Efeito agudo dos exercícios de caminhada, força e da combinação de ambos na rigidez arterial ambulatorial de pacientes com doença arterial periférica sintomática: um ensaio clínico cruzado e randomizado

Abstract

Patients with peripheral arterial disease (PAD) and intermittent claudication (IC) symptoms have high arterial stiffness, which explains, at least in part, high cardiovascular risk of these patients. Physical training has been recommended for the treatment of this population. On the other hand, whether acute exercise improves arterial stiffness in these patients needs to be tested. Therefore, the aims of this study were: (a) to evaluate the effects of a single session of strength exercise, walking and a combination of both on arterial stiffness in patients with symptomatic PAD and; (b) to describe individual responses and identify clinical predictors of arterial stiffness response after exercise. Twelve patients with PAD and IC symptoms participated underwent four experimental sessions in random order: walking exercise (W - 10 bouts of walking during 2 min at the speed corresponding to the onset of claudication pain with an interval of 2 min between the bouts), resistance exercise (R – 2 sets of 10 repetitions in eight exercises), resistance plus walking exercise (RW – 1 set of 10 repetitions in eight resistance exercises + 5 bouts of 2 min of walking with 2 min interval) and control session (C – rest). The ambulatory arterial stiffness index was obtained during daily activities after each session. Body mass index, ankle brachial index, gender and age were also evaluated. For comparison between sessions, Generalized Estimating Equations were used with a post hoc using Bonferroni correction for multiple comparisons. In addition, the net effect of exercise was calculated and Pearson's correlation was used to relate predictors to this effect. P<0.05 was used as significant. The ambulatory arterial stiffness index was lower in the R session as compared to the other sessions (P<0.001) and similar between the W, RW and C (P>0.05). Nine patients (75%) had a lower index after R as compared to the W and RW sessions, while two (17%) and three (25%) patients had lower ambulatory arterial stiffness index values after W and RW sessions, respectively, and only one (8%) had a similar response between R and C. Only the ankle brachial index was negatively correlated with the effects of R session (r = -0.618; P<0.05) and W session (r = -0.750; P<0.001). In conclusion, a single resistance exercise session reduced ambulatory arterial stiffness index in patients with symptomatic PAD, while walking and combined exercise did not change this variable. This response is more likely to occur in individuals with less severe disease.