Post-exercise effects of self-selected exercise intensity on cardiovascular parameters in peripheral artery disease: a randomized crossover study

Oliveira, Max Duarte de; Kanegusuku, Hélcio; Faria, Deivide Rafael Gomes de; Peçanha, Tiago de Oliveira; Wolosker, Nelson; Correia, Marilia de Almeida; Ritti-Dias, Raphael Mendes

doi:10.31744/einstein_journal/2025AO1498

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Original Article • einstein (São Paulo) 23 • 2025 • https://doi.org/10.31744/einstein_journal/2025AO1498 linkcopy

Post-exercise effects of self-selected exercise intensity on cardiovascular parameters in peripheral artery disease: a randomized crossover study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To analyze the post-exercise effects of self-selected exercise intensity compared with the intensity recommended by guidelines on blood pressure and heart rate variability in participants with peripheral artery disease.

Methods: This was a randomized crossover trial. Twenty participants with peripheral artery disease (52.6% men; 69.1±7.9 years; ankle-brachial index 0.59±0.15) underwent three experimental sessions: self-selected exercise intensity, intensity recommended by guidelines, and a control session (no exercise). Blood pressure (auscultatory method), heart rate, and heart rate variability were measured before and after the intervention.

Results: Acute reductions in systolic blood pressure were observed in the exercise sessions compared to the control (p<0.005). The heart rate decreased after control and increased after exercise sessions (p<0.001). The absolute heart rate increase after exercise sessions were higher than that in the Control Group p<0.001. Heart rate recovery showed a progressive decrease post-session over 300 s (p<0.001), with the root mean square of successive differences significantly decreasing up to 60 seconds in both exercise sessions (p<0.05).

Conclusion: Acute walking exercise sessions prescribed at self-selected exercise intensity had similar effects on reducing systolic blood pressure and heart rate recovery compared with walking exercise session performed at the guideline-recommended intensity.

ClinicalTrials.gov Identifier: NCT04333615.

Keywords:
Intermittent claudication; Peripheral arterial disease; Vascular diseases; Blood pressure; Heart rate; Walking

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A single session of self-selected intensity walking reduced systolic blood pressure in individuals with peripheral artery disease.
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Heart rate recovery responses after self-selected-intensity walking were similar to those following the guideline-prescribed exercise.
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Self-selected intensity exercise may offer a feasible strategy for patients with claudication, balancing comfort and cardiovascular benefits.
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These findings support flexible exercise prescriptions tailored to individual comfort without compromising the cardiovascular benefits.

This randomized crossover trial evaluated the acute effects of a self-selected intensity walking session compared to the intensity recommended by guidelines on cardiovascular outcomes in patients with peripheral artery disease. These findings demonstrate that walking at a self-paced intensity provides comparable reductions in systolic blood pressure and similar patterns of heart rate recovery as the intensity recommended by the guidelines. These results highlight the potential of self-selected-intensity exercise as a feasible and effective strategy for clinical exercise prescription in patients with peripheral artery disease.

Variables		Values (n=20)
Clinical characteristics
	Age (years)	69.1±7.9
	Sex (%, men)	52.6
	Body mass Index (kg/m²)	27.2±5.7
	Ankle-brachial Index	0.59±0.15
Risk factors, %
	Coronary artery disease	31.5
	History of COVID-19	20.0
	Diabetes	42.1
	Dyslipidemia	73.6
	Hypertension	63.2
	Obesity	52.6
	Renal failure	5.2
	Current smoker	26.3
	Stroke	31.5
Medication, %
	Angiotensin converting enzyme inhibitors	27.7
	Angiotensin II receptor antagonists	38.8
	Antiplatelet	77.6
	Beta blockers	33.3
	Calcium blocker	27.7
	Diuretics	27.7
	Peripheral vasodilator	22.2
	Statin	83.3

	Intensity recommended by the guidelines	Self-selected intensity	Control	p value
Systolic blood pressure, mmHg	123 (117; 129)	119 (114; 124)	121 (115; 128)	0.635
Diastolic blood pressure, mmHg	69 (65; 73)	69 (64; 74)	70(66; 73)	0.955
Heart rate, bpm*	71 (64; 77)	69 (62; 75)	71 (63; 77)	0.927
RMSSD, ms*	33.4 (26.1; 42.7)	39.1 (28.3;52.2)	44.5 (33.4; 59.0)	0.143
SDNN, ms*	30.0 (20.9; 40.7)	29.9 (22.7; 40.7)	36.3 (26.3; 48.8)	0.128
Pnn50, %*	22.0 (10.6; 35.9)	33.0 (20.6; 48.9)	28.0 (17.5; 41.5)	0.408
LF, n.u*	44.2 (31.6; 49.1)	32.5 (27.6; 43.9)	25.9 (25.7; 42.8)	0.311
HF, n.u*	54.9 (50.6; 57.9)	66.2 (56.3; 73.6)	74.1 (61.4; 76.9)	0.179
LF/HF*	3.0 (0.5; 3.1)	2.6 (-1.3; 9.4)	1.1 (-1.5; 6.7)	0.249

	Intensity recommended by the guidelines		Self-selected intensity		Control		Time	Session	Interation
	Pre	Post	Pre	Post	Pre	Post	Time	Session	Interation
Systolic blood Pressure, mmHg	119 114; 125	113 108; 119	122 116; 127	116*† 110; 121	122 117; 127	125 119; 130	0.018	0.001	0.001
Diastolic blood pressure, mmHg	70 66; 73	70 66; 73	69 64; 73	69 65; 73	70 67; 74	72 69; 76	0.374	0.208	0.057
Heart rate, bpm*	72 64; 80	75 68; 88	72 66; 78	71* 65; 76	73 65; 79	66† 59; 71	0.197	0.089	<0.001

	Intensity recommended by the guidelines	Self-selected intensity	Control	p value
	Δ (95%CI)	Δ (95%CI)	Δ (95%CI)
Systolic blood Pressure, mmHg	-6.3* (-10.3; −2.3)	-6.2* (-10.2; −2.2)	2.5 (-1.7; 6.3)	0.003
Diastolic blood pressure, mmHg	-0.2 (-2.8; 2.4)	0.2 (-2.4; 2.8)	2.0 (-0.5; 4.7)	0.451
Heart rate, bpm	3.1 (-3.3; 9.5)	-1.4 (-7.8; 5.0)	0.3 (-6.1; 6.7)	0.619

	Time recovery (seconds)					Time	Session	Interation
	0	30	60	120	300	Time	Session	Interation
Heart rate. bpm						<0.001	<0.001	<0.001
IRG	118 (107; 130)*	115 (104; 127)*†‡	113 (101; 124)*†‡	103 (92; 113)*†‡	89 (81; 97)*†‡
SSI	104 (94; 115)*	101 (91; 112)*†‡	99 (89; 109)*†	93 (84; 103)*†‡	88 (79; 97)*†‡
C	74 (67; 81)	75 (68; 82)	73 (67; 80)	74 (67; 80)	71 (66; 77)
RMSSD. ms						0.001	0.001	0.398
IRG	9.8 (3.8; 15.8)*	11.1 (6.2; 16.0)	11.4 (6.8; 16.1)*	16.1 (9.0; 23.1)†	20.4 (11.4; 29.5)†
SSI	12.1 (6.6; 17.7)*	13.6 (8.3; 19.0)	14.1 (8.6; 19.6)*	17.3 (9.5; 25.1)†	21.7 (12.7; 30.8)†
C	26.8 (15.1; 38.4)	26.5 (14.7; 38.3)	32.0 (16.9; 47.2)	33.2 (18.3; 48.0)	29.3 (19.2; 39.5)
SDNN. ms						0.003	0.005	0.009
IRG	11.5 (4.9; 18.1)*	18.0 (10.8; 25.2)	15.5 (10.8; 20.2)*	23.1 (14.9; 31.3)†	37.8 (22.7; 52.9)†
SSI	14.9 (8.4; 21.5)*	18.2 (12.3; 24.2)	17.4 (11.6; 23.2)*	22.5 (15.6; 29.4)†	29.3 (17.7; 41.0)†
C	41.1 (22.9; 59.4)	39.6 (26.7; 52.5)	40.2 (23.9; 56.6)	37.6 (24.8; 50.4)	40.0 (27.2; 52.8)

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[TFN1] Data are presented as mean±standard deviation or as relative frequencies.