Abstracts: Vascular

Nº de abstracts = 26

Modificado em 16 Março 2012

Experiences of living with intermittent claudication.

Egberg L, Andreassen S, Mattiasson AC.: Journal of Vascular Nursing: official publication of the Society for Peripheral Vascular Nursing, Março 2012 30(1):5-10.

Intermittent claudication is a symptom caused by peripheral arterial disease (PAD) and is associated with pain, impaired mobility and loss of control. Walking ability is reduced due to the pain, and both physical and social functions are often negatively affected, which may lead to patients feeling they are a burden to others. An interview study using a qualitative descriptive design to describe experiences of living with intermittent claudication caused by PAD was carried out during Winter and Spring 2009/2010. Fifteen people suffering from intermittent claudication were interviewed, and the interviews were analyzed using qualitative thematic analysis. Intermittent claudication greatly affects daily living. Six themes were identified: "Experiencing discomfort in the legs," "Moving around in a new way," "Feeling inconvenient when forced to stop," "Missing previous life," "Incorporating intermittent claudication in daily life," and "To lead a strenuous life." The main theme was "Adjusting to a restricted life." The findings show that intermittent claudication has a major impact on daily life. Apart from the severity of symptoms, how the illness is experienced differs among patients, depending on how active the ill person is or wants to be. These findings suggest that increased knowledge about living with intermittent claudication is important to understand the effects on the ill person's life, as a complement to physical examinations when planning individual treatment.

Use of a three-curved rocker sole shoe modification to improve intermittent claudication calf pain - A pilot study.

Hutchins SW, Lawrence G, Blair S, Aksenov A, Jones R.: Journal of Vascular Nursing: official publication of the Society for Peripheral Vascular Nursing, Março 2012 30(1):11-20.

This was a pilot study utilizing hospital-based walking trials to compare two footwear conditions. Two pairs of identical therapeutic shoes were ordered for volunteer claudicant subjects. One pair was adapted with a specifically designed three-curve rocker sole. Volunteer claudicant subjects (n = 8, mean age 66 +/- 9.9 years) with stable pain-free distances of 10 - 400 meters to calf claudication pain were recruited into the study. Walking trials were used to compare differences in both the pain-free distance to claudication and the intensity of the calf pain once claudicating exhibited by each subject while walking separately with the two footwear conditions during the same clinical session. The results demonstrated that claudicant pain-free walking distance was increased, and the intensity of claudication calf pain reduced when walking with the rocker-soled in comparison with baseline. A specifically designed rocker sole has the potential to offer a reduction in the intensity of calf pain experienced by claudicants. A more extensive study is planned to determine the efficacy of this new footwear adaptation when the footwear is worn for extended periods.

Axillary artery injury secondary to inferior shoulder dislocation.

Plaga BR, Looby P, Feldhaus SJ, Kreutzmann K, Babb A.: The Journal of emergency Medicine, 2010, 39(5):599-601. Orthopedic Institute, Sioux Falls, South Dakota 57117, USA.

BACKGROUND: Dislocation injuries of the glenohumeral joint are common in the general public and generally are corrected without complication. One serious complication with shoulder dislocations, or the subsequent reduction, is a lesion to the axillary artery. This specific complication is most frequently seen in the elderly population, where vascular structures have become less flexible. Also, these injuries are most common in association with anterior dislocations of the shoulder. OBJECTIVES: To bring awareness to the possibility of axillary artery injury with inferior dislocation of the shoulder, the treatment options, and a review. CASE REPORT: We report a 15-year-old male athlete who inferiorly dislocated his shoulder during wrestling practice. The injury was reduced at the scene with manual traction and the patient was transferred to our clinic for evaluation. The patient was determined to have a pseudoaneurysm of the axillary artery, and the history and treatment of the illness are presented. CONCLUSION: Axillary artery injuries secondary to shoulder dislocations are rare, especially in the young athlete, and proper recognition and treatment offer patients a full recovery.

Impact of exercise training on arterial wall thickness in humans. Thijssen DH, Cable NT, Green DJ

Clinical science (London, England : 1979)

122(7):311-22, 2012 Thickening of the carotid artery wall has been adopted as a surrogate marker of pre-clinical atherosclerosis, which is strongly related to increased cardiovascular risk. The cardioprotective effects of exercise training, including direct effects on vascular function and lumen dimension, have been consistently reported in asymptomatic subjects and those with cardiovascular risk factors and diseases. In the present review, we summarize evidence pertaining to the impact of exercise and physical activity on arterial wall remodelling of the carotid artery and peripheral arteries in the upper and lower limbs. We consider the potential role of exercise intensity, duration and modality in the context of putative mechanisms involved in wall remodelling, including haemodynamic forces. Finally, we discuss the impact of exercise training in terms of primary prevention of wall thickening in healthy subjects and remodelling of arteries in subjects with existing cardiovascular disease and risk factors.

The effect of moderate intensity exercise on arterial stiffness in resistance trained athletes, endurance trained athletes and sedentary controls: a cross-sectional observational study. Hoonjan B, Dulai R, Ahmed M, Lucey A, Morrissey D, Twycross-Lewis R, Greenwald S

British journal of sports medicine 45(15):A7-8, 2011 Dez Increased arterial stiffness is a significant risk factor for cardiovascular mortality. Acute changes to arterial stiffness in athletes following moderate intensity aerobic exercise are unknown. The purpose of this study was to compare central and peripheral arterial stiffness at rest and with moderate intensity exercise in resistance trained (RT) athletes, endurance trained (ET) athletes and sedentary controls. Fifty two participants (18 RT athletes, 19 ET athletes and 15 controls) underwent central (carotid to femoral) and peripheral (femoral to posterior tibial) pulse wave velocity (PWV) measurements before and at intervals 3, 15 and 30 min after half an hour of moderate intensity cycling (65% of maximal heart rate). PWV was measured using Doppler flow velocimeters as pulse detectors and calculated using the 'foot to foot' velocity method. Groups did not differ in resting central or peripheral PWV. In the endurance and control group, central PWV increased at 3 min postexercise compared with resting values (from 7.7±2.2 to 10.6±4.2 m/s; P = 0.01 and from 7.4±2.2 to 9.1±3.1 m/s; P = 0.02, respectively), followed by a decline to baseline in both groups within 15 min of exercise cessation. The RT group experienced no changes in central PWV, and there were no changes to peripheral PWV postexercise in any group. The study concluded that a 30 min bout of moderate intensity exercise led to a transient increase in central PWV in the endurance and control group, most likely due to mechanisms related to vasoconstriction, but did not reduce arterial stiffness. It is likely that repeated bouts of exercise are needed or a higher intensity of exercise required before reductions in arterial stiffness occur.

Effects of walking and strength training on resting and exercise cardiovascular responses in patients with intermittent claudication.

Vasa, Issue: 5, 390-7Grizzo Cucato G et, al.

Physical activity and cognition in women with vascular conditions. Vercambre MN, Grodstein F, Manson JE, Stampfer MJ, Kang JH.: Archives of Internal Medicine,

2011,07 - 171(14):1244-50. BACKGROUND: Individuals with vascular disease or risk factors have substantially higher rates of cognitive decline, yet little is known about means of maintaining cognition in this group.

METHODS: We examined the relation between physical activity and cognitive decline in participants of the Women's Antioxidant Cardiovascular Study, a cohort of women with prevalent vascular disease or at least 3 coronary risk factors. Recreational physical activity was assessed at baseline (October 1995 through June 1996) and every 2 years thereafter. Between December 1998 and July 2000, a total of 2809 women 65 years or older underwent a cognitive battery by telephone interview, including 5 tests of global cognition, verbal memory, and category fluency. Tests were administered 3 additional times over 5.4 years. We used multivariable-adjusted general linear models for repeated measures to compare the annual rates of cognitive score changes across levels of total physical activity and energy expended in walking, as assessed at Women's Antioxidant Cardiovascular Study baseline.

RESULTS: We found a significant trend (P < .001 for trend) toward decreasing rates of cognitive decline with increasing energy expenditure. Compared with the bottom quintile of total physical activity, significant differences in rates of cognitive decline were observed from the fourth quintile (P = .04 for the fourth quintile and P < .001 for the fifth quintile), or the equivalent of daily 30-minute walks at a brisk pace. This was equivalent to the difference in cognitive decline observed for women who were 5 to 7 years younger. Regularly walking for exercise was strongly related to slower rates of cognitive decline (P = .003 for trend).

CONCLUSION: Regular physical activity, including walking, was associated with better preservation of cognitive function in older women with vascular disease or risk factors.

Comparison of the effect of upper body-ergometry aerobic training vs treadmill training on central cardiorespiratory improvement and walking distance in patients with claudication. Bronas UG, Treat-Jacobson D, Leon AS

.: Journal of vascular surgery, 2011, 53(6):1557-64.

BACKGROUND: Supervised treadmill-walking exercise programs have been proven to be a highly effective in improving walking distance in peripheral arterial disease (PAD) patients with lifestyle-limiting claudication. Limited information is available on the contributions of central cardiorespiratory functions for improving these patients' walking capacity with exercise training.

METHODS: This study randomized 28 participants (21 men; age, 65.6 years; 92.7% smoking history, 36.6% with diabetes) with lifestyle-limiting PAD-related claudication to 3 hours/week of supervised exercise training for 12 weeks, using arm-ergometry (n = 10) or treadmill-walking (n = 10) vs a usual-care control group (n = 8). Cardiorespiratory function measurements were assessed before and after training at a submaximal workload and at the onset of claudication (pain-free walking distance [PFWD]) and at maximal walking distance [(MWD]). Changes in these functions from baseline were analyzed among the groups with analysis of covariance. Associations between variables were determined by Pearson's partial correlations.

RESULTS: The mean baseline demographic, medical, and exercise variables were similar among the groups. There were similar significant differences in the submaximal double product (heart rate × systolic blood pressure) and at MWD, ventilatory threshold, ventilatory oxygen uptake (VO(2)) at onset of claudication, and VO(2) peak in response to training in both exercise groups vs the control group. Statistically significant, moderate correlations (r = 0.60-0.68) were found between changes in all cardiorespiratory variables and changes in PFWD or MWD.

CONCLUSION: Improvements in cardiorespiratory function after arm-ergometry or treadmill-training were significantly associated with improvements in both PFWD and MWD, providing supporting evidence of systemic contributions to exercise training-related improvements in walking capacity seen in patients with claudication.

Celiac artery dissection from heavy weight lifting.

Riles TS, Lin JC.: Journal of Vascular surgery, 2011.06 53(6):1714-5.
In this case report, we present a 45-year-old man who experienced abdominal pain while bench-pressing heavy weights. A computed tomography angiogram showed a dissection of the celiac artery extending into the hepatic and splenic arteries, with thrombus in the false lumen into the common hepatic artery. With resolution of his symptoms, he was discharged after several days of warfarin and metoprolol therapy. To our knowledge, this is the first reported case of a dissection of the celiac artery and its branches caused by weight lifting.

Celiac artery dissection from heavy weight lifting.Riles, TS, Lin, JC: Division of Vascular Surgery, New York University, Langone Medical Center, New York, NY. 53(6):1714-5.

In this case report, we present a 45-year-old man who experienced abdominal pain while bench-pressing heavy weights. A computed tomography angiogram showed a dissection of the celiac artery extending into the hepatic and splenic arteries, with thrombus in the false lumen into the common hepatic artery. With resolution of his symptoms, he was discharged after several days of warfarin and metoprolol therapy. To our knowledge, this is the first reported case of a dissection of the celiac artery and its branches caused by weight lifting.

Bilateral internal carotid and vertebral artery dissection after a horse-riding injury.

Zeid M. Keilani, John D. Berne, Mouchammed Agko: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North Ame, 2010, 52(4):1052-7. Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.

Blunt cerebrovascular injuries, defined as blunt injuries to the internal carotid or vertebral arteries, are uncommon and usually occur in victims of high-speed deceleration motor vehicle crashes. A blunt cerebrovascular injury after an equestrian accident is an extremely unusual presentation. In recent years, advances in screening and treatment with pharmacologic anticoagulation before the onset of neurologic symptoms have improved outcomes for these patients. Endovascular stenting and embolization, although unproven, offer a new potential approach for these complex injuries. We present a unique case of four-vessel blunt cerebrovascular injuries after a horse-riding injury that required multidisciplinary management.

Brachial-ankle pulse wave velocity is associated with walking distance in patients referred for peripheral arterial disease evaluation.

Amoh-Tonto CA, Malik AR, Kondragunta V, Ali Z, Kullo IJ.: Atherosclerosis, 2009, 206(1):173-8. George Washington University School of Medicine, Washington DC, USA.

OBJECTIVE: Impaired functional capacity predicts morbidity and increased mortality in patients with PAD. We hypothesized that brachial-ankle pulse wave velocity (baPWV), a measure of arterial stiffness, is associated with functional capacity in patients undergoing noninvasive evaluation for peripheral arterial disease (PAD). METHODS: We studied 114 patients (age 68+/-10 years) referred to Mayo Clinic's noninvasive vascular laboratory. Functional capacity was estimated in terms of distance walked in 5 min on a treadmill at a speed of 1.0-2.0 mph. Ankle-brachial index (ABI) was obtained with Doppler method before and 1 min after exercise. baPWV was estimated noninvasively using an oscillometric device. The association of baPWV with walking distance was assessed using accelerated failure time and Cox proportional-hazards models. RESULTS: The mean baPWV was higher in patients who were unable to complete the walk test compared to those who successfully completed the test (P=0.008). Higher baPWV was associated with a lower walking distance after adjustment for heart rate, mean arterial pressure, and cardiovascular risk factors (P=0.017) and after additional adjustment for pulse pressure (P=0.034) and ABI (P=0.030). Higher baPWV was associated with failure to complete the treadmill walk test, after adjustment for heart rate, mean arterial pressure, and cardiovascular risk factors (P=0.025) and after additional adjustment for pulse pressure (P=0.041) and ABI (P=0.039). CONCLUSION: Increased baPWV, a measure of arterial stiffness, is associated with impaired functional capacity in patients undergoing evaluation for PAD.

Effect of walking on pressure variations that occur at the interface between elastic stockings and the skin.

de Godoy JM, Braile DM, Perez FB, Godoy Mde F.: International wound journal, 2010-06 7(3):191-3. Department of Cardiology and Cardiovascular Surgery, Medicine School of São José do Rio Preto-FAMERP, São Paulo, Brazil.

Compression stockings during walking. While study participants walked, the pressure variations at the interface between elastic stockings and the skin were measured dynamically. Three healthy individuals wearing 10/20 and 20/30 elastic compression stockings manufactured by Sigvaris((R)) (Jundiai, São Paulo-Brazil) were requested to walk along a course for ten times at a constant speed. For every event, an apparatus specifically developed for the study and programmed to take readings at half-second intervals was used to measure the pressure exerted by the elastic stockings. The pressure exerted by the 10/20 stockings varied between 5 and 32 mmHg and for the 20/30 stockings it varied from 10 to 52 mmHg. Elastic stockings with larger pressures generate larger pressure variations during muscle activity (P-value < 0.001). In conclusion, muscle movements during walking cause the pressure exerted by elastic stockings on the leg to vary; thus, the pressure is not constant but has peaks and troughs according to the type of muscle movement and the gradient of the stockings.

Superior mesenteric artery syndrome after blunt abdominal trauma: a case report.

Falcone JL, Garrett KO.: Vascular and endovascular surgery, 2010, 44(5):410-2. Division of General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15215, USA.

Superior mesenteric artery (SMA) syndrome is a rare cause of bowel obstruction. It is characterized anatomically by a narrowed aortomesenteric angle, causing a mechanical obstruction at the third portion of the duodenum. Patients usually present after prolonged confinement in the supine position, significant acute weight loss, application of body casts, and severe burns with symptoms of a small bowel obstruction. We present the case of a healthy 22-year-old male athlete with SMA syndrome that occurred after blunt abdominal injury in the setting of mild chronic weight loss; he was treated nonoperatively.

Obesity, weight loss, and vascular function

Robert D. Brook, Endocrine, 2006, (29)1, 21-25.

Obesity promotes the development of several major cardiovascular risk factors. Moreover, excess adiposity may play a direct role in initiating atherosclerosis as fat cells are capable of affecting the systemic vasculature through a variety of mechanisms. Recent studies demonstrate that obesity per se may impair vascular endothelial function. This is important as endothelial dysfunction is a key factor in the pathogenesis of atherosclerosis and in triggering acute ischemic events. At present, few studies have determined the beneficial impact of weight loss on cardiovascular outcomes and mortality. However, several experiments have demonstrated that weight loss can lead to improvements in endothelial function, a validated surrogate marker of cardiovascular risk. The mechanisms whereby weight loss restores vascular health are likely multifactorial. However, the relative importance of reduced adiposity versus the specific dietary regimens prescribed, the role of concomitant exercise, and the direct effect of medications remain unclear. Several other unresolved issues such as the longevity of improvement, the amount of weight loss required, and whether the improvement in endothelial function actually translates into a reduction in cardiovascular events also remain to be determined. Nevertheless, lifestyle changes that lead to weight reduction are able to improve vascular function in over-weight adults.

Delayed presentation of popliteal pseudo-aneurysm following soccer football injury.

Chan YC, Ting AC, Qing KX, Cheng SW.: Annals of Vascular Surgery, 2010, 24(4):553.e13-6. Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong

Development of pseudo-aneurysm of the popliteal artery usually Results from trauma, infection, or iatrogenic causes after orthopedic operations. This is to our knowledge the first reported case in the world's literature of a delayed presentation of a large above-knee popliteal artery pseudo-aneurysm following a soccer football injury. The pseudo-aneurysm severely compressed the native artery, and open exploration with surgical vein-patch repair of the artery was chosen in preference to endovascular stent-graft in view of the compressive symptoms and large size of the chronic pseudo-aneurysm. This case highlights the importance of imaging such as duplex ultrasound, computed tomography, or magnetic resonance angiography if symptoms persist after Sports injury.

External iliac artery dissection secondary to endofibrosis in a cyclist.

Willson TD, Revesz E, Podbielski FJ, Blecha MJ.: Journal of Vascular Surgery, 2010, 52(1):219-21. Saint Joseph Hospital/Resurrection Healthcare, Department of Surgery, Chicago, IL 60657, USA.

Endofibrosis of the external iliac artery is an uncommon disease affecting primarily young, otherwise healthy, endurance athletes. Thigh pain during maximal exercise with quick resolution postexercise is characteristic of the so-called cyclist's iliac syndrome. We report an unusual case in which the typical endofibrotic plaque was accompanied by dissection of the external iliac artery. The patient was treated surgically with excision of the affected artery segment and placement of an interposition graft. This case highlights an unusual finding in association with external iliac artery endofibrosis and provides an opportunity to briefly review the literature on the subject.

External iliac vein stenosis owing to prolonged cycling.

Salam A, Chung J, Milner R.: Vascular , 2010 Mar-Apr 18(2):111-5. College of Medical and dental Sciences, Univeristy of Birmingham, Birmingham, UK.

Prolonged cycling has previously been associated with external iliac artery stenosis, termed "cyclists' iliac syndrome." However, no association between external iliac vein stenoses and cycling has been previously described. We describe a unique case of a 70-year-old cyclist presenting with an iliofemoral deep venous thrombosis owing to an external iliac vein stenosis. This is the first case of a potential association between cycling and iliac vein stenosis. Further study and follow-up will be required to assess whether angioplasty and stenting is the optimal method of therapy for iliac vein stenoses owing to cycling.

Objective determination of the predefined duration of a constant-load diagnostic tests in arterial claudication.

Mahe G, Abraham P, Zeenny M, Bruneau A, Vielle B, Leftheriotis G.: Journal of Vascular Surgery, 2010, 51(4):863-8. Department of Vascular Investigations, University Hospital Angers, Angers Cedex, France.

Objective: The predefined duration to arbitrarily stop the tests during constant-load treadmill exercise is a subject of debate and widely variable in the literature. We hypothesized that the upper and lower limits for predefined durations of constant-load 3.2 km/hour 10% grade tests could be derived from the distribution of walking distances observed on a treadmill in a population of subjects referred for claudication or from the optimal cutoff point distance on a treadmill to confirm a limitation self-reported by history. Methods: We conducted a retrospective analysis using a referral center, institutional practice, and ambulatory patients. We studied 1290 patients (86% male), 62.1 +/- 11.2 years of age, 169 +/- 8 cm height, 75.7 +/- 14.2 kg weight. Patients performed a standard constant-load treadmill test: 3.2 km hour(-1), 10% slope, maximized to 1000 meters (approximately 20 minutes). We analyzed the maximal walking distance self-reported (MWD(SR)) by history and the maximal walking distance measured on the treadmill (MWD(TT)). Patients reporting MWD(SR) >or=1000 meters were considered unlimited by history. Results: Only 197 patients (15.3%) completed the 20-minute treadmill test. Among the 504 patients who did not stop before 250 meters, 47.8% stopped within the next 250 meters (were unable to walk 500 meters). This proportion falls to 7.5% among the 213 patients who did not stop before 750 meters. When the final goal was to estimate whether the treadmill test can discriminate patients with or without limitation by history, area under the receiver operating characteristic (ROC) curve was 0.809 +/- 0.016 (95% confidence interval [CI], 0.778-0.841; P < .0001), the best diagnostic performance was attained for an MWD(TT) of 299 meters (approximately 6.15 minutes). Conclusion: In patients undergoing constant-load treadmill exercise with a protocol of 3.2 km hour(-1) and 10% slope: a predefined duration of 7 minutes could be proposed as a lower limit for the predefined duration of the tests specifically if one aims at confirming the limitation by history with treadmill testing. Owing to the low risk that patients that could walk 750 meters (approximately 15 minutes) will have to stop in the next 250 meters, 15 minutes seems a reasonable upper limit for the predefined test duration in clinical routine.

Variability and short-term determinants of walking capacity in patients with intermittent claudication.

Le Faucheur A, Noury-Desvaux B, Mahé G, Sauvaget T, Saumet JL, Leftheriotis G, Abraham P.: Journal of Vascular Surgery, 2010, 51(4):886-92. Laboratory for Vascular Investigations and Sports Medicine, University Hospital, Angers, France.

Objective: Global positioning system (GPS) recordings can provide valid information on walking capacity in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) during community-based outdoor walking. This study used GPS to determine the variability of the free-living walking distance between two stops (WDBS), induced by lower-limb pain, which may exist within a single stroll in PAD patients with IC and the potential associated parameters obtained from GPS analysis. Methods: This cross-sectional study of 57 PAD patients with IC was conducted in a university hospital. The intervention was a 1-hour free-living walking in a flat public park with GPS recording at 0.5 Hz. GPS-computed parameters for each patient were WDBS, previous stop duration (PSD), cumulated time from the beginning of the stroll, and average walking speed for each walking bout. The coefficient of variation of each parameter was calculated for patients with the number of walking bouts (N(WB)) >or=5 during their stroll. A multivariate analysis was performed to correlate WDBS with the other parameters. Results: Mean (SD) maximal individual WDBS was 1905 (1189) vs 550 (621) meters for patients with N(WB) or= 5, respectively (P or= 5, the coefficient of variation for individual WDBS was 43%. Only PSD and cumulated time were statistically associated with WDBS in 16 and 5 patients, respectively. Conclusions: A wide short-term variability of WDBS exists and likely contributes to the difficulties experienced by patients with IC to estimate their maximal walking distance at leisurely pace. Incomplete recovery from a preceding walk, as estimated through PSD, seems to dominantly account for the WDBS in patients with IC.

Walking economy before and after the onset of claudication pain in patients with peripheral arterial disease.

Gardner AW, Ritti-Dias RM, Stoner JA, Montgomery PS, Scott KJ, Blevins SM.: Journal of Vascular Surgery, 2010, 51(3):628-33. CMRI Diabetes and Metabolic Research Program, Harold Hamm Oklahoma Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA.

Purpose: To determine the walking economy before and after the onset of claudication pain in patients with peripheral arterial disease (PAD), and to identify predictors of the change in walking economy following the onset of claudication pain. Methods: A total of 39 patients with PAD were studied, in which 29 experienced claudication (Pain group) during a constant load, walking economy treadmill test (speed = 2.0 mph, grade = 0%) and 10 were pain-free during this test (Pain-Free group). Patients were characterized on walking economy (ie, oxygen uptake during ambulation), as well as on demographic characteristics, cardiovascular risk factors, baseline exercise performance measures, and the ischemic window calculated from the decrease in ankle systolic blood pressure following exercise. Results: During the constant load treadmill test, the Pain group experienced onset of claudication pain at 323 +/- 195 seconds (mean +/- standard deviation) and continued to walk until maximal pain was attained at 759 +/- 332 seconds. Walking economy during pain-free ambulation (9.54 +/- 1.42 ml x kg(-1) x min(-1)) changed (P < .001) after the onset of pain (10.18 +/- 1.56 ml x kg(-1) x min(-1)). The change in walking economy after the onset of pain was associated with ischemic window (P < .001), hypertension (P < .001), diabetes (P = .002), and height (P = .003). In contrast, the Pain-Free group walked pain-free for the entire 20-minute test duration without a change in walking economy (P = .36) from the second minute of exercise (9.20 +/- 1.62 ml x kg(-1) x min(-1)) to the nineteenth minute of exercise (9.07 +/- 1.54 ml x kg(-1) x min(-1)). Conclusion: Painful ambulation at a constant speed is associated with impaired walking economy, as measured by an increase in oxygen uptake in patients limited by intermittent claudication, and the change in walking economy is explained, in part, by severity of PAD, diabetes, and hypertension.

Modificado em 31 de Maio de 2010

Strength training increases walking tolerance in intermittent claudication patients: randomized trial.

Ritti-Dias RM, Wolosker N, de Moraes Forjaz CL, Carvalho CR, Cucato GG, Leão PP, de Fátima Nunes Marucci M.: Journal of Vascular Surgery, 2010, 51(1):89-95. School of Physical Education, University of Pernambuco, Pernambuco, Brazil.

Objective: To analyze the effects of strength training (ST) in walking capacity in patients with intermittent claudication (IC) compared with walking training (WT) effects. Methods: Thirty patients with IC were randomized into ST and WT. Both groups trained twice a week for 12 weeks at the same rate of perceived exertion. ST consisted of three sets of 10 repetitions of whole body exercises. WT consisted of 15 bouts of 2-minute walking. Before and after the training program walking capacity, peak VO(2), VO(2) at the first stage of treadmill test, ankle brachial index, ischemic window, and knee extension strength were measured. Results: ST improved initial claudication distance (358 +/- 224 vs 504 +/- 276 meters; P < .01), total walking distance (618 +/- 282 to 775 +/- 334 meters; P < .01), VO(2) at the first stage of treadmill test (9.7 +/- 2.6 vs 8.1 +/- 1.7 mL.kg(-1).minute; P < .01), ischemic window (0.81 +/- 1.16 vs 0.43 +/- 0.47 mm Hg minute meters(-1); P = .04), and knee extension strength (19 +/- 9 vs 21 +/- 8 kg and 21 +/- 9 vs 23 +/- 9; P < .01). Strength increases correlated with the increase in initial claudication distance (r = 0.64; P = .01) and with the decrease in VO(2) measured at the first stage of the treadmill test (r = -0.52; P = .04 and r = -0.55; P = .03). Adaptations following ST were similar to the ones observed after WT; however, patients reported lower pain during ST than WT (P < .01). Conclusion: ST improves functional limitation similarly to WT but it produces lower pain, suggesting that this type of exercise could be useful and should be considered in patients with IC.

Modificado: Domingo, 23 de Maio de 2010

The influence of a long term exercise program on lower limb movement variability and walking performance in patients with peripheral arterial disease.

Crowther RG, Spinks WL, Leicht AS, Sangla K, Quigley F, Golledge J.: Human Movement Science, 2009 28(4):494-503. Institute of Sport and Exercise Science, James Cook University, Townsville, Queensland 4811, Australia.

The purpose of this study was to examine the effects of a 12month exercise program on lower limb movement variability in patients with peripheral arterial disease (PAD). Participants (n=21) with an appropriate history of PAD and intermittent claudication (IC) volunteered for this study and were randomly allocated to either a control group (CPAD-IC) (n=11), which received normal medical therapy and a treatment group (TPAD-IC) (n=10), which received normal medical therapy treatment and a 12month supervised exercise program. All participants underwent 2D joint angular kinematic analysis during normal walking to assess lower limb movement variability and walking speed. Between-group differences were analyzed via mixed measures ANOVA. The 12month supervised exercise program made no significant impact on the lower limb movement variability or walking speed of the TPAD-IC group as determined by either intralimb joint coordination or single joint analysis techniques. Long term supervised exercise programs do not appear to influence the lower limb movement variability of PAD-IC patients.

Modificado: Domingo 04 de Abril de 2010 - 18h56

Strength training increases walking tolerance in intermittent claudication patients: randomized trial.

Ritti-Dias RM, Wolosker N, de Moraes Forjaz CL, Carvalho CR, Cucato GG, Leão PP, de Fátima Nunes Marucci M.:

Journal of Vascular Surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North Ame, 51(1):89-95, 2010. School of Physical Education, University of Pernambuco, Pernambuco, Brazil.

Effects of low-intensity exercise on patients with peripheral artery disease.

Pena KE, Stopka CB, Barak S, Gertner HR, Carmeli E.:

The Physician and sportsmedicine, 37(1):106-10, 2009. Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL, USA.

Background: Peripheral artery disease (PAD) is one of the many unhealthy conditions that may get worse with age. Its most common symptom is intermittent claudication (IC). Intermittent claudication is the exercise-induced ischemic pain caused by the reduced blood flow to the lower extremities. Objectives: To investigate the effects of low intensity treadmill walking on the functional capacity of PAD patients with IC. Walking ability (time, rate, and distance), heart rate, and blood pressure responses were recorded before, during, and after each exercise session. Only the initial and final values recorded were used for data analysis. This 6-week program of low-intensity, pain-free endurance training was designed to keep the exercise level low enough to minimize ischemic leg pain. Methods: Thirteen PAD patients volunteered for twice weekly exercise sessions for 6 consecutive weeks. Each session consisted of a 10-minute warm-up consisting of routine, pain-free static and proprioceptive neuromuscular facilitation stretching. Each patient exercised for 10 to 20 minutes as tolerated on the treadmill. Proprioceptive neuromuscular facilitation was conducted following walking. Results: As a group the patients with PAD had an average 148% improvement in distance, 34% in rate, and 94% in duration of walking. Five of the 13 patients had over 100% improvement in distance, with the maximum being 525%. One of the 13 patients had a 100% improvement in rate. Four of the 13 patients had over 100% improvement in duration, with the maximum being 500%. Conclusions: This study introduces a new method of low-intensity treadmill walking exercise, which seems to be an effective nonpharmacologic treatment even within a 6-week period for patients with IC due to PAD. It also supports the benefits of walking exercise to increase the mobility of these patients, thus improving functional capacity of life.