RESUMO
PURPOSE: This study aimed to determine the association between light-intensity physical activity and the incidence of all-cause and cardiovascular mortality in patients with peripheral artery disease (PAD) limited by claudication followed for up to 18.7 yr. METHODS: A total of 528 patients with PAD and claudication were screened in Baltimore between 1994 and 2002, and 386 were deemed eligible for the study. At baseline, patients were classified into three physical activity groups: 1) physically sedentary, 2) light intensity, and 3) moderate to vigorous intensity based on a questionnaire. All-cause and cardiovascular mortality of patients through December 2014 was determined using the National Death Index and the U.S. Department of Veterans Affairs and the U.S. Department of Defense Suicide Data Repository. RESULTS: Median survival time was 9.9 yr (interquartile range, 4.9-15.7 yr; range, 0.38-18.7 yr). During follow-up, 257 patients (66.6%) died, consisting of 40/48 (83.3%) from the sedentary group, 135/210 (64.3%) from the light-intensity group, and 82/128 (64.0%) from the moderate- to vigorous-intensity group. For all-cause mortality, light-intensity activity status (hazard ratio [HR] = 0.523, P = 0.0007) and moderate- to vigorous-intensity status (HR = 0.425, P < 0.0001) were significant predictors. During follow-up, 125 patients died because of cardiovascular causes (32.4%), in which light-intensity activity status (HR = 0.511, P = 0.0113) and moderate- to vigorous-intensity activity status (HR = 0.341, P = 0.0003) were significant predictors. CONCLUSIONS: Light-intensity physical activity is associated with nearly 50% lower risk of all-cause and cardiovascular mortality in high-risk patients with PAD and claudication. Furthermore, moderate- to vigorous-intensity physical activity performed regularly is associated with 58% and 66% lower risk of all-cause and cardiovascular mortality, respectively. The survival benefits associated with light-intensity physical activity make it a compelling behavioral intervention that extends beyond improving ambulation.
Assuntos
Exercício Físico , Claudicação Intermitente/mortalidade , Doença Arterial Periférica/mortalidade , Idoso , Baltimore/epidemiologia , Causas de Morte , Feminino , Seguimentos , Humanos , Claudicação Intermitente/etiologia , Masculino , Doença Arterial Periférica/complicações , Prognóstico , Modelos de Riscos Proporcionais , Comportamento Sedentário , Fatores de TempoRESUMO
OBJECTIVE: Time spent in sedentary behavior has been associated with worse inflammation and cardiometabolic biomarkers in various populations. However, the association between time spent in sedentary behavior and biomarkers remains unknown in patients with intermittent claudication. The aim of the current study was to analyze the relationship between sedentary behavior and inflammatory and cardiometabolic biomarkers in patients with symptomatic peripheral arterial disease (PAD). METHODS: The sample included 297 patients with intermittent claudication. Sedentary behavior was assessed using a step activity monitor. Biomarkers of inflammation, oxidative stress, lipid profile, insulin resistance, and endogenous fibrinolysis were assessed. Demographic data, body mass index, physical activity status, and measures of severity of PAD (ankle-brachial index, peak walking time, and ischemic window) also were obtained. RESULTS: Time spent in sedentary behavior was related with high-sensitivity C-reactive protein (b = 0.187; P = .005), glucose (b = 0.238; P < .001), fibrinogen (b = 0.167; P = .017), plasminogen activator inhibitor 1 activity (b = 0.143; P = .036), and high-density lipoprotein cholesterol (b = -0.133; P = .029). After adjustment for sex, age, physical activity status, body mass index, and severity of PAD, sedentary behavior remained related with high-sensitivity C-reactive protein (b = 0.170; P = .015), glucose (b = 0.178; P = .004), fibrinogen (b = 0.189; P = .010), and high-density lipoprotein cholesterol (b = -0.128; P = .032). CONCLUSIONS: Time spent in sedentary activities was associated with worse inflammatory and cardiometabolic profile in patients with intermittent claudication.
Assuntos
Glicemia/análise , Tolerância ao Exercício , Comportamentos Relacionados com a Saúde , Mediadores da Inflamação/sangue , Insulina/sangue , Claudicação Intermitente/sangue , Lipídeos/sangue , Comportamento Sedentário , Actigrafia/instrumentação , Idoso , Índice Tornozelo-Braço , Biomarcadores/sangue , Estudos Transversais , Teste de Esforço , Feminino , Fibrinólise , Humanos , Resistência à Insulina , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/fisiopatologia , Claudicação Intermitente/psicologia , Masculino , Pessoa de Meia-Idade , Atividade Motora , Estresse Oxidativo , Índice de Gravidade de Doença , Fatores de TempoRESUMO
PURPOSES: The study's purposes were to assess the cardiovascular responses during constant-load walking and to identify predictors of this response in peripheral artery disease (PAD) patients. METHODS: Seventy-nine patients with PAD performed a constant-load treadmill test (2 mph, 0% grade). During the test, systolic blood pressure (BP), diastolic BP, and HR were obtained at the fourth minute to the last minute of exercise. Patients were also characterized by demographic measures, cardiovascular risk factors, baseline exercise performance, and vascular measures. RESULTS: During constant-load walking, there was a significant increase (P < 0.01) in systolic BP (+12 ± 10 mm Hg), diastolic BP (+6 ± 9 mm Hg), and HR (+5 ± 5 bpm). The HR responses were negatively correlated with the ischemic window (r = -0.23, P < 0.05), expressed as an area under the curve of the resting ankle systolic BP and its recovery from a maximal graded treadmill test, and positively correlated with the HR during the first minute of recovery from the maximal graded treadmill test (r = 0.27, P < 0.05). The increase in cardiovascular variables during constant-load walking was greater in subjects with a higher body mass index and in men (P < 0.05). CONCLUSIONS: Patients with PAD had an increased cardiovascular response during constant-load walking, and these responses were greater in obese patients and in men. The clinical implication is that PAD patients engaged in walking training programs, particularly men and those with obesity, require frequent assessment of cardiovascular parameters to avoid exaggerated increases in BP and HR during constant-load walking.