Applicability of the step test for physical fitness assessment of women with chronic venous disease symptoms: a cross-sectional study

Abstract Background Chronic Venous Disease (CVD) can seriously impact physical fitness. Certain measures and aptitude tests can be employed to evaluate this condition in people with CVD that are simple, quick, and less expensive alternatives when compared to laboratory methods. Objectives To evaluate the applicability of the 4-minute step test, correlating its results with those of other measures and tests used with people with CVD symptoms. Methods Cross-sectional descriptive study carried out with 47 active women with CVD symptoms who participate in public physical exercise programs and were recruited by spontaneous demand. After clinical evaluation of disease stage, sociodemographic data were collected and calf circumference measurements, ankle goniometry, the tiptoe test, and the 4-minute step test were conducted. The women were already familiar with the apparatus used. Results The step test showed significant correlations (p<0.05) with calf measurements (r=0.31 and 0.32), flexibility (r=0.48 and 0.47), and the tiptoe test (r=0.33 for number of repetitions and 0.42 for speed of execution), in addition to an inverse correlation with disease severity (r=-0.29). Significant correlations were also found by age group (r=0.60 and 0.54, for calf circumference in the elderly) and by classification in tests and measurements (r=0.19 for the tiptoe test, and r=0 .29, for ankle flexibility). Conclusions The step test proved applicable and its use in conjunction with other aptitude tests offers a more complete evaluation of active women with CVD symptoms.

Aplicabilidade do teste do degrau na avaliação da aptidão física de mulheres com sintomas de doença venosa crônica: estudo transversal

Resumo Contexto A doença venosa crônica (DVC) pode impactar a aptidão física dos indivíduos. Algumas medidas e testes de aptidão são aplicados para avaliar essa condição em pessoas com DVC, sendo alternativas simples, rápidas e menos dispendiosas de avaliação comparadas a métodos laboratoriais. Objetivos Avaliar a aplicabilidade do teste do degrau de 4 minutos, correlacionando seus resultados com os de outras medidas e testes aplicados a pessoas com sintomas de DVC. Métodos Estudo descritivo transversal realizado com 47 mulheres ativas com sintomas de DVC, participantes de programas públicos de exercícios físicos e recrutadas por demanda espontânea. Foi realizada avaliação clínica da doença, e foram coletados dados sociodemográficos, medidas de perimetria de panturrilha e goniometria de tornozelo, teste ponta do pé e teste do degrau de 4 minutos. As mulheres já eram familiarizadas com o implemento utilizado. Resultados O teste do degrau apresentou correlações significativas (p < 0,05) com as medidas de panturrilha (r = 0,31 e 0,32), flexibilidade (r =0,48 e 0,47) e teste ponta do pé (r = 0,33 para n.º de repetições e 0,42 para velocidade de execução), além de correlação inversa com a gravidade da doença (r = -0,29). Correlações significativas também foram encontradas por faixa etária (r = 0,60 e 0,54, para perimetria de panturrilha em idosos) e por classificação nos testes e medidas (r = 0,19 para o teste ponta do pé e r = 0,29 para flexibilidade de tornozelo). Conclusões O teste do degrau se mostra aplicável, e sua utilização, em conjunto com outros testes de aptidão, permite uma avaliação mais completa de mulheres ativas com sintomas de DVC.

The relationship between clinical severity and outcome measures in patients with chronic venous insufficiency with or without leg ulcer

PURPOSE

To evaluate the relationship between clinical severity and functionality, sleep quality, depression, and quality of life (QoL) in patients with CVI with or without leg ulcers.

METHODS

A total of sixty patients with CVI were enrolled in the study. The patients were C2-6 according to the CEAP classification. All the patients were assessed with Venous Clinical Severity Score (VCSS) for clinical severity, Visual Analog Scale (VAS) for pain, right and left lower limb (RLL and LLL) circumference measurements for edema, 6-min-walk test (6-MWT) for functional capacity, Lower Extremity Functional Scale (LEFS) for functionality, Pittsburg Sleep Quality Index (PSQI) for sleep quality, Beck Depression Inventory version I (BDI-I) for depression, and The Quality of Life Questionnaire for Chronic Venous Diseases-20 (CIVIQ-20) for QoL.

RESULTS

The mean age of the patients was 45.83 ± 13.25 years, and the mean duration of disease was 8.30 ± 7.42 years. There was a significant association between VCSS and VAS-rest/activity, edema-RLL/LLL, PSQI, BDI-I, LEFS, and CIVIQ-20 in patients without leg ulcers. In addition, a significant association was found between VCSS and VAS-rest/activity and CIVIQ-20 in patients with leg ulcers.

CONCLUSION

The current study showed that an association has been found between clinical severity and pain at rest and during activity, edema, sleep quality, depression, lower extremity function, and QoL in patients without ulcers. However, clinical severity has been correlated with only pain at rest and during activity, and QoL in patients with leg ulcers.

Dysregulations of MicroRNA and Gene Expression in Chronic Venous Disease

Chronic venous disease (CVD) is a vascular disease of lower limbs with high prevalence worldwide. Pathologic features include varicose veins, venous valves dysfunction and skin ulceration resulting from dysfunction of cell proliferation, apoptosis and angiogenesis. These processes are partly regulated by microRNA (miRNA)-dependent modulation of gene expression, pointing to miRNA as a potentially important target in diagnosis and therapy of CVD progression. The aim of the study was to analyze alterations of miRNA and gene expression in CVD, as well as to identify miRNA-mediated changes in gene expression and their potential link to CVD development. Using next generation sequencing, miRNA and gene expression profiles in peripheral blood mononuclear cells of subjects with CVD in relation to healthy controls were studied. Thirty-one miRNAs and 62 genes were recognized as potential biomarkers of CVD using DESeq2, Uninformative Variable Elimination by Partial Least Squares (UVE-PLS) and ROC (Receiver Operating Characteristics) methods. Regulatory interactions between potential biomarker miRNAs and genes were projected. Functional analysis of microRNA-regulated genes revealed terms closely related to cardiovascular diseases and risk factors. The study shed new light on miRNA-dependent regulatory mechanisms involved in the pathology of CVD. MicroRNAs and genes proposed as CVD biomarkers may be used to develop new diagnostic and therapeutic methods.

Development of a Minimum Data Set Registry for Chronic Venous Insufficiency of the Lower Limbs

The purpose of this study was to develop a minimum data set (MDS) registry for the prevention, diagnosis and treatment of chronic venous insufficiency (CVI) of the lower limbs. We designed the instrument in two phases, comprising a literature review and an e-Delphi study to validate the content. We obtained a total of 39 documents that we used to develop a registry with 125 items grouped in 7 categories, as follows: Patient examination, venous disease assessment methods, diagnostic tests to confirm the disease, ulcer assessment, treatments to manage the disease at all its stages, patient quality of life, and patient health education. The instrument content was validated by 25 experts, 88% of whom were primary healthcare and hospital nurses and 84% had more than 10 years' experience in wound care. Using a two-round Delphi approach, we reduced the number of items in the MDS-CVI to 106 items. The categories remained unchanged. We developed an MDS for CVI with seven categories to assist healthcare professionals in the prevention, early detection, and treatment history of CVI. This tool will allow the creation of a registry in the primary care setting to monitor the venous health state of the population.