Correlation between physical activity levels of patients with intermittent claudication estimated using the Baltimore Activity Scale for Intermittent Claudication and a pedometer

Pollianny Ramos Lopes João Paulo dos Anjos Souza Barbosa Breno Quintella Farah Marcel da Rocha Chehuen Gabriel Grizzo Cucato Nelson Wolosker Cláudia Lúcia de Moraes Forjaz Raphael Mendes Ritti Dias About the authors

Abstracts

CONTEXTO:

Os pacientes com claudicação intermitente apresentam níveis reduzidos de atividade física. A Baltimore Activity Scale for Intermittent Claudication (BASIC) foi validada para quantificar o nível de atividade física destes pacientes. No entanto, esta validação se baseou em apenas dois dias de monitoramento com acelerômetros, de modo que ainda permanece incerto se a BASIC fornece informações sobre os níveis de atividade física semanal.

OBJETIVO:

Analisar a correlação entre o nível de atividade física estimada pela BASIC e o nível obtido pelo pedômetro em uma semana, em pacientes com claudicação intermitente.

MÉTODOS:

Foram estudados 150 pacientes com claudicação intermitente, com idade entre 30 e 80 anos. Foram obtidos os dados sociodemográficos e verificada a presença de comorbidades e de fatores de risco cardiovascular, e a BASIC. O pedômetro foi utilizado por sete dias consecutivos, sendo a análise feita em três diferentes períodos de monitorização (todos os dias, dias da semana e do fim de semana).

RESULTADOS:

Foi observada correlação entre a BASIC e a média de passos de todos os dias (rho=0,343; p<0,001), dos dias de semana (rho=0,336; p<0,001) e dos dias do final de semana (rho=0,317; p<0,001).

CONCLUSÃO:

Em pacientes com claudicação intermitente, o nível de atividade física estimado pela BASIC se correlaciona com o nível de atividade física semanal.

doença arterial periférica; atividade física; avaliação; questionário


BACKGROUND:

The levels of physical activity of patients with intermittent claudication (IC) are usually reduced. The Baltimore Activity Scale for Intermittent Claudication (BASIC) was designed to measure physical activity levels of patients with IC, but its validation was conducted against only two days of monitoring with an accelerometer, and it remains unclear whether BASIC provides information about weekly physical activity levels.

OBJECTIVE:

To analyze the correlation between physical activity levels of patients with IC estimated using BASIC or a pedometer for one week.

METHODS:

This study included 150 patients with IC aged 30 to 80 years. Sociodemographic data, comorbidities, cardiovascular risk factors and BASIC scores were recorded. Pedometers were used for seven consecutive days, and data were analyzed for three different periods (all days, weekdays and weekends).

RESULTS:

BASIC scores and mean number of steps were correlated on all days (rho=0.343, p<0.001), weekdays (rho=0.336, p<0.001) and weekends (rho=0.317, p<0.001).

CONCLUSION:

In patients with IC, physical activity levels estimated using BASIC correlate with weekly physical activity levels.

peripheral arterial disease; physical activity; evaluation; questionnaire


INTRODUCTION

The mains cause of peripheral arterial disease (PAD), the partial or total obstruction of arteries that supply blood to the upper and lower limbs, is atherosclerosis11. Hirsch AT, Haskal ZJ, Hertzer NR, et al. Acc/aha 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): 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. Circulation. 2006;113:e463-654. PMid:16549646. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.174526
http://dx.doi.org/10.1161/CIRCULATIONAHA...
. In Brazil, the prevalence of PAD is 10.5% among patients older than 18 years22. Makdisse M, Pereira AdC, Brasil DP, et al. Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do brasil. Arq Bras Cardiol. 2008;91:402-14. http://dx.doi.org/10.1590/S0066-782X2008001800008
http://dx.doi.org/10.1590/S0066-782X2008...
. The most frequent symptom of PAD is intermittent claudication (IC), which may include pain, muscle cramps, burning and tingling. IC occurs in the limb affected by the disease during the practice of physical activities and disappears at rest11. Hirsch AT, Haskal ZJ, Hertzer NR, et al. Acc/aha 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): 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. Circulation. 2006;113:e463-654. PMid:16549646. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.174526
http://dx.doi.org/10.1161/CIRCULATIONAHA...
.

Previous studies have shown that patients with IC have low levels of physical activity33. Barbosa JPdAS, Henriques PM, Barros MVGd, Wolosker N, Ritti-Dias RM. Nível de atividade física em indivíduos com doença arterial periférica: Uma revisão sistemática. J Vasc Bras. 2012;11:22-8. http://dx.doi.org/10.1590/S1677-54492012000100005
http://dx.doi.org/10.1590/S1677-54492012...
. This conditions is directly associated with low fitness and poor quality of life44. Gardner AW, Montgomery PS, Scott KJ, Afaq A, Blevins SM. Patterns of ambulatory activity in subjects with and without intermittent claudication. J Vasc Surg. 2007;46:1208-14. PMid:17919876 PMCid:PMC2222553. http://dx.doi.org/10.1016/j.jvs.2007.07.038
http://dx.doi.org/10.1016/j.jvs.2007.07....
, 55. Herman SD, Liu K, Tian L, et al. Baseline lower extremity strength and subsequent decline in functional performance at 6-year follow-up in persons with lower extremity peripheral arterial disease. J Am Geriatr Soc. 2009;57:2246-52. PMid:19874404 PMCid:PMC2883286. http://dx.doi.org/10.1111/j.1532-5415.2009.02562.x
http://dx.doi.org/10.1111/j.1532-5415.20...
, as well as with greater risk of disease worsening and mortality among this population66. Gardner AW, Montgomery PS, Parker DE. Physical activity is a predictor of all-cause mortality in patients with intermittent claudication. J Vasc Surg. 2008;47:117-22. PMid:18178462 PMCid:PMC2701190. http://dx.doi.org/10.1016/j.jvs.2007.09.033
http://dx.doi.org/10.1016/j.jvs.2007.09....
. Therefore, the amount of physical activity of patients with IC is greatly relevant. Previous studies have used movement sensors, such as pedometers77. Crowther RG, Spinks WL, Leicht AS, Quigley F, Golledge J. Relationship between temporal-spatial gait parameters, gait kinematics, walking performance, exercise capacity, and physical activity level in peripheral arterial disease. J Vasc Surg. 2007;45:1172-8. PMid:17543681. http://dx.doi.org/10.1016/j.jvs.2007.01.060
http://dx.doi.org/10.1016/j.jvs.2007.01....

8. Crowther RG, Spinks WL, Leicht AS, Sangla K, Quigley F, Golledge J. Effects of a long-term exercise program on lower limb mobility, physiological responses, walking performance, and physical activity levels in patients with peripheral arterial disease. J Vasc Surg. 2008;47:303-9. PMid:18241753. http://dx.doi.org/10.1016/j.jvs.2007.10.038
http://dx.doi.org/10.1016/j.jvs.2007.10....
- 99. Gardner AW, Parker DE, Montgomery PS, Khurana A, Ritti-Dias RM, Blevins SM. Gender differences in daily ambulatory activity patterns in patients with intermittent claudication. J Vasc Surg. 2010;52:1204-10. PMid:20692790 PMCid:PMC2974800. http://dx.doi.org/10.1016/j.jvs.2010.05.115
http://dx.doi.org/10.1016/j.jvs.2010.05....
and accelerometers1010. Craft LL, Guralnik JM, Ferrucci L, et al. Physical activity during daily life and circulating biomarker levels in patients with peripheral arterial disease. Am J Cardiol. 2008;102:1263-8. PMid:18940304 PMCid:PMC3404486. http://dx.doi.org/10.1016/j.amjcard.2008.06.051
http://dx.doi.org/10.1016/j.amjcard.2008...
, to measure the level of physical activity of these patients. However, these instruments are limited for use in clinical practice, and questionnaires have been developed to measure the amount of physical activity in patients with IC66. Gardner AW, Montgomery PS, Parker DE. Physical activity is a predictor of all-cause mortality in patients with intermittent claudication. J Vasc Surg. 2008;47:117-22. PMid:18178462 PMCid:PMC2701190. http://dx.doi.org/10.1016/j.jvs.2007.09.033
http://dx.doi.org/10.1016/j.jvs.2007.09....
, 1111. Souza Barbosa JP, Lima RA, Gardner AW, De Barros MV, Wolosker N, Ritti-Dias RM. Reliability of the baltimore activity scale questionnaire for intermittent claudication. Angiology. 2012;63:254-8. PMid:21733944. http://dx.doi.org/10.1177/0003319711414864
http://dx.doi.org/10.1177/00033197114148...

12. Gardner AW, Montgomery PS. The baltimore activity scale for intermittent claudication: A validation study. Vasc Endovasc Surg. 2006;40:383-91. PMid:17038572. http://dx.doi.org/10.1177/1538574406288575
http://dx.doi.org/10.1177/15385744062885...
- 1313. Ritti-Dias RM, Gobbo LA, Cucato GG, et al. Translation and validation of the walking impairment questionnaire in brazilian subjects with intermittent claudication. Arq Bras Cardiol. 2009;92:136-49. PMid:19360247..

The Baltimore Activity Scale for Intermittent Claudication (BASIC)1212. Gardner AW, Montgomery PS. The baltimore activity scale for intermittent claudication: A validation study. Vasc Endovasc Surg. 2006;40:383-91. PMid:17038572. http://dx.doi.org/10.1177/1538574406288575
http://dx.doi.org/10.1177/15385744062885...
was developed to measure the level of physical activity of patients with PAD and limitations due to IC symptoms. In a validation study, Gardner and Montgomery1212. Gardner AW, Montgomery PS. The baltimore activity scale for intermittent claudication: A validation study. Vasc Endovasc Surg. 2006;40:383-91. PMid:17038572. http://dx.doi.org/10.1177/1538574406288575
http://dx.doi.org/10.1177/15385744062885...
found a strong correlation between the level of physical activity measured using BASIC and that estimated using an accelerometer on two different days (r=0.76). Despite validation, it remains unclear whether BASIC provides information about the level of weekly physical activity of these patients. Therefore, this study analyzed the correlation between the level of physical activity estimated using BASIC and that resulting from the use of a pedometer for one week in a group of patients with IC.

METHODS

Patients

From February to July 2011, 440 patients were seen in our University Hospital. Inclusion criteria were age from 30 to 80 years, ankle brachial index (ABI) below 0.90, limited walking capacity due to IC symptoms, and no mental disability identified by the MINI questionnaire of mental health1414. Almeida OP. Mini exame dos estado mental eo diagnóstico de demência no brasil. Arq Neuropsiquiatr. 1998;56:605-12. PMid:9850757. http://dx.doi.org/10.1590/S0004-282X1998000400014
http://dx.doi.org/10.1590/S0004-282X1998...
. According to these criteria, of the 440 patients seen, 158 were recruited for the study, but eight were excluded because they did not return for the second collection visit. The final sample comprised 150 patients. All patients received instructions to continue their usual medications during the study.

Study procedures were explained to patients before data collection, and all patients signed informed consent terms. This study was approved by the Ethics in Research Committee of Universidade de Pernambuco (268/10) and of Hospital de Clínicas of the School of Medicine of Universidade de São Paulo (0188/11), both in Brazil.

Ankle-brachial index

To measure ABI, systolic blood pressures of the arm and ankle were measured simultaneously by two examiners with the patient at rest. Brachial blood pressure was recorded for the arm with the higher pressure measured using the auscultation technique, and ankle pressure was measured using vascular Doppler scans (Medmega DV610, Brazil) of both legs. A mercury sphygmomanometer was used for the measurements. ABI was calculated by dividing the systolic blood pressure of the ankle with the higher pressure by the systolic blood pressure of the arm. These procedures have been described in detail elsewhere1515. Wolosker N, Rosoky RA, Nakano L, Basyches M, Puech-Leao P. Predictive value of the ankle-brachial index in the evaluation of intermittent claudication. Rev Hosp Clin Fac Med Sao Paulo. 2000;55:61-4. PMid:10959125. http://dx.doi.org/10.1590/S0041-87812000000200005
http://dx.doi.org/10.1590/S0041-87812000...
.

Walking capacity evaluation

To evaluate walking capacity, the patients underwent a treadmill (WTL model, Imbrasport, Brazil) test using a specific progressive protocol for individuals with IC, in which speed is constant at 3.2 km/h and grade is increased 2% at each two minutes until maximal pain1616. Gardner AW, Skinner JS, Cantwell BW, Smith L. Progressive vs single-stage treadmill tests for evaluation of claudication. Med Sci Sports Exerc. 1991;23:402. PMid:2056896. http://dx.doi.org/10.1249/00005768-199104000-00003
http://dx.doi.org/10.1249/00005768-19910...
. All individuals were already familiar with this protocol before the study. The test was interrupted when the individual was not able to walk anymore due to pain in the lower limbs. During the test, the time when the patient reported the onset of pain (claudication distance) and the maximum distance that the patient was able to walk despite the pain (total walking distance) were recorded.

Baltimore Activity Scale for Intermittent Claudication

BASIC has five questions about IC symptoms (Figure 1). The respondents select the answer that best describes their symptoms and the level of physical activity for each question. Values range from 0 to 2 points, and the total score is the sum of the points in the five questions. Total scores range from 0 to 10, where zero stands for the lowest level of physical activity, and ten, the highest1212. Gardner AW, Montgomery PS. The baltimore activity scale for intermittent claudication: A validation study. Vasc Endovasc Surg. 2006;40:383-91. PMid:17038572. http://dx.doi.org/10.1177/1538574406288575
http://dx.doi.org/10.1177/15385744062885...
. BASIC reproducibility in the Brazilian population ranges from moderate to strong (0.43 to 0.85)1111. Souza Barbosa JP, Lima RA, Gardner AW, De Barros MV, Wolosker N, Ritti-Dias RM. Reliability of the baltimore activity scale questionnaire for intermittent claudication. Angiology. 2012;63:254-8. PMid:21733944. http://dx.doi.org/10.1177/0003319711414864
http://dx.doi.org/10.1177/00033197114148...
.

Figure 1
Baltimore Activity Scale for Intermittent Claudication (BASIC).

Level of physical activity measured using pedometer

The level of physical activity was measured by calculating the number of steps that each patient took. For that purpose, a pedometer (YAMAX DigiWalker SW-200, YAMAX Corporation, Tokyo, Japan) was used for seven consecutive days. Patients received instructions about how to use the device correctly. Mean number of steps taken was analyzed for three periods: all the days of the week, weekdays and weekends1717. Tudor-Locke C, Craig CL, Aoyagi Y, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act. 2011;8:80. PMid:21798044 PMCid:PMC3169444. http://dx.doi.org/10.1186/1479-5868-8-80
http://dx.doi.org/10.1186/1479-5868-8-80...
. In a subsample of 25 patients, the reproducibility of pedometer data was evaluated seven days later, and the intraclass correlation coefficient was r=0.72.

Statistical analysis

All analyses were conducted using the Statistical Package for the Social Sciences (SPSS) 17.0. The Kolmogorov-Smirnov test was used to test data normality. The Spearman rank correlation coefficient was used to analyze the association between BASIC scores and pedometer findings. A correlation coefficient above 0.70 was classified as a strong association between variables; from 0.69 to 0.30, as moderate; and below 0.30, as weak.

A paired t test was used to compare the mean number of steps on weekdays and on weekends. The level of significance was set at p<0.05, and data were described as mean ± standard deviation and relative frequency.

RESULTS

Patient general characteristics are shown in Table 1.

Table 1
Characteristics of patients with intermittent claudication (n=150).

Mean patient age was above 60 years. Most participants were men and overweight. The most prevalent comorbidity was hypertension, followed by dyslipidemia, heart disease and diabetes. Smoking was reported by 24% of the patients.

Mean levels of physical activity estimated using BASIC and the pedometer are shown in Table 2. Mean BASIC score was 4.2±1.9, and mean number of steps a day in a week was 6.041±3.166; the number of steps was significantly higher on weekdays than on weekends (p<0.05).

Table 2
Mean number of steps measured by a pedometer during different monitoring periods and of the Baltimore Activity Scale for Intermittent Claudication (BASIC).

Figure 2 shows the results of the correlation between BASIC scores and pedometer results. The correlations between BASIC scores and the different periods of pedometer monitoring were moderate, ranging from 0.32 to 0.34.

Figure 2
Correlations (rho) calculated between the level of physical activity estimated using the Baltimore Activity Scale for Intermittent Claudication (BASIC). Graph A - all days; Graph B - weekdays; Graph C - weekends.

DISCUSSION

The main finding of this study was that the level of physical activity estimated using BASIC was correlated with the level of weekly physical activity measured using the pedometer. Moreover, this correlation was also found when weekdays or weekends were analyzed separately, which suggests that BASIC is consistent and represents data obtained in different periods of a week.

The correlation between the level of weekly physical activity according to BASIC and the pedometer was 0.34. These data are lower than those found in the study conducted by Gardner and Montgomery1212. Gardner AW, Montgomery PS. The baltimore activity scale for intermittent claudication: A validation study. Vasc Endovasc Surg. 2006;40:383-91. PMid:17038572. http://dx.doi.org/10.1177/1538574406288575
http://dx.doi.org/10.1177/15385744062885...
, who found a correlation of 0.76 when validating BASIC during two days in comparison with accelerometer results. The differences between correlation coefficients may be linked to the method used to validate BASIC (pedometer vs. accelerometer). Both pedometer and accelerometer are instruments used to monitor human movement. However, pedometers are specific to evaluate the usual level of physical activity by counting the number of steps, whereas accelerometers are more complete in their evaluation of physical activity because they measure, in addition to the number steps, the intensity and duration of the movements of upper and lower limbs1818. Oliveira MM, Maia JA. Avaliação da actividade física em contextos epidemiológicos. Uma revisão da validade e fiabilidade do acelerómetro tritrac-r3d, do pedómetro yamax digi-walker e do questionário de baecke. Rev Port Cien Desp. 2001;1:73-88..

Although a pedometer was used, the results of this study revealed that BASIC had a moderate and significant correlation with the level of weekly physical activity measured. Studies that measured the level of physical activity in other populations using questionnaires also found moderate correlations with movement sensors. Benedetti et al.1919. Benedetti TRB, Antunes PC, Rodriguez-Añez CR, Mazo GZ, Petroski EL. Reprodutibilidade e validade do questionário internacional de atividade física (ipaq) em homens idosos. Rev Bras Med Esporte. 2007;13:11-6. http://dx.doi.org/10.1590/S1517-86922007000100004
http://dx.doi.org/10.1590/S1517-86922007...
evaluated 29 patients older than 60 years and found a correlation of r=0.24 between the International Physical Activity Questionnaire (IPAQ) and the number of weekly steps. Similar results were found in a group of elderly patients with Alzheimer (r=0.57) and physically active elderly women (r=0.27)2020. Lima RA, Freitas CMSM, Smethurst WS, Santos CM, Barros MVG. Nível de atividade física em idosos com doença de alzheimer mediante aplicação do ipaq e de pedômetros. Rev Bras Ativ Fis Saúde. 2010;15:180-5. , 2121. Benedetti TB, Mazo GZ, Barros MVG. Aplicação do questionário internacional de atividades físicas para avaliação do nível de atividades físicas de mulheres idosas: Validade concorrente e reprodutibilidade teste-reteste. Rev Bras Ciên Mov. 2004;12:25-34., Therefore, the correlation found in our study (rho=0.34) was similar to that found in studies that analyzed conventional instruments to measure physical activity.

Our study may be the first to describe the pattern of physical activity of patients with IC on weekdays and weekends. The patients had a lower level of physical activity on weekends than on weekdays, which is in agreement with other studies with elderly patients2222. Tudor-Locke C, Ham SA, Macera CA, et al. Descriptive epidemiology of pedometer-determined physical activity. Med Sci Sports Exerc. 2004;36:1567-73. PMid:15354039. http://dx.doi.org/10.1249/01.MSS.0000139806.53824.2E
http://dx.doi.org/10.1249/01.MSS.0000139...
, 2323. Ewald B, Duke J, Thakkinstian A, Attia J, Smith W. Physical activity of older australians measured by pedometry. Australas J Ageing. 2009;28:127-33 PMid:19845652. http://dx.doi.org/10.1111/j.1741-6612.2009.00372.x
http://dx.doi.org/10.1111/j.1741-6612.20...
. It is important to note that significant correlations were found between BASIC scores and mean number of steps on weekdays (rho=0.34) and on weekends (rho=0.32). These results might indicate that less active patients on weekdays may also be less active on weekends.

In practical terms, the moderate correlations found in this study suggest that most patients that had a higher number of steps during the week were also those with a higher BASIC score. In a similar way, most patients with the lowest number of steps during the week were those that had the lowest questionnaire scores. Therefore, in most cases, BASIC was a good indicator of physical activity and provided additional data to understand the clinical conditions of the patients. Its main advantage is that this information may be obtained rapidly during only one visit, in contrast to other measures of physical activity levels, such as movement sensors, that require the use of a device for one week.

The results of this study should be analyzed cautiously due to some limitations. The sample comprised patients with IC, and the results may be different in groups of different patients, such as those with PAD without IC. Moreover, all patients were recruited in a vascular reference center, where patients are strongly encouraged to practice unsupervised physical activity and to quit smoking, which may have affected results. The level of physical activity was measured using a pedometer, which has a series of limitations, such as not counting movements of the upper limbs or during activities other than walking, such as water sports. However, as walking is the primary treatment for patient with IC11. Hirsch AT, Haskal ZJ, Hertzer NR, et al. Acc/aha 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): 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. Circulation. 2006;113:e463-654. PMid:16549646. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.174526
http://dx.doi.org/10.1161/CIRCULATIONAHA...
, the use of a pedometer is justified in this population.

In conclusion, the results of this study revealed a moderate correlation between the level of activity estimated using BASIC and the level of weekly physical activity measured when using a pedometer, regardless of the time of the week considered, which suggests that BASIC is a good alternative to measuring the level of weekly physical activity of patients with IC.

References

  • 1
    Hirsch AT, Haskal ZJ, Hertzer NR, et al. Acc/aha 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): 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. Circulation. 2006;113:e463-654. PMid:16549646. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.174526
    » http://dx.doi.org/10.1161/CIRCULATIONAHA.106.174526
  • 2
    Makdisse M, Pereira AdC, Brasil DP, et al. Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do brasil. Arq Bras Cardiol. 2008;91:402-14. http://dx.doi.org/10.1590/S0066-782X2008001800008
    » http://dx.doi.org/10.1590/S0066-782X2008001800008
  • 3
    Barbosa JPdAS, Henriques PM, Barros MVGd, Wolosker N, Ritti-Dias RM. Nível de atividade física em indivíduos com doença arterial periférica: Uma revisão sistemática. J Vasc Bras. 2012;11:22-8. http://dx.doi.org/10.1590/S1677-54492012000100005
    » http://dx.doi.org/10.1590/S1677-54492012000100005
  • 4
    Gardner AW, Montgomery PS, Scott KJ, Afaq A, Blevins SM. Patterns of ambulatory activity in subjects with and without intermittent claudication. J Vasc Surg. 2007;46:1208-14. PMid:17919876 PMCid:PMC2222553. http://dx.doi.org/10.1016/j.jvs.2007.07.038
    » http://dx.doi.org/10.1016/j.jvs.2007.07.038
  • 5
    Herman SD, Liu K, Tian L, et al. Baseline lower extremity strength and subsequent decline in functional performance at 6-year follow-up in persons with lower extremity peripheral arterial disease. J Am Geriatr Soc. 2009;57:2246-52. PMid:19874404 PMCid:PMC2883286. http://dx.doi.org/10.1111/j.1532-5415.2009.02562.x
    » http://dx.doi.org/10.1111/j.1532-5415.2009.02562.x
  • 6
    Gardner AW, Montgomery PS, Parker DE. Physical activity is a predictor of all-cause mortality in patients with intermittent claudication. J Vasc Surg. 2008;47:117-22. PMid:18178462 PMCid:PMC2701190. http://dx.doi.org/10.1016/j.jvs.2007.09.033
    » http://dx.doi.org/10.1016/j.jvs.2007.09.033
  • 7
    Crowther RG, Spinks WL, Leicht AS, Quigley F, Golledge J. Relationship between temporal-spatial gait parameters, gait kinematics, walking performance, exercise capacity, and physical activity level in peripheral arterial disease. J Vasc Surg. 2007;45:1172-8. PMid:17543681. http://dx.doi.org/10.1016/j.jvs.2007.01.060
    » http://dx.doi.org/10.1016/j.jvs.2007.01.060
  • 8
    Crowther RG, Spinks WL, Leicht AS, Sangla K, Quigley F, Golledge J. Effects of a long-term exercise program on lower limb mobility, physiological responses, walking performance, and physical activity levels in patients with peripheral arterial disease. J Vasc Surg. 2008;47:303-9. PMid:18241753. http://dx.doi.org/10.1016/j.jvs.2007.10.038
    » http://dx.doi.org/10.1016/j.jvs.2007.10.038
  • 9
    Gardner AW, Parker DE, Montgomery PS, Khurana A, Ritti-Dias RM, Blevins SM. Gender differences in daily ambulatory activity patterns in patients with intermittent claudication. J Vasc Surg. 2010;52:1204-10. PMid:20692790 PMCid:PMC2974800. http://dx.doi.org/10.1016/j.jvs.2010.05.115
    » http://dx.doi.org/10.1016/j.jvs.2010.05.115
  • 10
    Craft LL, Guralnik JM, Ferrucci L, et al. Physical activity during daily life and circulating biomarker levels in patients with peripheral arterial disease. Am J Cardiol. 2008;102:1263-8. PMid:18940304 PMCid:PMC3404486. http://dx.doi.org/10.1016/j.amjcard.2008.06.051
    » http://dx.doi.org/10.1016/j.amjcard.2008.06.051
  • 11
    Souza Barbosa JP, Lima RA, Gardner AW, De Barros MV, Wolosker N, Ritti-Dias RM. Reliability of the baltimore activity scale questionnaire for intermittent claudication. Angiology. 2012;63:254-8. PMid:21733944. http://dx.doi.org/10.1177/0003319711414864
    » http://dx.doi.org/10.1177/0003319711414864
  • 12
    Gardner AW, Montgomery PS. The baltimore activity scale for intermittent claudication: A validation study. Vasc Endovasc Surg. 2006;40:383-91. PMid:17038572. http://dx.doi.org/10.1177/1538574406288575
    » http://dx.doi.org/10.1177/1538574406288575
  • 13
    Ritti-Dias RM, Gobbo LA, Cucato GG, et al. Translation and validation of the walking impairment questionnaire in brazilian subjects with intermittent claudication. Arq Bras Cardiol. 2009;92:136-49. PMid:19360247.
  • 14
    Almeida OP. Mini exame dos estado mental eo diagnóstico de demência no brasil. Arq Neuropsiquiatr. 1998;56:605-12. PMid:9850757. http://dx.doi.org/10.1590/S0004-282X1998000400014
    » http://dx.doi.org/10.1590/S0004-282X1998000400014
  • 15
    Wolosker N, Rosoky RA, Nakano L, Basyches M, Puech-Leao P. Predictive value of the ankle-brachial index in the evaluation of intermittent claudication. Rev Hosp Clin Fac Med Sao Paulo. 2000;55:61-4. PMid:10959125. http://dx.doi.org/10.1590/S0041-87812000000200005
    » http://dx.doi.org/10.1590/S0041-87812000000200005
  • 16
    Gardner AW, Skinner JS, Cantwell BW, Smith L. Progressive vs single-stage treadmill tests for evaluation of claudication. Med Sci Sports Exerc. 1991;23:402. PMid:2056896. http://dx.doi.org/10.1249/00005768-199104000-00003
    » http://dx.doi.org/10.1249/00005768-199104000-00003
  • 17
    Tudor-Locke C, Craig CL, Aoyagi Y, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act. 2011;8:80. PMid:21798044 PMCid:PMC3169444. http://dx.doi.org/10.1186/1479-5868-8-80
    » http://dx.doi.org/10.1186/1479-5868-8-80
  • 18
    Oliveira MM, Maia JA. Avaliação da actividade física em contextos epidemiológicos. Uma revisão da validade e fiabilidade do acelerómetro tritrac-r3d, do pedómetro yamax digi-walker e do questionário de baecke. Rev Port Cien Desp. 2001;1:73-88.
  • 19
    Benedetti TRB, Antunes PC, Rodriguez-Añez CR, Mazo GZ, Petroski EL. Reprodutibilidade e validade do questionário internacional de atividade física (ipaq) em homens idosos. Rev Bras Med Esporte. 2007;13:11-6. http://dx.doi.org/10.1590/S1517-86922007000100004
    » http://dx.doi.org/10.1590/S1517-86922007000100004
  • 20
    Lima RA, Freitas CMSM, Smethurst WS, Santos CM, Barros MVG. Nível de atividade física em idosos com doença de alzheimer mediante aplicação do ipaq e de pedômetros. Rev Bras Ativ Fis Saúde. 2010;15:180-5.
  • 21
    Benedetti TB, Mazo GZ, Barros MVG. Aplicação do questionário internacional de atividades físicas para avaliação do nível de atividades físicas de mulheres idosas: Validade concorrente e reprodutibilidade teste-reteste. Rev Bras Ciên Mov. 2004;12:25-34.
  • 22
    Tudor-Locke C, Ham SA, Macera CA, et al. Descriptive epidemiology of pedometer-determined physical activity. Med Sci Sports Exerc. 2004;36:1567-73. PMid:15354039. http://dx.doi.org/10.1249/01.MSS.0000139806.53824.2E
    » http://dx.doi.org/10.1249/01.MSS.0000139806.53824.2E
  • 23
    Ewald B, Duke J, Thakkinstian A, Attia J, Smith W. Physical activity of older australians measured by pedometry. Australas J Ageing. 2009;28:127-33 PMid:19845652. http://dx.doi.org/10.1111/j.1741-6612.2009.00372.x
    » http://dx.doi.org/10.1111/j.1741-6612.2009.00372.x

Publication Dates

  • Publication in this collection
    Jul-Sep 2013

History

  • Received
    21 Jan 2013
  • Accepted
    04 Apr 2013
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