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Effects of isometric handgrip training in patients with peripheral artery disease: a randomized controlled trial [with consumer summary]
Correia MA, Oliveira PL, Farah BQ, Vianna LC, Wolosker N, Puech-Leao P, Green DJ, Cucato GG, Ritti-Dias RM
Journal of the American Heart Association 2020 Feb 18;9(4):e013596
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Meta-analyses have shown that isometric handgrip training (IHT) can reduce brachial systolic and diastolic blood pressure (BP) by > 6/4 mmHg, respectively. However, whether IHT promotes these effects among patients with peripheral artery disease, who exhibit severe impairment in cardiovascular function, is currently unknown. This study aimed to evaluate the effects of IHT on the cardiovascular function of patients with peripheral artery disease. METHODS AND RESULTS: A randomized controlled trial with peripheral artery disease patients assigned to either the IHT or control group was conducted. The IHT group performed 3 sessions per week, for 8 weeks, of unilateral handgrip exercises, consisting of 4 sets of isometric contractions for 2 minutes at 30% of maximum voluntary contraction and a 4-minute interval between sets. The control group received a compression ball in order to minimize the placebo effects, representing sham training. The primary outcome was brachial BP. The secondary outcomes were central BP, arterial stiffness parameters, cardiac autonomic modulation, and vascular function. The IHT program reduced diastolic BP (75 (10) mmHg preintervention versus 72 (11) mmHg postintervention), with no change in the control group (74 (11) mmHg preintervention versus 74 (11) mmHg postintervention), with this between-group difference being significant (p = 0.04). Flow-mediated dilation improved in the IHT group (6.0% (5.7) preintervention versus 9.7% (5.5) postintervention), with no change in the control group (7.6% (5.5) preintervention versus 7.4% (5.1) postintervention), with this between-group difference being significant (p = 0.04). There was no change in other measured variables over the intervention period. CONCLUSIONS: IHT reduced brachial diastolic BP and improved local vascular function in patients with peripheral artery disease. CLINICAL TRIAL REGISTRATION: URL https://www.ClinicalTrials.gov/. Unique identifier NCT02742220.

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