Cardiovascular Responses to Walking in Patients with Peripheral Artery Disease

Ritti‐Dias, Raphael Mendes; Menêses, Annelise Lins; Parker, Donald E.; Montgomery, Polly S.; Khurana, Aman; Gardner, Andrew W.

doi:10.1249/mss.0b013e31821ecf61

Cited by 28 publications

(31 citation statements)

References 38 publications

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“…The current consensus is that treadmill walking and supine plantar flexion elicit augmented HR and MAP response in patients with PAD compared with control subjects (2,3,11,20,31). Importantly, those patients with higher exercise BP have a higher risk of adverse cardiovascular events (10,11,17,40).…”

Section: Discussionmentioning

confidence: 99%

Inhibition of cyclooxygenase attenuates the blood pressure response to plantar flexion exercise in peripheral arterial disease

Müller

Drew

Ross

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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Muller MD, Drew RC, Ross AJ, Blaha CA, Cauffman AE, Kaufman MP, Sinoway LI. Inhibition of cyclooxygenase attenuates the blood pressure response to plantar flexion exercise in peripheral arterial disease. Am J Physiol Heart Circ Physiol 309: H523-H528, 2015. First published June 8, 2015 doi:10.1152/ajpheart.00267.2015.-Prostanoids are produced during skeletal muscle contraction and subsequently stimulate muscle afferent nerves, thereby contributing to the exercise pressor reflex. Humans with peripheral arterial disease (PAD) have an augmented exercise pressor reflex, but the metabolite(s) responsible for this augmented response is not known. We tested the hypothesis that intravenous injection of ketorolac, which blocks the activity of cyclooxygenase, would attenuate the rise in mean arterial blood pressure (MAP) and heart rate (HR) evoked by plantar flexion exercise. Seven PAD patients underwent 4 min of single-leg dynamic plantar flexion (30 contractions/min) in the supine posture (workload: 0.5-2.0 kg). MAP and HR were measured on a beat-by-beat basis; changes from baseline in response to exercise were determined. Ketorolac did not affect MAP or HR at rest. During the first 20 s of exercise with the most symptomatic leg, ⌬MAP was significantly attenuated by ketorolac (2 Ϯ 2 mmHg) compared with control (8 Ϯ 2 mmHg, P ϭ 0.005), but ⌬HR was similar (6 Ϯ 2 vs. 5 Ϯ 1 beats/min). Importantly, patients rated the exercise bout as "very light" to "fairly light," and average pain ratings were 1 of 10. Ketorolac had no effect on perceived exertion or pain ratings. Ketorolac also had no effect on MAP or HR in seven age-and sex-matched healthy subjects who performed a similar but longer plantar flexion protocol (workload: 0.5-7.0 kg). These data suggest that prostanoids contribute to the augmented exercise pressor reflex in patients with PAD. PERIPHERAL ARTERIAL DISEASE (PAD) is a form of atherosclerosis that preferentially affects the lower extremity. Because leg blood flow is impaired in PAD, it is not surprising that dynamic exercise, such as walking, provokes pain in the calf, thigh, or buttocks, termed "intermittent claudication." Clinical exercise testing (e.g., the Bruce treadmill protocol) also causes a large increase in blood pressure (BP) in PAD patients, and studies (10, 11) have linked this augmented pressor response to cardiovascular morbidity and mortality. In recent years, our laboratory has focused on BP control in patients with PAD. Specifically, we found that 1) the BP response to single-leg dynamic plantar flexion exercise was augmented in PAD patients compared with healthy control subjects; 2) the pressor response occurred at very low workloads and before the onset of pain; 3) the pressor response correlated with the anklebrachial index (ABI), suggesting that disease severity plays a role; and 4) intravenous infusion of ascorbic acid lowered the pressor response to exercise in PAD (13,28). To date, the mechanisms for these findings are largely unknown. Understanding BP regulation during exercise in PAD ...

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Section: Discussionmentioning

confidence: 99%

Inhibition of cyclooxygenase attenuates the blood pressure response to plantar flexion exercise in peripheral arterial disease

Müller

Drew

Ross

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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“…However, it is possible that the episodes of ischemia produced by walking throughout the monitoring period have influenced this response. Previous studies showed that PAD patients have exaggerated cardiovascular responses during walking [38–39], which have been attributed to an activation of pressor reflex caused by ischemia in lower limbs. This response might oppose the hypotensive effect of previous exercise.…”

Section: Discussionmentioning

confidence: 99%

A single bout of resistance exercise does not modify cardiovascular responses during daily activities in patients with peripheral artery disease

Rodrigues

Forjaz

Andrade-Lima

et al. 2014

Blood Pressure Monitoring

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Objective To analyze the post-effects of a single bout of resistance exercise on cardiovascular parameters in patients with peripheral artery disease (PAD). Design Randomized cross-over. Methods Seventeen PAD patients performed two experimental sessions: control (C) and resistance exercise (R). Both sessions were identical (8 exercises, 3 × 10 reps), except that R session was performed with intensity between 5–7 in the OMNI-RES scale and the C session was performed without any load. Systolic blood pressure (BP), diastolic BP, heart rate (HR), and rate pressure product (RPP) were measured for one hour after the interventions in the laboratory, and during 24-hour using ambulatory BP monitoring. Results After the R session, systolic BP (greatest reduction: −6±2 mmHg, p<0.01) and RPP (greatest reduction: −888±286 mmHg*bpm; p<0.01) decreased until 50 minutes after exercise. From the second hour until 23-hour after exercise BP, HR and RPP product were similar (p>0.05) between R and C sessions. Blood pressure load, nocturnal blood pressure fall and morning surge were also similar between R and C sessions (p>0.05). Conclusion A single bout of resistance exercise decreased BP and cardiac work for one hour after exercise in clinical conditions, and did not modify ambulatory cardiovascular variables during 24-hours in patients with PAD.

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“…The time course of the reduction in ankle systolic blood pressure after treadmill exercise from the resting baseline value was quantified by calculating the area under the curve. Because the ischemic window is a function of both PAD severity and the amount of exercise performed, the ischemic window was normalized per meter walked 21 .…”

Section: Methodsmentioning

confidence: 99%

Factors Associated with Sedentary Behavior in Patients with Intermittent Claudication

Farah¹,

Ritti‐Dias²,

Cucato³

et al. 2016

European Journal of Vascular and Endovascular Surgery

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Objectives Time spent in sedentary behavior has been associated with cardiometabolic risk factor in the general population and in patients with symptomatic peripheral artery disease (PAD). Given the association of sedentary behavior and poor health outcomes, it is important to identify factors associated of sedentary behavior in these patients. The aim of this study was to identify factors associated with the sedentary time in patients with symptomatic PAD. Methods The sample included 297 patients with symptomatic PAD. Sedentary behavior was assessed using a step activity monitor and the patients were divided into tertiles. Demographic data, body mass index, comorbid conditions, and measures of severity of PAD (ankle-brachial index, ischemic window, claudication measurements, peak oxygen uptake and walking economy) were obtained. Results Patients in the highest tertile (i.e., more sedentary) have a higher body mass index and a higher prevalence of diabetes mellitus, metabolic syndrome and obesity than patients in the lowest tertile, whereas their peak walking time, peak oxygen uptake and walking economy were lower (P<.05 for all). Using multiple regression procedures, the factors associated of the sedentary time were male sex (b=0.217, R2=0.180, p=0.001), body mass index (b=0.154, R2=0.059, p=0.013), peak walking time (b=−0.360, R2=0.066, p=<0.001) and walking economy (b=−0.187, R2=0.142, p=0.004). Conclusion In patients with symptomatic PAD, greater time spent in sedentary behavior was found in men, and in patients with higher body mass index, lower peak walking time, and lower walking economy.

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Cardiovascular Responses to Walking in Patients with Peripheral Artery Disease

Cited by 28 publications

References 38 publications

Inhibition of cyclooxygenase attenuates the blood pressure response to plantar flexion exercise in peripheral arterial disease

Inhibition of cyclooxygenase attenuates the blood pressure response to plantar flexion exercise in peripheral arterial disease

A single bout of resistance exercise does not modify cardiovascular responses during daily activities in patients with peripheral artery disease

Factors Associated with Sedentary Behavior in Patients with Intermittent Claudication

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