Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492012000300005
Jornal Vascular Brasileiro
Artigo Original

Triagem pré-participação em exercício físico em pacientes com doença arterial periférica

Exercise pre-participation screening in patients with peripheral arterial disease

Pollianny Ramos Lopes; João Paulo dos Anjos Souza Barbosa; Aluísio Henrique Rodrigues de Andrade Lima; Alessandra de Souza Miranda; Lausanne Barreto de Carvalho Cahú Rodrigues; Sérgio Luiz Cahú Rodrigues; Raphael Mendes Ritti Dias

Downloads: 2
Views: 1378

Resumo

CONTEXTO: Os indivíduos com doença arterial periférica (DAP) apresentam alto risco de doença cardiovascular. Dessa forma, é imprescindível que os instrumentos de triagem pré-participação em exercício indiquem quais pacientes com DAP devem realizar avaliação cardiovascular antes de iniciar o programa de exercício. OBJETIVO: Comparar a sensibilidade de dois instrumentos de triagem pré-participação em exercício para identificação de indivíduos com DAP. MÉTODOS: Vinte e oito pacientes com DAP de ambos os sexos responderam ao questionário de prontidão para a atividade física (PAR-Q) e um questionário de estratificação do risco cardiovascular (QERC) baseado nas diretrizes do American College of Sports Medicine. RESULTADOS: O PAR-Q mostrou que a questão seis (Algum médico já recomendou o uso de medicamentos para a sua pressão arterial ou condição cardiovascular?) foi a que apresentou maior frequência de respostas positivas (82,1%). Considerando todas as respostas, cinco indivíduos não tiveram nenhuma positiva ao questionário (17,9%), indicando que estariam aptos para a prática de atividade física. Os resultados do QERC mostraram que as questões 11 (Você sente queimação ou sensação de câimbras em suas pernas quando faz caminhada?) e 2 (Algum médico já falou que você tem pressão alta?) apresentaram a maior frequência de respostas positivas (82,1%). CONCLUSÕES: Segundo o QERC, todos os indivíduos da amostra foram considerados com alto risco cardiovascular. O PAR-Q não foi sensível o suficiente para identificar todos os sujeitos, ao passo que o QERC identificou todos os indivíduos. Assim, sugere-se a utilização do QERC para identificação de indivíduos com DAP.

Palavras-chave

doença arterial periférica, exercício, saúde, avaliação, validade dos testes

Abstract

BACKGROUND: Exercise has been recommended as the main treatment for individuals with peripheral artery disease (PAD). However, since these individuals have increased cardiovascular risk, a cardiovascular assessment before onset of exercise program must be performed. OBJECTIVE: The purpose of this study was to compare the efficacy of two screening tools for identifying individuals with PAD. METHODS: Twenty-eight men and women with PAD, who answered the Physical Activity Readiness Questionnaire (PAR-Q) and the stratification of cardiovascular risk questionnaire (SCRQ). RESULTS: The PAR-Q results showed that question six (Has any physician recommended the use of blood pressure or cardiovascular medications?) had higher frequency of positive responses (82.1%). Considering all responses, five individuals had all negative answers (17.9%). The results of the SCRQ showed that the question 11 (Do you have leg cramps or burning sensation cramp when you walk?) and the 2nd (Have you ever been told by a physician you have high blood pressure?) showed higher frequency of positive responses (82.1%). According to the criteria for cardiovascular risk stratification, all individuals were considered to be at high cardiovascular risk. CONCLUSION: The PAR-Q questionnaire was not sensitive enough to identify all subjects with PAD. On the other hand, the SRCQ was more efficient in identifying the subjects with PAD. Therefore, the use of SRCQ for screening PAD patients is suggested.

Keywords

peripheral arterial disease, exercise, health, evaluation, validity of tests

Referências

Munger MA, Hawkins DW. Atherothrombosis: epidemiology, pathophysiology, and prevention. J Am Pharm Assoc. 2004;44(2^s1):S5-12.

Aragão JA, Reis FP, Borges Neto RR. Prevalência da doença arterial obstrutiva periférica em doentes com insuficiência renal crônica. J Vasc Bras. 2009;8(4):301-6.

Makdisse M, Pereira AC, Brasil DP. Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do Brasil. Arq Bras Cardiol. 2008;91(6):402-14.

Ritti-Dias RM, Wolosker N, De Moraes Forjaz CL. Strength training increases walking tolerance in intermittent claudication patients: randomized trial. J Vasc Surg. 2010;51(1):89-95.

Hirsch AT, Haskal ZJ, Hertzer NR. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47(6):1239‑312.

Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004. Circulation. 2011;124(1):17-23.

Câmara LC, Santarém JM, Wolosker N, Dias RMR. Exercícios resistidos terapêuticos para indivíduos com doença arterial obstrutiva periférica: evidências para a prescrição. J Vasc Bras. 2007;6(3):246-56.

Norgren L, Hiatt WR, Dormandy JA. Inter-society consensus for the management of peripheral arterial disease. Int Angiol. 2007;26(2):81-157.

Gardner AW, Katzel LI, Sorkin JD, Goldberg AP. Effects of long-term exercise rehabilitation on claudication distances in patients with peripheral arterial disease: a randomized controlled trial. J Cardiopulm Rehabil. 2002;22(3):192-8.

Watson L, Ellis B, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2008.

Spronk S, Bosch JL, den Hoed PT, Veen HF, Pattynama PM, Hunink MG. Intermittent claudication: clinical effectiveness of endovascular revascularization versus supervised hospital-based exercise training-randomized controlled trial. Radiology. 2009;250(2):586-95.

Collins EG, Langbein WE, Orebaugh C. Cardiovascular training effect associated with polestriding exercise in patients with peripheral arterial disease. J Cardiovasc Nurs. 2005;20(3):177-85.

Cucato GG, Ritti-Dias RM, Wolosker N, Santarem JM, Jacob Filho W, Forjaz CL. Post-resistance exercise hypotension in patients with intermittent claudication. Clinics. 2011;66(2):221-6.

Grizzo Cucato G, De Moraes Forjaz CL, Kanegusuku H. Effects of walking and strength training on resting and exercise cardiovascular responses in patients with intermittent claudication. Vasa. 2011;40(5):390-7.

Treesak C, Kasemsup V, Treat-Jacobson D, Nyman JA, Hirsch AT. Cost-effectiveness of exercise training to improve claudication symptoms in patients with peripheral arterial disease. Vasc Med. 2004;9(4):279-85.

Yoshida RA, Matida CK, Sobreira ML. Estudo comparativo da evolução e sobrevida de pacientes com claudicação intermitente, com ou sem limitação para exercícios, acompanhados em ambulatório específico. J Vasc Bras. 2008;7(2):112-22.

Dias RM, Forjaz CL, Cucato GG. Obesity decreases time to claudication and delays post-exercise hemodynamic recovery in elderly peripheral arterial disease patients. Gerontology. 2009;55(1):21-6.

Gardner AW, Ritti-Dias RM, Stoner JA, Montgomery PS, Scott KJ, Blevins SM. Walking economy before and after the onset of claudication pain in patients with peripheral arterial disease. J Vasc Surg. 2010;51(3):628-33.

Ritti-Dias RM, De Moraes Forjaz CL, Cucato GG, Costa LA, Wolosker N, de Fátima Nunes Marucci M. Pain threshold is achieved at intensity above anaerobic threshold in patients with intermittent claudication. J Cardiopulm Rehabil Prev. 2009;29(6):396-401.

Ritti-Dias RM, Meneses AL, Parker DE, Montgomery PS, Khurana A, Gardner AW. Cardiovascular responses to walking in patients with peripheral artery disease. Med Sci Sports Exerc. 2011;43(11):2017-23.

Shephard RJ, Cox MH, Simper K. An analysis of "PAR-Q" responses in an office population. Can J Public Health. 1981;72(1):37-40.

ACSM's guidelines for exercise testing and prescription. 2006.

Wolosker N, Rosoky RA, Nakano L, Basyches M, Puech-Leão P. Predictive value of the ankle-brachial index in the evaluation of intermittent claudication. Rev Hosp Clin Fac Med Sao Paulo. 2000;55(2):61-4.

Luz LGO, Maranhão Neto GA, Farinatti PTV. Validade do questionário de prontidão para a atividade física (PAR-Q) em idosos. Rev Bras Cineantropom Desempenho Hum. 2007;9(4):366-71.

Zerati AE, Wolosker N, Ayzin Rosoky RM, Fernandes Saes G, Ragazzo L, Puech-Leão P. Prevalence of metabolic syndrome in patients with intermittent claudication and its correlation with the segment of arterial obstruction. Angiology. 2010;61(8):784-8.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddd2dc80e8825bf661da3e9 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections