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Iacopi E, Pieruzzi L, Riitano N, Abbruzzese L, Goretti C, Piaggesi A. The Weakness of the Strong Sex: Differences Between Men and Women Affected by Diabetic Foot Disease. INT J LOW EXTR WOUND 2023; 22:19-26. [PMID: 33480296 DOI: 10.1177/1534734620984604] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We aimed to analyze sex-related differences in clinical outcomes among patients with diabetic foot disease (DFD) managed in a third-level referral center. We retrospectively analyzed data of admissions performed in our department between 2011 and 2015 for DFD. We collected demographic and clinical data, procedures performed during the admission, and short- and long-term outcomes in terms of healing rate and healing time, major amputation, and mortality rates during the follow-up. We focused on differences between genders and tried to figure out if sex could be considered a predictive factor. We collected data from 1237 admission performed in 842 patients (615 men [73%] and 227 women [27%]; age: 68.6 ± 27.9 years; diabetes duration: 16.4 ± 13.4 years; body mass index: 28.2 ± 6.4 kg/m2; hemoglobin A1c 7.9 ± 1.9%). Men showed a higher prevalence of comorbidities and previous ulcers or revascularization procedures. Men had a significantly higher healing rate compared with women (85.4% vs 63.2%, P < .001), but a longer healing time (124 ± 27 days vs 87 ± 14 days, P = .02). Major amputation did not differ between groups, while mortality rate was significantly higher in men (24.5% vs 16.1%, P = .02). In Cox's regression analysis, male sex was a positive predictive factor for healing and a negative one for time to heal and mortality. The difference in mortality was confirmed by a Kaplan-Meier analysis (log rank test: P = .03). DFD represents a severe disease and a strong marker of mortality affecting more severely on clinical outcomes and survival on men.
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A single functional training session induces positive emotions and post-exercise hypotension. Sci Sports 2022. [DOI: 10.1016/j.scispo.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bearne LM, Delaney N, Nielsen M, Sheehan KJ. Inequity in exercise-based interventions for adults with intermittent claudication due to peripheral arterial disease: a systematic review. Disabil Rehabil 2022:1-10. [PMID: 35931094 DOI: 10.1080/09638288.2022.2102255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the equity in access to trials of exercise interventions for adults with intermittent claudication due to peripheral arterial disease. METHODS Systematic electronic database searches of MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Clinical Trials, PEDRO, Opengrey, ISRCTN and ClinincalTrials.gov for randomised controlled trials of exercise interventions for adults with intermittent claudication were conducted. Data extraction was informed by Cochrane's PROGRESS-Plus framework. RESULTS Searches identified 6412 records. Following the screening of 262 full texts, 49 trials including 3695 participants were included. All trials excluded potential participants on at least one equity factor. This comprised place of residence, language, sex, personal characteristics (e.g., age and disability), features of relationships (e.g., familial risk factors) and time-dependent factors, (e.g., time since revascularisation). Overall, 1839 of 7567 potential participants (24.3%) were excluded based on equity factors. Disability was the most frequently reported factor for exclusions. CONCLUSION Trialists endeavour to enrol a representative sample in exercise trials whilst preserving the safety profile of the intervention. This review highlights that these efforts can inadvertently lead to inequities in access as all trials excluded potential participants on at least one equity factor. Future exercise trials should optimise participation to maximise generalisability of findings. PROSPERO registration no. CRD42020189965.Implications for rehabilitationEquity factors influence health opportunities and outcomes.All trials of exercise for people with intermittent claudication excluded adults on at least one equity factor.Disability was the predominant factor for exclusions from trials.Trials should optimise participation to maximise generalisability of results as these findings are used to inform treatment and service design.
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Affiliation(s)
- Lindsay Mary Bearne
- School of Life Course and Population Sciences, King's College London, London, United Kingdom.,Centre for Applied Health and Social Care Research, Kingston University and St George's, University of London, London, United Kingdom
| | - Nancy Delaney
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
| | - Mae Nielsen
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
| | - Katie Jane Sheehan
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
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Dias-Santos EG, Farah BQ, Germano-Soares AH, Correia MDA, Souza AA, Hora JEJ, Ritti-Dias RM, Andrade-Lima A. Effects of Exercise Mode on Arterial Stiffness in Symptomatic Peripheral Artery Disease Patients: A Randomized Crossover Clinical Trial. Ann Vasc Surg 2021; 74:382-388. [PMID: 33549795 DOI: 10.1016/j.avsg.2020.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Exercise program has been recommended for the treatment of symptomatic peripheral artery disease (PAD) patients. However, whether exercise promotes reduction in arterial stiffness in these patients, who exhibit high arterial stiffness, is poor known. AIM To analyze the effects of a single session of resistance, walking, and combined exercises on arterial stiffness in symptomatic PAD patients and to describe individual responses and identify clinical predictors of arterial stiffness responses after exercises. METHODS Twelve patients with symptomatic PAD underwent four experimental sessions in random order: walking exercise (W - 10 bouts of 2-min walking at the speed corresponding to the onset of claudication pain with 2-min interval among sets), resistance exercise (R - 2 sets of 10 reps in eight resistance exercises), combined exercise (CO - 1 set of 10 reps in eight resistance exercises + 5 bouts of 2-min walking with 2-min interval between) and control session (C - resting in exercise room). Ambulatory arterial stiffness index (AASI) was obtained during ambulatory period after each session. Body mass index, ankle brachial index, sex and age also were evaluated. RESULTS AASI was lower in R compared to other sessions (R - 0.52 ± 0.05; W - 0.59 ± 0.05; CO - 0.64 ± 0.05; C - 0.60 ± 0.05, P < 0.001), with 75% of patients presenting lower AASI after R session. No difference was found between W, CO and C sessions (P> 0.05). Ankle brachial index was negatively correlated with R and W sessions net effect (r = -0.618 and -0.750, respectively; P< 0.05 for both), no correlation was found with CO. CONCLUSION A single bout of resistance exercise acutely reduces arterial stiffness in symptomatic PAD, while walking and combined exercise did not alter this variable. This response is more likely to occur in individuals with less severe disease.
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Affiliation(s)
| | - Breno Quintela Farah
- Department of Physical Education, Federal Rural University of Pernambuco, PE, Brazil
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5
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Miyasato RS, Felix AJ, Andrade-Lima A, da Silva ND, Ritti-Dias RM, Wolosker N, Cornelissen V, Goessler KF, Forjaz CLDM. Cardiovascular Responses during and after Maximal Walking in Men and Women with Symptomatic Peripheral Artery Disease. Ann Vasc Surg 2020; 71:9-18. [PMID: 32800891 DOI: 10.1016/j.avsg.2020.07.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/16/2020] [Accepted: 07/25/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Walking is recommended for patients with peripheral arterial disease (PAD). It has been shown that patients with PAD present sharper increases in blood pressure (BP) and heart rate (HR) during maximal walking when compared with healthy subjects. Additionally, women with PAD present a worse physiological profile, and it is possible that they may present higher cardiovascular load during and after a bout of maximal walking than men. Thus, the objective of this study was to compare cardiovascular and autonomic responses during and after maximal walking between men and women with PAD and intermittent claudication (IC). METHODS Forty patients with PAD and IC (20 men and 20 women) underwent, in random order, 2 sessions: control (standing on treadmill) and exercise (maximal treadmill walking test with Gardner's protocol). During the exercise, HR and BP were measured. Before and after the sessions, cardiovascular variables (BP HR, cardiac output, peripheral vascular resistance, and stroke volume) and autonomic modulation (HR and BP variabilities and baroreflex sensitivity) were assessed. In addition, an ambulatory BP monitoring was recorded after each session. RESULTS Men and women presented similar maximal walking capacity. During the walking test, HR and systolic BP increased similarly in men and women. After the maximal walking, cardiovascular and autonomic responses did not differ between the genders. In addition, postintervention ambulatory BP parameters were also similar in men and women. Therefore, in men and women, maximal walking similarly reduced clinic systolic BP and stroke volume, and increased HR and total power of HR variability during the recovery period. CONCLUSIONS Men and women with PAD and IC present similar cardiovascular and autonomic responses during and after maximal walking.
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Affiliation(s)
- Roberto Sanches Miyasato
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Alex Jesus Felix
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Natan Daniel da Silva
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Karla Fabiana Goessler
- Applied Physiology & Nutrition Research Group, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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de Souza Cavina AP, Pizzo Junior E, Machado AF, Biral TM, Pastre CM, Vanderlei FM. Load monitoring on Pilates training: a study protocol for a randomized clinical trial. Trials 2019; 20:597. [PMID: 31623638 PMCID: PMC6798512 DOI: 10.1186/s13063-019-3684-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Currently there are campaigns to raise the awareness of the need to practice physical exercise with several objectives, mainly as a preventive measure. The Pilates method is a form of therapeutic exercise for maintaining and improving health. However, despite being popular, there is still no scientific evidence on the standardization and progression of the method. Therefore, the purpose of this study was to develop a protocol to monitor the progression of daily Pilates loads between the basic, intermediate, and advanced levels, as well as to analyze the effects of the method on psychometric, cardiorespiratory, and autonomic measures. Methods/design In total, 54 healthy men underwent 36 sessions of Pilates mat work. Before each training session, cardiorespiratory measures, pain (visual analogue scale), and a psychometric questionnaire were collected. Heart rate (HR), subjective perception of effort (SPE), and RR intervals were measured during the sessions and used later in the analysis of the progression of training load by monitoring the internal training load and heart rate variability. At the end of the sessions, cardiorespiratory measures, the visual analogue scale, and the psychometric questionnaire were measured again. After 15 min of rest, the final HR measurement was made and the participants noted the effort on the SPE scale. The psychometric, cardiorespiratory, and autonomic measures were evaluated before and after each of the 36 training sessions. Discussion This is a parallel randomized clinical trial of standardized Pilates training, with the aim of estimating training loads and measuring the efficacy of Pilates through clinical, cardiorespiratory, and autonomic outcomes. The protocol can easily be reproduced and could be used to support professionals in prescribing the method. Trial registration ClinicalTrials.gov, NCT03232866. Registered on 28 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3684-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allysiê Priscilla de Souza Cavina
- Postgraduate Program in Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil. .,Faculdade de Ciências e Tecnologia - FCT/UNESP, Departamento de Fisioterapia, Rua Roberto Simonsen, 305 - Cidade Universitária, Presidente Prudente, SP, 19060-900, Brazil.
| | - Eduardo Pizzo Junior
- Graduate in Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Aryane Flauzino Machado
- Postgraduate Program in Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Taíse Mendes Biral
- Postgraduate Program in Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
| | - Carlos Marcelo Pastre
- Department of Physiotherapy, Universidade Estadual Paulista (FCT/UNESP), Presidente Prudente, SP, Brazil
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Ritti-Dias RM, Correia MDA, Andrade-Lima A, Cucato GG. Exercise as a therapeutic approach to improve blood pressure in patients with peripheral arterial disease: current literature and future directions. Expert Rev Cardiovasc Ther 2018; 17:65-73. [DOI: 10.1080/14779072.2019.1553676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Aluísio Andrade-Lima
- Department of Physical Education, Federal University of Sergipe, Aracaju, Brazil
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8
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Farah BQ, Rodrigues SLC, Silva GO, Pedrosa RP, Correia MA, Barros MVG, Deminice R, Marinello PC, Smart NA, Vianna LC, Ritti-Dias RM. Supervised, but Not Home-Based, Isometric Training Improves Brachial and Central Blood Pressure in Medicated Hypertensive Patients: A Randomized Controlled Trial. Front Physiol 2018; 9:961. [PMID: 30083107 PMCID: PMC6065303 DOI: 10.3389/fphys.2018.00961] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/29/2018] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Breno Q Farah
- Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil.,Department of Physical Education, Rural Federal University of Pernambuco, Recife, Brazil
| | - Sergio L C Rodrigues
- Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil.,Department of Physical Education, Rural Federal University of Pernambuco, Recife, Brazil
| | - Gustavo O Silva
- Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil
| | - Rodrigo P Pedrosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, Brazil
| | - Marilia A Correia
- Graduate Program in Medicine, Universidade Nove de Julho, São Paulo, Brazil
| | - Mauro V G Barros
- Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil
| | - Rafael Deminice
- Department of Physical Education, Faculty of Physical Education and Sport, State University of Londrina, Londrina, Brazil
| | - Poliana C Marinello
- Department of Physical Education, Faculty of Physical Education and Sport, State University of Londrina, Londrina, Brazil
| | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Lauro C Vianna
- Faculty of Physical Education, Federal University of Brasilia, Brazilia, Brazil
| | - Raphael M Ritti-Dias
- Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil
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9
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Resistance Exercise Can Modify Cardiovascular Responses of Professors During Teaching and Sleep. Asian J Sports Med 2018. [DOI: 10.5812/asjsm.67657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Correia MDA, Andrade-Lima A, Germano-Soares AH, Cucato GG, Costa EC, Ritti-Dias RM. AORTIC POST-RESISTANCE EXERCISE HYPOTENSION IN PATIENTS WITH PERIPHERAL ARTERY DISEASE. REV BRAS MED ESPORTE 2018. [DOI: 10.1590/1517-869220182401162482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: A single session of resistance training decreases brachial blood pressure (BP) in patients with peripheral artery disease (PAD). However, it is not known whether similar responses occur in aortic BP, which is a better predictor of cardiovascular risk. Objective: This study aimed to analyze the effects of a single session of resistance training on aortic BP in PAD patients. Methods: This randomized, crossover, controlled trial involved 16 patients. All of them performed a session of resistance training (R - 3 x 10 reps in eight exercises, 5-7 on the OMNI Scale) and a control session (C - resting for 50 min). Before and after each session, aortic BP was assessed by applanation tonometry technique. Results: There was an increase in systolic (P<0.002) and mean (P<0.001) aortic BP in both sessions; however, higher increases were observed in C session (P<0.001). Additionally, diastolic aortic BP only increased after C session (P=0.004). The hypotensive effect of the exercise on systolic, diastolic, and mean aortic BP were -12±2, -6±2, and -7±2 mmHg, respectively. Conclusion: A single session of resistance training promoted a hypotensive effect on aortic BP of patients with PAD, indicating an acute reduction in cardiovascular risk in this population. Level of Evidence I; Therapeutic studies - Investigating the results of treatment.
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Abstract
BACKGROUND Exercise programmes are a relatively inexpensive, low-risk option compared with other, more invasive therapies for treatment of leg pain on walking (intermittent claudication (IC)). This is the fourth update of a review first published in 1998. OBJECTIVES Our goal was to determine whether an exercise programme was effective in alleviating symptoms and increasing walking treadmill distances and walking times in people with intermittent claudication. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events, and improving quality of life. SEARCH METHODS For this update, the Cochrane Vascular Information Specialist searched the Specialised Register (last searched 15 November 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10) via the Cochrane Register of Studies Online, along with trials registries. SELECTION CRITERIA Randomised controlled trials of an exercise regimen versus control or versus medical therapy for people with IC due to peripheral arterial disease (PAD). We included any exercise programme or regimen used for treatment of IC, such as walking, skipping, and running. Inclusion of trials was not affected by duration, frequency, or intensity of the exercise programme. Outcome measures collected included treadmill walking distance (time to onset of pain or pain-free walking distance and maximum walking time or maximum walking distance), ankle brachial index (ABI), quality of life, morbidity, or amputation; if none of these was reported, we did not include the trial in this review. DATA COLLECTION AND ANALYSIS For this update (2017), RAL and AH selected trials and extracted data independently. We assessed study quality by using the Cochrane 'Risk of bias' tool. We analysed continuous data by determining mean differences (MDs) and 95% confidence intervals (CIs), and dichotomous data by determining risk ratios (RRs) and 95% CIs. We pooled data using a fixed-effect model unless we identified significant heterogeneity, in which case we used a random-effects model. We used the GRADE approach to assess the overall quality of evidence supporting the outcomes assessed in this review. MAIN RESULTS We included two new studies in this update and identified additional publications for previously included studies, bringing the total number of studies meeting the inclusion criteria to 32, and involving a total of 1835 participants with stable leg pain. The follow-up period ranged from two weeks to two years. Types of exercise varied from strength training to polestriding and upper or lower limb exercises; supervised sessions were generally held at least twice a week. Most trials used a treadmill walking test for one of the primary outcome measures. The methodological quality of included trials was moderate, mainly owing to absence of relevant information. Most trials were small and included 20 to 49 participants. Twenty-seven trials compared exercise versus usual care or placebo, and the five remaining trials compared exercise versus medication (pentoxifylline, iloprost, antiplatelet agents, and vitamin E) or pneumatic calf compression; we generally excluded people with various medical conditions or other pre-existing limitations to their exercise capacity.Meta-analysis from nine studies with 391 participants showed overall improvement in pain-free walking distance in the exercise group compared with the no exercise group (MD 82.11 m, 95% CI 71.73 to 92.48, P < 0.00001, high-quality evidence). Data also showed benefit from exercise in improved maximum walking distance (MD 120.36 m, 95% CI 50.79 to 189.92, P < 0.0007, high-quality evidence), as revealed by pooling data from 10 studies with 500 participants. Improvements were seen for up to two years.Exercise did not improve the ABI (MD 0.04, 95% CI 0.00 to 0.08, 13 trials, 570 participants, moderate-quality evidence). Limited data were available for the outcomes of mortality and amputation; trials provided no evidence of an effect of exercise, when compared with placebo or usual care, on mortality (RR 0.92, 95% CI 0.39 to 2.17, 5 trials, 540 participants, moderate-quality evidence) or amputation (RR 0.20, 95% CI 0.01 to 4.15, 1 trial, 177 participants, low-quality evidence).Researchers measured quality of life using Short Form (SF)-36 at three and six months. At three months, the domains 'physical function', 'vitality', and 'role physical' improved with exercise; however this was a limited finding, as it was reported by only two trials. At six months, meta-analysis showed improvement in 'physical summary score' (MD 2.15, 95% CI 1.26 to 3.04, P = 0.02, 5 trials, 429 participants, moderate-quality evidence) and in 'mental summary score' (MD 3.76, 95% CI 2.70 to 4.82, P < 0.01, 4 trials, 343 participants, moderate-quality evidence) secondary to exercise. Two trials reported the remaining domains of the SF-36. Data showed improvements secondary to exercise in 'physical function' and 'general health'. The other domains - 'role physical', 'bodily pain', 'vitality', 'social', 'role emotional', and 'mental health' - did not show improvement at six months.Evidence was generally limited in trials comparing exercise versus antiplatelet therapy, pentoxifylline, iloprost, vitamin E, and pneumatic foot and calf compression owing to small numbers of trials and participants.Review authors used GRADE to assess the evidence presented in this review and determined that quality was moderate to high. Although results showed significant heterogeneity between trials, populations and outcomes were comparable overall, with findings relevant to the claudicant population. Results were pooled for large sample sizes - over 300 participants for most outcomes - using reproducible methods. AUTHORS' CONCLUSIONS High-quality evidence shows that exercise programmes provided important benefit compared with placebo or usual care in improving both pain-free and maximum walking distance in people with leg pain from IC who were considered to be fit for exercise intervention. Exercise did not improve ABI, and we found no evidence of an effect of exercise on amputation or mortality. Exercise may improve quality of life when compared with placebo or usual care. As time has progressed, the trials undertaken have begun to include exercise versus exercise or other modalities; therefore we can include fewer of the new trials in this update.
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Affiliation(s)
- Risha Lane
- Hull Royal InfirmaryVascular UnitAnlaby RoadHullUKHU3 2JZ
| | - Amy Harwood
- Hull Royal InfirmaryVascular UnitAnlaby RoadHullUKHU3 2JZ
| | - Lorna Watson
- NHS FifeCameron House, Cameron BridgeWindygatesLevenUKKY8 5RG
| | - Gillian C Leng
- National Institute for Health and Care Excellence10 Spring GardensLondonUKSW1A 2BU
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Cavalcante B, Ritti-Dias R, Soares A, Lima A, Correia M, De Matos L, Gobbi F, Leicht A, Wolosker N, Cucato G. A Single Bout of Arm-crank Exercise Promotes Positive Emotions and Post-Exercise Hypotension in Patients with Symptomatic Peripheral Artery Disease. Eur J Vasc Endovasc Surg 2017; 53:223-228. [DOI: 10.1016/j.ejvs.2016.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/23/2016] [Indexed: 12/15/2022]
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13
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Lima AHRA, Correia MA, Soares AHG, Farah BQ, Forjaz CLM, Silva AS, Brasileiro-Santos MS, Santos AC, Ritti-Dias RM. Acute effects of walking and combined exercise on oxidative stress and vascular function in peripheral artery disease. Clin Physiol Funct Imaging 2016; 38:69-75. [DOI: 10.1111/cpf.12384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/04/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Aluísio H. R. A. Lima
- Exercise Hemodynamic Laboratory; School of Physical Education and Sport; University of São Paulo; São Paulo Brazil
| | - Marilia A. Correia
- Graduate Program in Physical Education; University of Pernambuco and University Federal of Paraiba; Paraiba Brazil
| | - Antônio H. G. Soares
- Graduate Program in Physical Education; University of Pernambuco and University Federal of Paraiba; Paraiba Brazil
| | - Breno Q. Farah
- Graduate Program in Physical Education; University of Pernambuco and University Federal of Paraiba; Paraiba Brazil
| | - Cláudia L. M. Forjaz
- Exercise Hemodynamic Laboratory; School of Physical Education and Sport; University of São Paulo; São Paulo Brazil
| | - Alexandre S. Silva
- Israel Institute of Education and Research Albert Einstein; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Maria S. Brasileiro-Santos
- Graduate Program in Physical Education; University of Pernambuco and University Federal of Paraiba; Paraiba Brazil
| | - Amilton C. Santos
- Graduate Program in Physical Education; University of Pernambuco and University Federal of Paraiba; Paraiba Brazil
| | - Raphael M. Ritti-Dias
- Israel Institute of Education and Research Albert Einstein; Hospital Israelita Albert Einstein; São Paulo Brazil
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14
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Dantas FFO, da Silva Santana F, da Silva TSR, Cucato GG, Farah BQ, Ritti-Dias RM. Acute Effects of T'ai Chi Chuan Exercise on Blood Pressure and Heart Rate in Peripheral Artery Disease Patients. J Altern Complement Med 2016; 22:375-9. [PMID: 27058396 DOI: 10.1089/acm.2015.0230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the acute effect of a t'ai chi chuan session on blood pressure and heart rate in patients with peripheral artery disease (PAD). DESIGN Randomized crossover intervention study. SETTING Outpatient therapy center. PARTICIPANTS Seven patients with PAD, aged 50-79 years, not using β-blockers, calcium-channel blockers, or nondihidropiridinic vasodilators. INTERVENTION T'ai chi chuan and control session (both sessions lasted 40 minutes). OUTCOME MEASURES Systolic and diastolic blood pressure and heart rate, which were evaluated before and after the intervention (10, 30, and 50 minutes). RESULTS T'ai chi chuan exercise acutely decreased systolic blood pressure at 30 minutes after exercise (p = 0.042) and increased diastolic blood pressure at 50 minutes after exercise (p = 0.041). Heart rate did not change after t'ai chi chuan exercise. CONCLUSION T'ai chi chuan acutely decreases systolic blood pressure in patients with PAD.
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Affiliation(s)
| | | | | | | | - Breno Quintella Farah
- 4 Associate Graduate Program in Physical Education, University of Pernambuco , Recife, Brazil .,5 Group Research in Health and Sport, ASCES College , Caruaru, Brazil
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Lima AH, Miranda AS, Correia MA, Soares AH, Cucato GG, Sobral Filho DC, Gomes SL, Ritti-Dias RM. Individual blood pressure responses to walking and resistance exercise in peripheral artery disease patients: Are the mean values describing what is happening? JOURNAL OF VASCULAR NURSING 2015; 33:150-6. [DOI: 10.1016/j.jvn.2015.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 02/06/2023]
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Cucato GG, Chehuen MDR, Ritti-Dias RM, Carvalho CRF, Wolosker N, Saxton JM, Forjaz CLDM. Post-walking exercise hypotension in patients with intermittent claudication. Med Sci Sports Exerc 2015; 47:460-7. [PMID: 25033263 DOI: 10.1249/mss.0000000000000450] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to investigate the acute effect of intermittent walking exercise (WE) on blood pressure (BP) responses in patients with intermittent claudication (IC). Secondly, this study aimed to gain improved insight into the physiological mechanisms controlling BP regulation after intermittent WE in this patient group. METHODS Twenty patients with IC participated in two experimental sessions in a random order, as follows: WE (15 × 2-min bouts of WE interpolated with 2-min rest intervals) and control (standing rest on a treadmill for 60 min). BP, cardiac output (CO: CO2 rebreathing), and cardiovascular autonomic modulation (spectral analysis of HR variability) were assessed before and after both experimental sessions during supine rest, and stroke volume (SV) and systemic vascular resistance (SVR) were calculated. Data were analyzed using two-way ANOVA. RESULTS WE decreased systolic, diastolic, and mean BP, with net effects of -13 ± 2, -5 ± 2, and -7 ± 2 mm Hg versus control, respectively (all P < 0.05). WE also decreased SV (-5.62 ± 1.97 mL, P < 0.05) and CO (-0.05 ± 0.13 L·min(-1), P < 0.05) versus preintervention and prevented the observed increase in SVR in the control condition (+4.2 ± 1.4 U, P < 0.05). HR showed a decrease (P < 0.05), consistent with evidence of increased vagal modulation, in the control condition. BP measurements over the subsequent 24 h were similar between experimental conditions. CONCLUSIONS In patients with IC, WE induced a postexercise hypotension response that had a significant magnitude versus control but was not maintained over the next 24 h of daily activities. The acute postexercise hypotension response was mediated by a decrease in CO and SV, which was not compensated by an augmentation of SVR, as observed in the control arm of the study.
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Affiliation(s)
- Gabriel Grizzo Cucato
- 1Hospital Israelita Albert Einstein, São Paulo, BRAZIL; 2Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, BRAZIL; 3School of Physical Education, Pernambuco University, Pernambuco, BRAZIL; 4Hospital das Clínicas, University of São Paulo, São Paulo, BRAZIL; and 5School of Health Sciences, University of East Anglia, Norwich, UNITED KINGDOM
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