Efeitos do treinamento em ergômetro de braço na pressão arterial ambulatorial em pacientes com doença arterial periférica

Abstract

Patients with peripheral artery disease (PAD) are at high risk of fatal and non-fatal cardiovascular events. Strategies that help reduce cardiovascular risk in these patients are necessary to improve the health and quality of life of these patients. Studies with arm crank (AC) training have shown benefits in the functional capacity of patients with PAD, bypassing the main barrier to exercising in these patients, pain. However, the effect of this type of training on indicators of cardiovascular function, such as ambulatory blood pressure, is not yet established. Therefore, the aim of the present study was to analyze the effects of AC training on ambulatory blood pressure in patients with PAD and to compare it with the current exercise recommendation, walking training (WT). In this randomized controlled clinical trial, patients were randomly allocated into three experimental groups: AC training, WT and control group (CG). The AC and WT groups performed two weekly sessions with an intensity equivalent to 13-15 on the Borg subjective perception of exertion scale. Patients in the CG attended twice a week just to carry out various activities and socializing in a group, with no exercise involved. In addition, all groups were encouraged to increase their level of physical activity, which is usually the guideline in clinical management. Prior to the start and after 12 weeks of intervention, the following indicators of ambulatory blood pressure systolic (SBP), mean (MAP) and diastolic (DBP) were obtained: 24-hour mean, waking period, sleeping period, morning rise, nocturnal pressure load and mean real variability. For the analysis, the generalized estimation equations were used, having as factors the groups (AC, WT and CG) and the times (pre and post-intervention) and P <0.05 as significance. All groups started from the same ambulatory blood pressure values. After 12 weeks, it was possible to observe an interaction effect on the 24-hour DBP with a post hoc effect only on the AC [pre 78 (10) vs. powder 72 (5) mmHg, p=0.005]; in the MAP of wakefulness in [AC: pre 94 (11) vs. post 96 (11), p=0.044] and [WT: pre 94 (11) vs. post 96 (11) mmHg, p=0.044]; in wakefulness DBP of the AC group [pre 81 (11) vs. powder 76 (14) mmHg, p=0.001]; in the 24-hour DBP pressure load [AC: pre 45 (42) vs. powder 24 (35) %, p=0.016]; in the real mean variability of DBP [AC: pre 9 (3) vs. powder 8 (2); and WT pre 7 (3) vs. after 8 (3), CG: pre 7 (4) vs. after 7 (3), p=0.018. In the other variables, it was not possible to observe significant effects. In conclusion, the preliminary results of this clinical trial demonstrate that 12 weeks of AC training possibly reduces 24h DBP and waking DBP and MAP, DBP values in real mean variability and 24h pressure load in patients with PAD and symptoms of intermittent claudication.