Treinamento de Caminhada Melhora a Variabilidade da Pressão Arterial Ambulatorial em Claudicantes

Abstract

Fundamento: O treinamento de caminhada (TC) melhora a capacidade de caminhar e reduz a pressão arterial (PA) clínica em pacientes com doença arterial periférica (DAP), mas seus efeitos na PA ambulatorial permanecem desconhecidos. Objetivos: Investigar o efeito de 12 semanas de TC na PA ambulatorial e sua variabilidade em pacientes com DAP. Métodos: Trinta e cinco pacientes do sexo masculino com DAP e sintomas de claudicação foram alocados aleatoriamente em dois grupos: controle (n = 16, 30 min de alongamento) e TC (n = 19, 15 séries de 2 minutos de caminhada na frequência cardíaca em que ocorreu limiar de dor intercalados por 2 minutos de repouso em pé). Antes e depois de 12 semanas, a PA ambulatorial de 24 horas foi avaliada. Os índices de variabilidade da PA ambulatorial avaliados em ambos os momentos incluíram o desvio-padrão de 24 horas (DP 24 ), o desvio-padrão ponderado de vigília e sono (DP vs ) e a variabilidade real média de 24 horas (VRM 24 ). Os dados foram analisados por ANOVAs mistas de dois fatores, considerando significativo P<0,05. Resultados: Após 12 semanas, nenhum dos grupos apresentou alterações na PA de 24 horas, vigília e sono. O TC diminuiu as variabilidades da PA sistólica e média (

Walking Training Improves Systemic and Local Pathophysiological Processes in Intermittent Claudication

“…Additionally, WT significantly decreased CRP, ICAM and VCAM, and prevented the increase in TNF-α observed in the CO group. As expected, the employed submaximal WT protocol improved walking capacity and cardiovascular function 22 . COD and TWD improvements (75.5 and 65.5%, respectively) were similar to those obtained with supervised maximal WT protocols 9,31 .…”

“…WT group followed a protocol already used in this population 22,23 . Patients from this group executed two supervised training sessions per week.…”

“…In this population, the inclusion of a CO group that had to move for supervised sessions was essential to assure that improvements obtained by the WT group could not be attributed to the active commuting necessary to get to the training sessions. Stretching was chosen as the control intervention because it is an alternative mode of physical activity that has been shown not to modify walking capacity nor cardiovascular function and regulation in patients with IC 22,23 . Thus, CO group performed stretching classes for 30 min, twice a week.…”

“…On the other hand, recent guidelines from the American College of Cardiology, American Heart Association and Society for Vascular Surgery [8][9][10] point out that pain-free and low-intensity walking protocols that avoid moderate-to-maximum claudication ischemia and pain can improve walking ability and functional status, being recommended for these patients. Thus, some useful and reproducible submaximal protocols for patients with PAD and IC have been created and tested [22][23][24][25] . Among them, we have developed a WT protocol based on the heart rate (HR) of pain threshold that is a reproducible physiological marker 23 .…”

“…This training protocol has been shown to evoke low pain and produce significant physiological stimulus above the anaerobic threshold during its execution 23 . Additionally, it has improved cardiovascular function and autonomic regulation in patients with IC after a period of training 22 . However, despite these benefits, little is known about its effects on important factors for vascular health, such as NO bioavailability, oxidative stress and inflammation.…”