart rate variability parameters after isometric handgrip training (4 trials to SDNN: MD = -1.44 ms and 95% CI = -8.02, 5.14 ms; RMSSD: MD = -1.48 ms and 95% CI = -9.41, 6.45 ms; PNN50: MD = 0.85% and 95% CI = -1.10, 2.81%; 7 trials to LF: -0.17 n.u. and 95% CI = -6.32, 5.98 n.u.; HF: MD = 0.17 n.u. and 95% CI = -5.97, 6.30 n.u.; and LF/HF: MD = 0.13 and 95% CI = -0.34, 0.59). In conclusion, current literature indicates that isometric handgrip training does not improve heart rate variability.

Functional and Cardiovascular Measurements in Patients With Peripheral Artery Disease: COMPARISON BETWEEN MEN AND WOMEN.

PURPOSE: To compare functional and cardiovascular variables of men and women with peripheral artery disease (PAD). METHODS: This observational, cross-sectional study included 67 women and 144 men (age 66 ± 9 and 67 ± 10 yr, respectively) with PAD. Patients were submitted to a clinical evaluation, 6-min walk test (6MWT) and cardiovascular evaluation, including blood pressure, arterial stiffness variables, and heart rate variability. RESULTS: Women had lower claudication onset distance (P = .033) and 6MWT distance (P < .001), and similar percentage of the predicted 6MWT distance (P > .05). Women had higher pulse pressure (P = .002), augmentation index (P < .001), augmentation index corrected by 75 bpm (P < .001), and brachial and central systolic blood pressure (P = .041 and P = .029). Diastolic blood pressure, pulse wave velocity, and heart rate variability were similar between sexes (P > .05). CONCLUSION: Although predicted 6MWT performance was similar between sexes, women had higher blood pressure and wave reflection variables compared with men. Interventions to reduce blood pressure and wave reflection should be emphasized in women with PAD.

Barriers and Levels of Physical Activity in Patients With Symptomatic Peripheral Artery Disease: Comparison Between Women and Men.

This cross-sectional study compared physical activity levels and barriers between 212 men and women with symptomatic peripheral artery disease. Physical activity was objectively measured by an accelerometer. Barriers to physical activity were obtained using a validated questionnaire. Women reported higher amounts of light physical activity (p < .001) and lower moderate-vigorous physical activity (p < .001) than men. Women more often reported barriers such as "not having anyone to accompany" (p = .006), "lack of money" (p = .018), "fear of falling or worsening the disease" (p = .010), "lack of security" (p = .015), "not having places to sit when feeling leg pain" (p = .021), and "difficulty in getting to a place to practice physical activity" (p = .015). In conclusion, women with symptomatic peripheral artery disease presented with lower amounts of moderate-vigorous activity and more barriers to activity than men. Strategies to minimize the barriers, including group actives and nonpainful exercises, are recommended for women with peripheral artery disease.

Cerebral Blood Flow during Exercise in Heart Failure: Effect of Ventricular Assist Devices.

INTRODUCTION: In healthy individuals, cerebral blood flow (CBF) increases during exercise, but few studies have compared changes in CBF during exercise in patients with heart failure (HF) to healthy controls (CTRL) or assessed the effects of left ventricular assist devices (LVAD). We hypothesized that subjects implanted with LVAD would exhibit impaired cerebrovascular responses to cycle exercise when compared with age- and sex-matched healthy CTRL subjects but would have enhanced responses relative to subjects with HF. METHODS: Internal carotid artery (ICA) blood flow and intracranial middle (MCAv) and posterior cerebral (PCAv) artery velocities were measured continuously using Doppler ultrasound, alongside cardiorespiratory measures at rest and in response to an incremental submaximal cycle ergometer exercise protocol in nine LVAD participants (58 ± 15 yr, 87 ± 16 kg, 172 ± 8 cm, six females), nine age- and sex-matched subjects with HF (58 ± 8 yr, 84 ± 11 kg, 177 ± 6 cm), and nine CTRL (55 ± 14 yr, 74 ± 16 kg, 168 ± 10 cm). RESULTS: At rest, ICA hemodynamics (velocity, shear rate, and flow) were greater in CTRL and LVAD than that in HF (P < 0.05). Higher MCAv (+5.52 ± 1.59 cm·s, P = 0.003) and PCAv (+5.82 ± 1.41 cm·s, P = 0.001) were also observed in LVAD subjects than healthy CTRL. During exercise, ICA flow increased at all workloads in CTRL, but not in HF or LVAD groups. MCAv increased from baseline in both HF and CTRL participants (P = 0.0001), but not in LVAD subjects. Nonetheless, CTRL and LVAD showed higher MCAv (P = 0.006) and PCAv (P < 0.0001) values throughout exercise than HF. CONCLUSION: Our findings indicate that LVAD subjects exhibit higher CBF at rest and during exercise than matched HF participants but attenuated brain blood flows during exercise when compared with healthy subjects. CBF should be considered when designing exercise training interventions in patients with HF and LVAD.

Supervised, but Not Home-Based, Isometric Training Improves Brachial and Central Blood Pressure in Medicated Hypertensive Patients: A Randomized Controlled Trial.

Meta-analyses have shown that supervised isometric handgrip training reduces blood pressure in hypertensives. However, the mechanism(s) underlying these effects in medicated hypertensive patients, as well as the effects from home-based exercise training, is uncertain. The purpose of this study was to compare the effects of supervised and home-based isometric handgrip training on cardiovascular parameters in medicated hypertensives. In this randomized controlled trial, 72 hypertensive individuals (38-79 years old, 70% female) were randomly assigned to three groups: home-based, supervised isometric handgrip training or control groups. Home-based and supervised isometric handgrip training was completed thrice weekly (4 × 2 min at 30% of maximal voluntary contraction, with 1-min rest between bouts, alternating the hands). Before and after 12 weeks brachial, central and ambulatory blood pressures (BP), arterial stiffness, heart rate variability, vascular function, oxidative stress and inflammation markers were obtained. No significant (p > 0.05) effect was observed for ambulatory BP, arterial stiffness, heart rate variability, vascular function and oxidative stress and inflammatory markers in all three groups. Brachial BP decreased in the supervised group (Systolic: 132 ± 4 vs. 120 ± 3 mmHg; Diastolic: 71 ± 2 vs. 66 ± 2 mmHg, p < 0.05), whereas no significant differences were observed in the home-based (Systolic: 130 ± 4 vs. 126 ± 3 mmHg; diastolic: 73 ± 3 vs. 71 ± 3 mmHg) and control groups (p > 0.05). Supervised handgrip exercise also reduced central BP systolic (120 ± 5 vs. 109 ± 5 mmHg), diastolic (73 ± 2 vs. 67 ± 2 mmHg); and mean BP (93 ± 3 vs. 84 ± 3 mmHg), whereas no significant effects were found in the home-based (Systolic: 119 ± 4 vs. 115 ± 3 mmHg; Diastolic: 74 ± 3 vs. 71 ± 3 mmHg) and control groups (p > 0.05). In conclusion, supervised, but not home-based, isometric training lowered brachial and central BP in hypertensives.