ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease. Objective selfreported self reported COVID19 COVID 19 COVID-1 Methods 9 53 (5 4 ie i e . 2020 followup follow up follow-up 2021. 2021 2021) telephone obtained Results 630 63 0 63.0 453 45 3 45.3 fatigue 739 73 73.9 849 84 84.9 time 239 23 23.9 396 39 6 39.6 activity respectively followup, up, (women 261 26 1 26.1 p<0.001 p0001 p 001 717 71 7 71.7% p=0.001 43 4.3 217 21 21.7% p=0.013 p0013 013 94 9.4 245 24 5 24.5% p=0.038. p0038 p=0.038 038 p=0.038) Conclusion Selfreported Self COVID1 COVID- 202 63. 45. 73. 8 84. 2 23. 39. 26. p<0.00 p000 00 71.7 p=0.00 4. 21.7 p=0.01 p001 01 9. 24.5 p003 p=0.03 03 20 p<0.0 p00 71. p=0.0 21. 24. p<0. p0 p=0. p<0 p=0 p< p=

ABSTRACT Objective: To analyze the association between the time spent in sedentary behavior and physical activity of different intensities with cardiovascular health in men and women with peripheral artery disease. Methods: Two hundred and sixty patients with peripheral artery disease and claudication symptoms (65.7% men; 66±1 years; ankle brachial index 0.57±0.18) were evaluated. Physical activity and sedentary behavior were assessed using an accelerometer. Physical activity was classified into light and moderate-vigorous intensities. The cardiovascular outcomes included blood pressure (oscillometric method), cardiac autonomic modulation (heart rate variability), and arterial stiffness (pulse wave velocity). Results: Women spent more time engaged in light physical activity than men (341±14 min/day versus 306±9 min/day; p=0.040, respectively). There was no significant difference in the time spent on sedentary behavior and moderate-vigorous physical activity. Women had a higher systolic blood pressure (p=0.025), higher augmentation index (p<0.001), and lower sympathovagal balance (p=0.047) than men. Pulse wave velocity was only negatively associated with light physical activity (β= -4.66; 95%CI= -8.57; -0.76) in men. Light and moderate-vigorous physical activity and sedentary behavior were not associated with other cardiovascular outcomes. Conclusion: Higher levels of light physical activity were associated with lower arterial stiffness in men with peripheral artery disease. Objective Methods 65.7% 657 65 7 (65.7 661 66 1 66± years 0.57±0.18 057018 0 57 18 evaluated accelerometer moderatevigorous moderate vigorous oscillometric method, method , method) heart variability, variability variability) pulse velocity. . velocity) Results 341±14 34114 341 14 (341±1 minday min day 3069 306 9 306± p0040 p 040 p=0.040 respectively. respectively respectively) p=0.025, p0025 p=0.025 025 (p=0.025) p<0.001, p0001 p<0.001 001 (p<0.001) p=0.047 p0047 047 (p=0.047 β= β (β 4.66 466 4 -4.66 95CI CI 95 95%CI 8.57 857 8 -8.57 0.76 076 76 -0.76 Conclusion 65.7 6 (65. 0.57±0.1 05701 5 341±1 3411 34 (341± 30 p004 04 p=0.04 p002 p=0.02 02 (p=0.025 p000 p<0.00 00 (p<0.001 (p=0.04 4.6 46 -4.6 8.5 85 -8.5 0.7 07 -0.7 65. (65 0.57±0. 0570 341± 3 (341 p00 p=0.0 (p=0.02 p<0.0 (p<0.00 (p=0.0 4. -4. 8. -8. 0. -0. (6 0.57±0 057 (34 p0 p=0. p<0. (p<0.0 (p=0. -4 -8 -0 ( 0.57± 05 (3 p=0 p<0 (p<0. (p=0 - 0.57 p= p< (p<0 (p= 0.5 (p< (p

ABSTRACT Objective: This study aimed to evaluate the association between physical activity levels and lower urinary tract symptoms in 20,732 Brazilian men. Methods: This cohort study included 20,732 men of ≥40 years of age, who participated in health screening between January 2008 and December 2018. Standardized health data (anthropometric, laboratory, clinical, and lifestyle data) were collected. A logistic regression model was used to examine associations based on the occurrence of lower urinary tract symptoms. Results: Depressive symptoms (p<0.001), age (p<0.001), erectile dysfunction (p<0.001), and total prostate-specific antigens (p<0.001) were associated with higher odds of lower urinary tract symptoms in men, after adjusting the other factors. However, physical activity levels were associated with lower odds of developing lower urinary tract symptoms (low active, p<0.001; active, p=0.002; and high active, p=0.005). Conclusion: All physical activity levels were associated with lower odds of lower urinary tract symptoms in 20,732 Brazilian men. Objective 20732 20 732 20,73 Methods 40 ≥4 200 2018 anthropometric, anthropometric (anthropometric laboratory clinical collected Results p<0.001, p0001 p p<0.001 , 0 001 prostatespecific prostate specific (p<0.001 factors However low active p=0.002 p0002 002 p=0.005. p0005 p=0.005 . 005 p=0.005) Conclusion 2073 2 73 20,7 4 ≥ 201 p000 p<0.00 00 (p<0.00 p=0.00 207 7 20, p00 p<0.0 (p<0.0 p=0.0 p0 p<0. (p<0. p=0. p<0 (p<0 p=0 p< (p< p= (p

Resumo Avaliar a confiabilidade e a concordância intra-avaliador das avaliações da pressão arterial (PA), rigidez arterial e variabilidade da frequência cardíaca (VFC) em pacientes com doença de Parkinson (DP). Vinte pacientes com DP realizaram três visitas ao laboratório, durante as quais foram realizadas avaliações da PA braquial e central (tonometria de aplanação e auscultatório, respectivamente), rigidez arterial (velocidade da onda de pulso carotídeo-femoral e índice de aumento) e VFC em repouso. A PA sistólica braquial e central apresentou valores maiores na visita 1 quando comparada às visitas 2 e 3 (122±13 vs. 116±16 vs. 120±15, p=0,029). Não houve diferenças significativas (p>0,05) entre as visitas experimentais para outros parâmetros. A PA braquial e central apresentou um coeficiente de correlação intraclasse (CCI) acima de 0,842 e um erro padrão de medida (EPM) menor que 5,0%. Os gráficos de Bland–Altman indicaram baixa concordância entre as visitas 1 e 2 e boa concordância entre as visitas 2 e 3. Os índices de rigidez arterial exibiram valores de CCI entre 0,781 e 0,886, e o EPM variou de 7,3% a 25,2%. Os gráficos de Bland–Altman indicaram concordância moderada a boa entre as visitas para os parâmetros de rigidez arterial. Os índices de VFC apresentaram valores de CCI variando de 0,558 a 0,854 e valores de EPM que variam de 5,1% a 76,0%. Os gráficos de Bland–Altman indicaram concordância moderada entre as visitas para os parâmetros de VFC. Em pacientes com DP, a PA braquial e central apresenta baixa confiabilidade intra-avaliador e concordância entre as visitas 1 e 2 e boa confiabilidade intra-avaliador e concordância entre as visitas 2 e 3. Em geral, as avaliações de rigidez arterial e VFC apresentam confiabilidade intra-avaliador e concordância aceitáveis entre as visitas, exceto para o equilíbrio simpático-vagal cardíaco. intraavaliador intra avaliador PA, , (PA) (VFC DP. . (DP) laboratório tonometria auscultatório respectivamente, respectivamente respectivamente) velocidade carotídeofemoral carotídeo femoral aumento repouso 122±13 12213 122 13 (122±1 vs 11616 116 16 116±1 12015 120 15 120±15 p=0,029. p0029 p p=0,029 0 029 p=0,029) p>0,05 p005 05 (p>0,05 (CCI 0842 842 0,84 (EPM 50 5 5,0% BlandAltman Bland Altman 0781 781 0,78 0886 886 0,886 73 7 7,3 252 25 25,2% 0558 558 0,55 0854 854 0,85 51 5,1 760 76 76,0% geral simpáticovagal simpático vagal cardíaco (PA (DP 122±1 1221 12 (122± 1161 11 116± 1201 120±1 p002 p=0,02 02 p>0,0 p00 (p>0,0 084 84 0,8 5,0 078 78 0,7 088 88 0,88 7, 25,2 055 55 0,5 085 85 5, 76,0 122± (122 120± p=0,0 p>0, p0 (p>0, 08 8 0, 07 25, 76, (12 p=0, p>0 (p>0 (1 p=0 p> (p> ( p= (p

Abstract To assess the intrarater reliability and agreement of blood pressure (BP), arterial stiffness, and heart rate variability (HRV) assessments in patients with Parkinson`s disease (PD). Twenty patients with PD visited the laboratory three times, during which brachial and central BP (auscultatory and applanation tonometry, respectively), arterial stiffness (carotid-femoral pulse wave velocity and augmentation index), and HRV assessments were performed at rest. Brachial and central systolic BP presented greater values on visit 1 when compared to visits 2 and 3 (122±13 vs. 116±16 vs. 120±15, p=0.029). There were no significant differences (p>0.05) among the experimental visits for other parameters. Brachial and central BP showed an intraclass correlation coefficient (ICC) above 0.842 and a standard error of measurement (SEM) lower than 5.0%. Bland–Altman plots indicated low agreement between visits 1 and 2 and good agreement between visits 2 and 3. Arterial stiffness indices exhibited ICC values between 0.781 and 0.886, and SEM ranged from 7.3% to 25.2%. Bland–Altman plots indicated moderate to good agreement among visits for arterial stiffness parameters. HRV indices presented ICC values ranging from 0.558 to 0.854 and SEM values ranging from 5.1% to 76.0%. Bland–Altman plots indicated moderate agreement among visits for HRV parameters. In PD patients, brachial and central BP present low intrarater reliability and agreement between visits 1 and 2 and good intrarater reliability and agreement between visits 2 and 3. In general, arterial stiffness and HRV assessments present acceptable intrarater reliability and agreement among visits, except for cardiac sympathovagal balance. BP, , (BP) (HRV Parkinsons Parkinson s PD. . (PD) times auscultatory tonometry respectively, respectively respectively) carotidfemoral carotid femoral index, index index) rest 122±13 12213 122 13 (122±1 vs 11616 116 16 116±1 12015 120 15 120±15 p=0.029. p0029 p p=0.029 0 029 p=0.029) p>0.05 p005 05 (p>0.05 parameters (ICC 0842 842 0.84 (SEM 50 5 5.0% BlandAltman Bland Altman 0781 781 0.78 0886 886 0.886 73 7 7.3 252 25 25.2% 0558 558 0.55 0854 854 0.85 51 5.1 760 76 76.0% general balance (BP (PD 122±1 1221 12 (122± 1161 11 116± 1201 120±1 p002 p=0.02 02 p>0.0 p00 (p>0.0 084 84 0.8 5.0 078 78 0.7 088 88 0.88 7. 25.2 055 55 0.5 085 85 5. 76.0 122± (122 120± p=0.0 p>0. p0 (p>0. 08 8 0. 07 25. 76. (12 p=0. p>0 (p>0 (1 p=0 p> (p> ( p= (p

ABSTRACT Objective Peak oxygen consumption (VO2peak), anaerobic threshold, walking economy, and cardiovascular responses during walking are used to guide and monitor walking training in patients with peripheral artery disease and intermittent claudication. Women with peripheral artery disease and intermittent claudication present greater impairments than men, and evaluating training markers according to sex for decisions regarding walking prescription in this population is important. This study aimed to compare VO2peak, walking economy, anaerobic threshold, and cardiovascular responses during walking in men and women with peripheral artery disease and intermittent claudication. Methods Forty patients (20 men and 20 women with similar baseline characteristics) underwent a cardiopulmonary treadmill test (3.2km/h and 2% increase in slope every 2 minutes until maximal leg pain). The VO2 and rate-pressure product were assessed. Data from men and women were compared using t-tests. Results There were no significant differences between men and women (VO2peak: 15.0±4.8 versus 13.9±2.9mL∙kg-1∙min-1, p=0.38; walking economy: 9.6±2.7 versus 8.4±1.6mL∙kg-1∙min-1, p=0.09; anaerobic threshold: 10.5±3.2 versus 10.5±2.2mL∙kg-1∙min-1, p=0.98; rate pressure product at 1st stage: 13,465± 2,910 versus 14,445±4,379bpm∙mmHg, p=0.41; and rate pressure product at anaerobic threshold:13,673±3,100 versus 16,390±5,870bpm∙mmHg, p=0.08 and rate pressure product at peak exercise: 21,253±6,141 versus 21,923±7,414bpm∙mmHg, p=0.76, respectively). Conclusion Men and women with peripheral artery disease and similar baseline characteristics presented similar responses to walking, suggesting that decisions regarding walking prescription and monitoring can be made regardless of sex in this specific population. VO2peak VOpeak , VO (VO2peak) threshold economy important (2 3.2km/h 32kmh kmh 3 2km h km pain. pain . pain) ratepressure assessed ttests. ttests t tests. tests t-tests (VO2peak 15048 15 0 4 8 15.0±4. 13.9±2.9mL∙kg1∙min1, 13929mLkg1min1 mLkgmin 13.9±2.9mL∙kg 1∙min 1, 13 9 9mL kg 1 min mL 13.9±2.9mL∙kg-1∙min-1 p=0.38 p038 p 38 9627 6 7 9.6±2. 8.4±1.6mL∙kg1∙min1, 8416mLkg1min1 8.4±1.6mL∙kg 6mL 8.4±1.6mL∙kg-1∙min-1 p=0.09 p009 09 10532 10 5 10.5±3. 10.5±2.2mL∙kg1∙min1, 10522mLkg1min1 10.5±2.2mL∙kg 2mL 10.5±2.2mL∙kg-1∙min-1 p=0.98 p098 98 st stage 13465 465 13,465 2910 910 2,91 144454379bpmmmHg bpmmmHg 14 445 379bpm mmHg bpm 14,445±4,379bpm∙mmHg p=0.41 p041 41 threshold13,673±3,100 threshold136733100 13,673±3,100 673 100 threshold:13,673±3,10 163905870bpmmmHg 16 390 870bpm 16,390±5,870bpm∙mmHg p008 08 p=0.0 exercise 212536141 21 253 141 21,253±6,14 219237414bpmmmHg 923 414bpm 21,923±7,414bpm∙mmHg p076 76 p=0.76 respectively. respectively respectively) ( 1504 15.0±4 kg1 min1 13.9±2.9mL∙kg1∙min1 mLkg 13929mLkg1min 13929mLkg 1min 13.9±2.9mL∙kg-1∙min- p=0.3 p03 962 9.6±2 8.4±1.6mL∙kg1∙min1 8416mLkg1min 8416mLkg 8.4±1.6mL∙kg-1∙min- p00 1053 10.5±3 10.5±2.2mL∙kg1∙min1 10522mLkg1min 10522mLkg 10.5±2.2mL∙kg-1∙min- p=0.9 p09 1346 46 13,46 291 91 2,9 44 p=0.4 p04 threshold13 threshold13,673±3,10 threshold13673310 136733100 13,673±3,10 67 threshold:13,673±3,1 39 p=0. 21253614 25 21,253±6,1 92 p07 p=0.7 150 15.0± 13.9±2.9mL∙kg1∙min 13.9±2.9mL∙kg-1∙min p0 96 9.6± 8.4±1.6mL∙kg1∙min 8.4±1.6mL∙kg-1∙min 105 10.5± 10.5±2.2mL∙kg1∙min 10.5±2.2mL∙kg-1∙min 134 13,4 29 2, threshold1 threshold13,673±3,1 threshold1367331 13673310 13,673±3,1 threshold:13,673±3, p=0 2125361 21,253±6, 15.0 9.6 10.5 13, threshold13,673±3, threshold136733 1367331 13,673±3, threshold:13,673±3 p= 212536 21,253±6 15. 9. 10. threshold13,673±3 threshold13673 136733 13,673±3 threshold:13,673± 21253 21,253± threshold13,673± threshold1367 13673 13,673± threshold:13,673 2125 21,253 threshold13,673 threshold136 1367 13,673 threshold:13,67 212 21,25 threshold13,67 136 13,67 threshold:13,6 21,2 threshold13,6 13,6 threshold:13, 21, threshold13, threshold:13 threshold:1

RESUMEN El objetivo de este estudio es evaluar el efecto de la estimulación eléctrica transcutánea del nervio vago (EETNV) sobre la inflamación, la modulación autonómica cardíaca y la evolución clínica de pacientes con COVID-19. Se trata de un ensayo clínico, controlado por simulado, aleatorizado y ciego, en el que participarán 52 individuos hospitalizados diagnosticados de COVID-19, que serán aleatorizados en dos grupos de tratamiento: grupo experimental (tratamiento médico habitual asociado a la EETNV activa) o grupo control (tratamiento médico habitual asociado a la EETNV simulada). La EETNV se realizará mediante un estimulador eléctrico neuromuscular (modelo Dualpex 071 de Quark Medical Products), con el electrodo de estimulación colocado en el trago izquierdo, con corriente alterna, frecuencia de 30Hz y 50% de variación, intensidad ajustada al umbral sensorial del paciente, con una duración de 90 minutos cada sesión de estimulación, dos veces al día, durante siete días consecutivos, lo que totaliza 14 sesiones. Se evaluarán antes y después de la intervención la interleucina-6 (IL-6) y la interleucina-10 (IL-10), el cortisol y la proteína C reactiva (PCR), la presión arterial, la variabilidad de la frecuencia cardíaca por los parámetros de baja frecuencia (BF), alta frecuencia (AF) y razón de baja y alta frecuencia (BF/AF), así como la evolución clínica de los pacientes, incluidos los parámetros de ansiedad y depresión cuyos datos se obtendrán de historias clínicas y cuestionarios. También se realizará un seguimiento de 7 y 14 días tras finalizadas las intervenciones para verificar la evolución clínica, incluidos el nivel de ansiedad y de depresión, y durante seis meses se evaluará la memoria y la atención. (EETNV inflamación COVID19. COVID19 COVID 19. 19 COVID-19 clínico simulado ciego 5 COVID19, 19, tratamiento activa simulada. simulada . simulada) modelo 07 Products, Products , Products) izquierdo alterna Hz 50 variación paciente 9 día consecutivos 1 sesiones interleucina6 interleucina 6 interleucina- IL6 IL (IL-6 interleucina10 10 interleucina-1 IL10, IL10 (IL-10) PCR, PCR (PCR) arterial BF, BF (BF) AF (AF BF/AF, BFAF BF/AF (BF/AF) cuestionarios atención COVID1 COVID-1 0 (IL- interleucina1 IL1 (IL-10 (PCR (BF (BF/AF COVID- (IL (IL-1

RESUMO O objetivo deste estudo é avaliar o efeito da estimulação elétrica transcutânea do nervo vago (EETNV) na inflamação, modulação autonômica cardíaca e evolução clínica dos pacientes com COVID-19. Trata-se de um ensaio clínico, controlado por sham, randomizado e cego, no qual participarão 52 indivíduos hospitalizados com diagnóstico de COVID-19, que serão randomizados em dois grupos de tratamento: grupo experimental (tratamento médico usual associado à EETNV ativa) ou grupo-controle (tratamento médico usual associado à EETNV sham). A EETNV será realizada por meio de um estimulador elétrico neuromuscular (modelo Dualpex 071 da Quark Medical Products), com o eletrodo de estimulação posicionado sobre o tragus esquerdo, com corrente alternada, frequência de 30Hz e variação de 50%, intensidade ajustada para o limiar sensorial do paciente, com duração de 90 minutos cada sessão de estimulação, duas vezes ao dia, durante sete dias consecutivos, totalizando 14 sessões. Serão avaliados pré e pós-intervenção o nível de interleucina-6 (IL-6) e interleucina-10 (IL-10), cortisol e proteína C reativa (PCR), pressão arterial, variabilidade da frequência cardíaca pelos parâmetros de baixa frequência (BF), alta frequência (AF) e pela razão da baixa e alta frequência (BF/AF), além de evolução clínica dos pacientes, incluindo o nível de ansiedade e depressão, cujos dados serão obtidos por meio de prontuários e questionários. Será realizado também um acompanhamento 7 e 14 dias após o término das intervenções para verificar a evolução clínica, incluindo nível de ansiedade e depressão, e durante seis meses serão avaliadas memória e atenção. (EETNV inflamação COVID19. COVID19 COVID 19. 19 COVID-19 Tratase Trata se clínico sham cego 5 COVID19, 19, tratamento ativa grupocontrole controle sham. . sham) modelo 07 Products, Products , Products) esquerdo alternada Hz 50 50% paciente 9 dia consecutivos 1 sessões pósintervenção pós intervenção interleucina6 interleucina 6 interleucina- IL6 IL (IL-6 interleucina10 10 interleucina-1 IL10, IL10 (IL-10) PCR, PCR (PCR) arterial BF, BF (BF) AF (AF BF/AF, BFAF BF/AF (BF/AF) depressão questionários atenção COVID1 COVID-1 0 (IL- interleucina1 IL1 (IL-10 (PCR (BF (BF/AF COVID- (IL (IL-1

ABSTRACT This study aims to evaluate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on inflammation, cardiac autonomic modulation, and clinical evolution of patients with COVID-19. This is a clinical, sham-controlled, randomized, and blind trial, in which 52 hospitalized individuals diagnosed with COVID-19 will participate. They will be randomized into: experimental group (usual medical treatment associated with active taVNS) and control group (usual medical treatment associated with sham taVNS). The taVNS will be performed by a neuromuscular electric stimulator (Dualpex model 071 of Quark Medical Products), with the stimulation electrode positioned on the left tragus, with alternating current, at a 30Hz frequency with 50% variation. Intensity will be adjusted to the patient’s sensory threshold, with 90-minutes-long stimulation sessions, happening twice per day for seven consecutive days, totaling 14 sessions. Interleukin-6 (IL-6) and interleukin-10 (IL-10), cortisol and C-reactive protein (CRP), blood pressure, heart rate variability (HRV) by low frequency (LF), high frequency (HF) and low and high frequency ratio (LF/HF) parameters will be evaluated before and after the intervention, as well as patients’ clinical evolution-including anxiety and depression levels-whose data will be obtained through medical records and questionnaires. A follow-up will also be performed seven and 14 days after the end of the interventions to verify the clinical evolution, including anxiety and depression levels. Memory and attention levels will be evaluated for six months. (taVNS inflammation modulation COVID19. COVID19 COVID 19. 19 shamcontrolled, shamcontrolled controlled, controlled sham-controlled trial 5 COVID-1 participate into usual taVNS. . Dualpex 07 Products, Products , Products) tragus current Hz 50 variation patient s threshold 90minuteslong minuteslong 90 minutes long sessions 1 Interleukin6 Interleukin 6 Interleukin- IL6 IL (IL-6 interleukin10 interleukin 10 interleukin-1 IL10, IL10 (IL-10) Creactive C reactive CRP, CRP (CRP) pressure HRV (HRV LF, LF (LF) HF (HF LF/HF LFHF (LF/HF intervention evolutionincluding levelswhose whose questionnaires followup follow up months COVID1 COVID- 0 9 (IL- interleukin1 interleukin- IL1 (IL-10 (CRP (LF (IL (IL-1

Abstract BACKGROUND: Sitting time, screen time and low physical activity (PA) levels have been associated with several diseases and all-cause mortality. PA is related to better sleep quality and absence of daytime sleepiness, along with lower risks of obstructive syndrome apnea (OSA). However, studies on the relationship between sitting time, screen time and OSA are scarce in the literature. OBJECTIVE: To analyze associations between PA levels, sitting time, screen time and OSA among adults with suspected sleep disorder. DESIGN AND SETTING: Cross-sectional study conducted at Hospital Israelita Albert Einstein. METHODS: Data were collected from 369 adults with suspected sleep disorders who visited the hospital’s neurophysiology clinic between August 2015 and January 2017. RESULTS: Correlations between hypopnea and PA indicators were demonstrated for total sitting time (0.123; P = 0.019) and total screen time (0.108; P = 0.038). There was also a correlation between latency for rapid-eye-movement sleep (REM_LAT) and total sitting time (0.103; P = 0.047) and a negative correlation between mean oxyhemoglobin saturation (SaO_Avg) and total PA time (-0.103; P = 0.048). There were no associations between PA parameters and apnea-hypopnea index. After adjusting for confounding factors (body mass index, age and gender), sitting time and screen time were not associated with OSA. CONCLUSION: After adjusting for anthropometric and clinical factors, excessive sitting time or screen time was not associated with OSA in adults suspected of sleep disorders. Age, gender, hypertension, body mass index and waist circumference were associated with OSA.

RESUMO A inatividade física está associada à baixa variabilidade da frequência cardíaca (VFC) em adolescentes. Entretanto, não está claro se o número de aulas de Educação Física (EF) causa impacto na VFC. Este estudo transversal verificou a associação entre a frequência das aulas de EF com parâmetros de VFC em adolescentes do sexo masculino. Foram incluídos 1.152 meninos (16,6 ± 1,2 anos). A quantidade de aulas de EF foi avaliada através de questionário e os adolescentes foram estratificados de acordo (nenhuma aula de EF; uma aula de EF / sem; ≥2 aulas de EF / sem). Os domínios do tempo (SDNN, RMSSD, PNN50) e da frequência (LF, HF, balanço simpático-vagal) da VFC foram obtidos. Modelos Lineares Generalizados foram usados para comparar os parâmetros da VFC de acordo com a quantidade de aulas de EF, ajustando para fatores de confusão. Não houve diferença nas medidas de VFC de tempo: (SDNN, p = 0,77; RMSSD, p = 0,72; PNN50, p = 0,83) e frequência (LF, p = 0,61; HF, p = 0,61; balanço simpatovagal, p = 0,60) entre as diferentes frequências das aulas de EF. A frequência das aulas de EF não está associada aos parâmetros de VFC de adolescentes do sexo masculino.

ABSTRACT Physical inactivity is associated with low heart rate variability (HRV) in adolescents. However, whether the number of physical education (PE) classes impact HRV remains unclear. This cross-sectional study verified the association between the frequency of PE classes and HRV parameters in male adolescents. This study included 1152 boys (16.6 ± 1.2 years). The quantity of PE classes was assessed though questionnaire and the adolescents were stratified accordingly (no PE class; one PE class/wk; ≥2 PE classes/wk). Time- (SDNN, RMSSD, PNN50) and frequency-domains (LF, HF, sympathovagal balance) of HRV were obtained. Generalized Linear Models were used for comparing the HRV parameters according to the quantity of PE classes, adjusting for confounders. There was no difference in HRV measures of time: (SDNN, p = 0.77; RMSSD, p=0.72; PNN50, p=0.83) and frequency (LF, p=0.61; HF, p=0.61; sympathovagal balance, p=0.60) between the different frequencies of PE classes. The frequency of PE classes in not associated with HRV parameters of male adolescents.

Resumo Fundamento: Estudos transversais anteriores demonstraram que a atividade física está associada a menor risco cardiovascular em pacientes com doença arterial periférica (DAP). No entanto, não é possível estabelecer causalidade e estudos com desenho longitudinal são necessários. Objetivo: Analisar as alterações nos parâmetros de risco cardiovascular e níveis de atividade física após 2 anos de acompanhamento em pacientes com DAP sintomática. Métodos: O presente estudo teve início em 2015. Na primeira fase, foram incluídos 268 pacientes. Na segunda fase, após 2 anos (mediana = 26 meses), foram reavaliados 72 pacientes. Parâmetros de risco cardiovascular, como pressão arterial, modulação autonômica cardíaca e rigidez arterial, e níveis de atividade física foram medidos na linha de base e após 2 anos de acompanhamento. A associação entre as alterações delta (valores após 2 anos – valores da linha de base) na atividade física e nos parâmetros cardiovasculares foi analisada por meio de regressão linear múltipla. O nível de significância foi estabelecido em p < 0,05 com DAP. Resultados: Pacientes reduziram seus níveis totais de atividade física em comparação com a linha de base (linha de base = 2.257,6 ± 774,5 versus acompanhamento = 2.041 ± 676,2 min/semana, p = 0,001). Após o acompanhamento, o índice tornozelo-braquial (0,62 ± 0,20 versus 0,54 ± 0,20, p = 0,003) e o desvio padrão de todos os intervalos RR (43,4 ± 27,0 versus 25,1 ± 13,4 ms, p < 0,001) foram menores, enquanto a velocidade da onda de pulso carotídeo-femoral foi maior (9,0 ± 3,0 versus 10,7 ± 3,4 m/s, p = 0,002) em relação aos valores basais. Não observamos associação entre os valores delta dos níveis de atividade física e os parâmetros de risco cardiovascular. Conclusão: Pacientes com DAP tiveram níveis reduzidos de atividade física e comprometimento em relação aos parâmetros de risco cardiovascular após 2 anos de acompanhamento.

Background: Previous cross-sectional studies have demonstrated that physical activity is associated with lower cardiovascular risk in patients with peripheral artery disease (PAD). However, it is not possible to establish causality, and longitudinal design studies are required. Objective: To analyze the changes in cardiovascular risk parameters and physical activity levels after a 2-year follow-up in patients with symptomatic PAD. Methods: This study started in 2015. In the first phase, 268 patients were included. In the second phase, after 2 years (median = 26 months), 72 patients were re-evaluated. Cardiovascular risk parameters, such as blood pressure, cardiac autonomic modulation, and arterial stiffness, and physical activity levels were measured at baseline and after 2 years of follow-up. Association among delta changes (values from follow-up – baseline) in physical activity and cardiovascular parameters were analyzed by multiple linear regression. The significance level was set at p < 0.05. Results: Patients reduced their total physical activity levels compared to baseline (baseline = 2257.6 ± 774.5 versus follow-up = 2041 ± 676.2 min/week, p = 0.001). After follow-up, ankle-brachial index (0.62 ± 0.20 versus 0.54 ± 0.20, p = 0.003), and standard deviation of all RR intervals (43.4 ± 27.0 versus 25.1 ± 13.4 ms, p < 0.001) were lower, whereas carotid-femoral pulse wave velocity was higher (9.0 ± 3.0 versus 10.7 ± 3.4 m/s, p = 0.002) compared to baseline values. We did not observe any association among delta values of physical activity levels and cardiovascular risk parameters. Conclusion: Patients with PAD had reduced physical activity levels and impaired cardiovascular risk parameters during 2-year follow-up.

ABSTRACT Objective To verify the association of changes on physical activity levels during coronavirus disease 2019 (COVID-19) outbreak of individuals with normal weight and overweight/obesity, and the influence of sex in this relationship. Methods This cross-sectional study (survey research) was conducted in Brazil between May 5 and May 17, 2020. Participants (n=1,828 / 1,062 women >18 years) were invited through social media to answer a structured questionnaire via Google Forms. The online assessment included self-reported responses to questions on physical activity, overall health, weight, and height. Binary logistic regression analyzed the relationship between overweight/obesity (body mass index ≥25kg/m2), the impact of COVID-19 on physical activity level, and the influence of sex. Results Compared to normal weight people, those with overweight/obesity practice less moderate to vigorous physical activity (p<0.001). There were associations between women and men with overweight/obesity and the impact of COVID-19 on the physical activity practice compared to normal weight people, adjusted by age, education level, social isolation, and previous physical activity level (p<0.017). Conclusion The study found an association of weight and changes in physical activity levels. Individuals with overweight/obesity were more likely to have a lower physical activity level during COVID-19 pandemic, regardless of sex.

ABSTRACT BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P < 0.05; control: 126 ± 4 versus 126 ± 3 mmHg, P > 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317.

Resumo 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. Objetivo: 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 (DP24), o desvio-padrão ponderado de vigília e sono (DPvs) e a variabilidade real média de 24 horas (VRM24). 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 (PA sistólica – 13,3 ± 2,8 vs 11,8 ± 2,3; 12,1 ± 2,84 vs 10,7 ± 2,5; e 9,4 ± 2,3 vs 8,8 ± 2,2 mmHg; PA média – 11,0 ± 1,7 vs 10,4 ± 1,9; 10,1 ± 1,6 vs 9,1 ± 1,7; e 8,0 ± 1,7 vs 7,2 ± 1,5 mmHg para DP24, DPvs e VRM24, respectivamente). Nenhum dos grupos apresentou mudanças significantesnos índices de variabilidade da PA diastólica após 12 semanas. Conclusões: O TC não altera os níveis ambulatoriais da PA, mas diminui a sua variabilidade em pacientes com DAP. Essa melhora pode ter um impacto favorável no risco cardiovascular de pacientes com DAP sintomática. (Arq Bras Cardiol. 2021; 116(5):898-905)

Background: Walking training (WT) improves walking capacity and reduces clinic blood pressure (BP) in patients with peripheral artery disease (PAD), but its effects on ambulatory BP remains unknown. Objective: To investigate the effect of 12 weeks of WT on ambulatory BP and its variability in patients with PAD. Methods: Thirty-five male patients with PAD and claudication symptoms were randomly allocated into two groups: control (n = 16, 30 min of stretching) and WT (n = 19, 15 bouts of 2 min of walking at the heart rate of leg pain threshold interspersed by 2 min of upright rest). Before and after 12 weeks, 24-hour ambulatory BP was assessed. Ambulatory BP variability indices assessed at both time points included the 24-hour standard deviation (SD24), the awake and asleep weighted standard deviation (SDdn), and the 24-hour average real variability (ARV24). Data were analyzed by mixed two-way ANOVAs, considering P<0.05 as significant. Results: After 12 weeks, neither group had significant changes in 24-hour, awake and sleep BPs. The WT decreased systolic and mean BP variabilities (Systolic BP – 13.3±2.8 vs 11.8±2.3, 12.1±2.84 vs 10.7±2.5 and 9.4±2.3 vs 8.8±2.2 mmHg); Mean BP – 11.0±1.7 vs 10.4±1.9, 10.1±1.6 vs 9.1±1.7 and 8.0.±1.7 vs 7.2±1.5 mmHg) for SD24, SDdn and ARV24, respectively). Neither group had significant changes in diastolic BP variabilities after 12 weeks. Conclusions: The WT does not change ambulatory BP levels but decreases ambulatory BP variability in patients with PAD. This improvement may have a favorable impact on the cardiovascular risk of patients with symptomatic PAD. (Arq Bras Cardiol. 2021; 116(5):898-905)

Resumo Fundamento A frequência cardíaca em repouso (FCR) pode ser uma ferramenta útil de triagem para o risco cardiovascular. Porém, os pontos de corte para FCR nunca foram descritos em populações jovens. Objetivo Estabelecer os pontos de corte para FCR em adolescentes brasileiros e analisar se há associação entre pontos de corte e fatores de risco cardiovascular. Métodos A amostra foi composta por 6.794 adolescentes (de 10 a 19 anos). A pressão arterial e a FCR foram avaliadas por dispositivo oscilométrico. Também foram avaliados o índice de massa corporal e a circunferência da cintura. Foi adotada a curva ROC para analisar a sensibilidade e especificidade, e as associações de FCR elevada com os fatores de risco cardiovascular foram analisadas por regressão logística binária. Foi considerado estatisticamente significante um valor de p < 0,05 para todas as análises. Resultados Os valores médios da FCR eram mais altos entre os participantes de 10 a 14 anos do naqueles de 15 a 19 anos, em meninos (p < 0,001) e meninas (< 0,001). Os pontos de corte de FCR propostos para detecção de fatores de risco cardiovascular foram significativos para meninos de 10 a 14 (> 92 bpm) e de 15 a 19 anos (> 82 bpm) e para meninas de 15 a 19 anos (> 82 bpm) (p < 0,05 para todos), enquanto nenhum ponto de corte foi identificado para as meninas de 10 a 14 anos (p > 0,05). Os pontos de corte propostos para a FCR foram associados com obesidade abdominal, sobrepeso e pressão arterial elevada em meninos e meninas. Os pontos de corte da FCR foram associados ao conjunto de fatores de risco cardiovascular em adolescentes de 15 a 19 anos. Conclusões Os pontes de corte propostos para a FCR foram associados com os fatores de risco cardiovascular em adolescentes.

Abstract Background Resting heart rate (RHR) may be a useful screening tool for cardiovascular risk. However, RHR cutoff points, an interesting clinical approach, have never been described in young populations. Objective To establish RHR cutoff points in Brazilian adolescents and to analyze whether cutoff points are associated with cardiovascular risk factors. Methods The sample was composed of 6,794 adolescents (10 to 19 years old). Blood pressure and RHR were assessed by oscillometric device. Body mass index and waist circumference were also assessed. Receiver operating characteristic curve was adopted to analyze the sensitivity and specificity, and associations of high RHR with cardiovascular risk factors were analyzed by binary logistic regression. A p value < 0.05 was considered statistically significant for all the analyses. Results Mean RHR values were higher among participants ages 10 to 14 years than 15 to 19 years, for boys (p < 0.001) and girls (< 0.001). The proposed RHR cutoff points for cardiovascular risk factors detection were significant for boys ages 10 to 14 (> 92 bpm) and 15 to 19 years (> 82 bpm), as well as for girls ages 15 to 19 years (> 82 bpm) (p < 0.05 for all), whereas no cutoff point was identified for girls ages 10 to 14 years (p > 0.05). Proposed RHR cutoff points were associated with abdominal obesity, overweight, and high blood pressure in boys in girls. RHR cutoff points were associated with the cluster of cardiovascular risk factors in adolescents ages 15 to 19 years. Conclusion The proposed RHR cutoff points were associated with cardiovascular risk factors in adolescents.