ABC | Volume 113, Nº3, September 2019

Original Article Gerage et al. Physical activity in PAD patients Arq Bras Cardiol. 2019; 113(3):410-416 Figure 2 – Frequency of PAD patients who achieved the current physical activity recommendations according to age group. 100 75 50 25 0 11% 3% 1% Frequency (n) < 60 years 60 to 64 years Age group ≥ 65 years Table 3 – Crude and adjusted association between adherence to physical activity recommendations and sociodemographic or clinical characteristics in PAD patients (n = 174) Variable Crude analysis Adjusted analysis* OR (95%CI) p OR (95%CI) p Age 0.87 (0.79; 0.97) 0.01 0.88 (0.80; 0.98) 0.02 Time of disease diagnosis 0.94 (0.78; 1.12) 0.46 0.98 (0.83; 1.16) 0.82 Ankle-brachial index 0.19 (0.02; 153.41) 0.77 1.14 (0.07; 173.68) 0.96 Six-minute walking distance 1.01 (0.99; 1.02) 0.12 1.00 (0.99; 1.02) 0.32 *Adjusted by age, time of the disease diagnosis, ankle brachial index, and six-minute walking distance. PAD patients to perform moderate and/or vigorous physical activities. In fact, as higher-intensity physical activities may precipitate the occurrence of intermittent claudication symptoms, PAD patients commonly perform lower-intensity physical activities to avoid the symptoms. In the present study, we also analyzed the frequency of patients who achieved the current physical activity recommendations according to age group. We observed that no patients over 70 years old met the current physical activity recommendations for the overall population. This result was confirmed by the multivariate analysis, which revealed that younger patients are more likely to achieve the current physical activity recommendations. These results are in accordance with previous studies carried out with a representative sample of adults from the United States 21 and with older adults in a population-based sample from Brazil, 19 which showed an inverse relationship between age and the amount of time spent in MVPA physical activities. The decrease in physical activity with increasing age might be due to a worsening in physical functions associated with the presence of the comorbid conditions, leading to an increase in sedentary behavior and functional capacity impairment. The ABI, considered one of the best prognostic indexes in PAD, 22 and walking capacity, a main clinical marker of PAD associated with endothelial function 23 inflammation 24 and several clinical indicators, 2,25 were not associated with the meeting of physical activity recommendations. These results are not surprising, since ABI 26 and walking capacity have been poorly associated with physical activity in patients with PAD. 27 Previous studies showed that low levels of physical activity and high levels of sedentary behavior were associated with several risk factors, such as high blood pressure, 28 increased arterial stiffness, 29 increased waist circumference and reduced HDL cholesterol, 30,31 in healthy and clinical populations. In symptomatic PAD patients, a study carried out by Garg et al. 32 reported that reduced physical activity was associated with increased mortality and cardiovascular events. In other words, patients who attempted to control or eliminate their intermittent claudication symptoms by reducing their physical activity, worsened their risk of myocardial infarction, stroke, and death. Thus, the finding of our study that the majority of PAD patients did not attain the current physical activity recommendations highlights the necessity of interventions to increase physical activity in these patients. Future studies are necessary to describe whether different forms of exercise, home-based programs or wearable physical activity monitors are more effective to help patients to attain the current physical activity recommendations. The present study has several limitations. Although the accelerometer has been considered a gold standard method to measure physical activities in free-living conditions, it was not possible to measure the type and the context in which the physical activity was performed, which hinders the analysis of what kind of activities were most often performed by these patients. In addition, the accelerometer does not assess physical activities such as water gymnastics and resistance training, which are commonly performed by elderly patients, and could underestimate the real physical activity levels of our sample. Given that there are no specific physical activity recommendation 414