Musculoskeletal complaints in cardiac rehabilitation: Prevalence and impact on cardiovascular risk factor profile and functional and psychosocial status | Revista Portuguesa de Cardiologia (English edition)

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Allison, José Miguel Santoalha, Vítor Araújo, Fernando Parada Pereira, Maria Júlia Maciel" "autores" => array:6 [ 0 => array:4 [ "nombre" => "José Afonso" "apellidos" => "Rocha" "email" => array:1 [ 0 => "afonsomrocha@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Thomas G." 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The CR program took place in a cardiac rehabilitation unit. Enrollment in CR was voluntary after referral from the attending cardiologist during the initial hospitalization. Written informed consent was obtained from all patients at program enrollment.ParticipantsPatients were considered eligible for CR if, in the three months before referral, they had one of the following: acute coronary syndrome, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Exclusion criteria followed the standard recommendations for phase II CR programs<a class="elsevierStyleCrossRef" href="#bib0185">7</a>: patients were excluded if they were considered unable to safely engage in exercise sessions (due to neuromuscular, orthopedic or cognitive impairment), had uncontrolled diabetes or unfavorable blood pressure response to exercise, ejection fraction <30%, New York Heart Association functional class ≥3, complex ventricular or supraventricular arrhythmias, or high-grade atrioventricular block.Of a total of 487 patients initially approached for CR participation, 38 (7.8%) refused to participate due to various constraints (accessibility 22; resumption of work 10; financial issues 6). A secondary analysis showed that, compared to those undergoing CR, those who did not attend the CR sessions were more frequently women (9 [16.7%] vs. 54 [12.0%], p=0.03) and were more likely to present previous CHD (37.8% vs. 16.8; p<0.05), hypertension (52.6% vs. 39.7%, p=0.05), and active smoking (71.4% vs. 55.7%; p<0.05). No between-group differences were detected in age, BMI, waist circumference, or prevalence of diabetes, dyslipidemia, or metabolic syndrome.Outcome measuresSociodemographic and clinical characteristicsSociodemographic characteristics were assessed through a structured questionnaire and included marital status, years of education, and work status. Information regarding the index event, revascularization procedure, CV risk factors, cardiac medications, and comorbidities were obtained from medical records.Anthropometric parameters (weight, height, BMI and waist circumference) were measured at baseline in accordance with the recommendations of the US National Institutes of Health.<a class="elsevierStyleCrossRef" href="#bib0190">8</a>Physical activity and functional capacityLeisure time physical activity was assessed using the International Physical Activity Questionnaire, measured in metabolic equivalents (MET)-min/week. Only non-professional physical activities and those lasting at least 15 min were included in the analysis.<a class="elsevierStyleCrossRef" href="#bib0195">9</a> We used a cut-off of 600 MET-min/week (30 min/day, 7 days/week) of moderate intensity physical activity.<a class="elsevierStyleCrossRef" href="#bib0200">10</a>Functional capacity was estimated from baseline symptom-limited maximal exercise using the standard Bruce protocol, and quantified by the amount of work performed in multiples of resting oxygen uptake (defined as 1 MET=3.5 ml oxygen per kg body weight per min). Standard tables were used to convert treadmill grade and speed into estimated MET levels.<a class="elsevierStyleCrossRef" href="#bib0205">11</a>Musculoskeletal complaintsMSC were characterized using an interviewer-administered Portuguese version of the Nordic Musculoskeletal Questionnaire.<a class="elsevierStyleCrossRefs" href="#bib0210">12,13</a> This consists of 40 questions regarding location (nine body areas: neck, shoulders, elbows, wrist/hands, mid and low back, hips/thighs, knee, ankles/feet), duration (last 12 months; last 7 days) and pain intensity (numeric scale). Since we aimed to establish the influence of long-standing MSC on CV risk factors and functional and psychosocial status, all patients reporting pain in the last 12 months were included in the analysis.Psychosocial factorsThe Hospital Anxiety and Depression Scale was used to assess the presence and severity of anxiety and depressive symptoms. It has been validated and used extensively in CHD research.<a class="elsevierStyleCrossRef" href="#bib0220">14</a> Each domain consists of seven questions, scored between 0 (no symptoms) and 3 (severe symptoms), with a total score ranging between 0 and 21. A cut-off of 8 in either domain was used to define clinical anxiety and depression.<a class="elsevierStyleCrossRef" href="#bib0225">15</a>The Short Form 36 Health Survey (SF-36, version 2), which is widely used and validated for CHD populations, was used to measure both physical and mental dimensions of quality of life. It consists of eight categories, four in each domain (physical and mental), to provide physical and mental health summary scores.<a class="elsevierStyleCrossRefs" href="#bib0230">16,17</a> Scores in each category range between 0 (worst) and 100 (best) quality of life. Scores are presented after standardization through linear transformations to achieve a mean score of 50 and standard deviation of 10.<a class="elsevierStyleCrossRef" href="#bib0240">18</a>Statistical analysisThe patients were divided into those with (MSC+) and those without (MSC−) musculoskeletal complaints. Between-group comparisons were made using the standard t test and the Mann-Whitney test for normal and non-normal continuous variables, respectively. Categorical variables were compared using the chi-square test. Binomial logistic regression was used to assess the prevalence of categorical CV risk factors through categories of MSC, with adjustment for age and gender.ResultsThe study sample consisted of 449 patients, mostly male (88.0%), with low educational level (<9 years of education: 44.0%), married (85.0%), and actively working (57.0%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Almost half presented with ST-segment elevation myocardial infarction (49.0%), with 83.0% undergoing PCI, 49.0% CABG (9.4%), and 7.0% receiving only medical treatment (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). There were no differences between groups regarding cardioprotective drug use (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Prevalence of musculoskeletal complaints and cardiovascular risk profileOf the study sample, 119 (26.5%) patients had MSC, 68 (58.0%) in the lower limbs, 40 (34.0%) in the spine and nine (7.7%) in the upper limbs. Among those with lower limb complaints, the majority reported knee pain (46; 68.7%) or ankle/foot pain (14; 20.3%). Mean reported visual analog scale pain score was 4.2±1.2 (range 1–9). Patients reporting MSC were older, more frequently women, and had a worse CV risk factor profile, with higher prevalences of dyslipidemia, hypertension, overweight, and metabolic syndrome. Despite a higher proportion of active smokers in the MSC− group, pack-year history was higher in MSC+, probably reflecting older age in the latter. No differences were found regarding diabetes or family history of CHD (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The MSC+ group showed higher BMI and more abdominal obesity (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Physical activity and functional capacityMSC+ patients were less active, with 65% reporting less than 600 MET-min/week, compared to 44% in the MSC− group (p<0.05). Functional capacity was, on average, 10% lower in MSC+ compared to MSC− (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).Psychosocial status and quality of lifeSymptoms of depression and anxiety were more prevalent and of greater severity in MSC+, with 36.0% MSC+ and 21.0% MSC− patients presenting clinical depression (p<0.05), and 39.0% MSC+ and 30.0% MSC− having clinical anxiety (p=0.06) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Both physical and mental dimensions of quality of life were significantly lower in MSC+ patients (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).Increased risk for cardiovascular risk factors according to musculoskeletal complaint statusUnivariate logistic regression showed that MSC+ patients had double the risk of having hypertension, dyslipidemia, and obesity (both general and visceral) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Physical inactivity was 2.4 times more prevalent in MSC+ compared to MSC− patients. Even after adjustment for age and gender, MSC status remained a strong predictor of CV risk factors, except for diabetes.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionMSC and CHD are common chronic conditions associated with significant disability and use of healthcare resources.<a class="elsevierStyleCrossRef" href="#bib0155">1</a> In this study we showed that MSC are not only common in the CHD population but are also associated with lower levels of physical activity and a worse CV risk factor profile, estimated functional capacity, and psychosocial status, irrespective of age and gender.The prevalence of MSC has been shown to be higher in CHD patients than in the general population. The US Centers for Disease Control estimated that the age and gender-adjusted prevalence of arthritis was 57.4% in CHD patients compared to 27.4% in the general population,<a class="elsevierStyleCrossRef" href="#bib0170">4</a> while Marzollini et al. reported a 56.0% prevalence of MSC in a multicenter cross-sectional study of 1803 CHD patients.<a class="elsevierStyleCrossRef" href="#bib0245">19</a> The lower prevalence found in our study (27.0%) is probably related to age-related referral bias commonly seen in CR, especially under-representation of older patients.<a class="elsevierStyleCrossRef" href="#bib0250">20</a>Physical inactivity has been linked to increased risk for CHD in several prospective cohort studies.<a class="elsevierStyleCrossRefs" href="#bib0255">21,22</a> An aggregate analysis of prospective primary prevention studies looking at physical activity levels and CV mortality found a median risk reduction of up to 40% in more compared to less active subjects, irrespective of age, gender and race/ethnicity.<a class="elsevierStyleCrossRef" href="#bib0265">23</a> Our results confirm the cumulative negative effect of CHD and MSC on physical activity levels, with an almost 30% increase in the prevalence of physical inactivity compared to CHD patients without MSC.<a class="elsevierStyleCrossRef" href="#bib0170">4</a> Moreover, reduced physical activity translates into lower functional capacity, which in turn is linked to higher CV morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0270">24</a>Clustering of adverse CV risk factors has been described in patients with MSC.<a class="elsevierStyleCrossRefs" href="#bib0170">4,19,25</a> Our study, like others,<a class="elsevierStyleCrossRef" href="#bib0245">19</a> confirms that patients with MSC are older, more sedentary and more frequently dyslipidemic and hypertensive compared with those without MSC. Exercise training exerts beneficial effects in both prevention and treatment of CHD and MSC. However, the impact of exercise on CV risk factor burden is controversial.<a class="elsevierStyleCrossRefs" href="#bib0280">26,27</a> Despite a clear dose-response curve between exercise and cardiometabolic risk factors, the magnitude of the effect appears modest and highly variable according to individual and exercise program characteristics.<a class="elsevierStyleCrossRef" href="#bib0290">28</a> Methodological difficulties regarding study design, patient selection, lack of standardization of exercise and physical activity protocols, and heterogeneity of instruments for measuring physical activity (including self-reported questionnaires, logbooks, pedometers and triaxial accelerometers) hinder conclusions regarding optimal dose and type of exercise for CV prevention. Since age and gender are related to CV risk factors, CHD, and MSC, we used an age- and gender-adjusted logistic regression model to obtain a clearer picture of the influence of MSC status on prevalence of classical risk factors. The study results confirm our prior assumption of an association of MSC with a worse CV risk factor profile.Both chronic pain due to musculoskeletal disturbances and CHD have a considerable impact on the psychosocial dimension of quality of life. The Longitudinal Aging Study Amsterdam followed 2285 individuals aged 55–85 for up to six years and found an increased risk for depression in both cardiac (+33%) and musculoskeletal (+36%) cases.<a class="elsevierStyleCrossRef" href="#bib0295">29</a> Our study replicated both the incidence of depression in CHD and the cumulative effect of coexisting CHD and MSC.It is therefore recommended to systematically assess psychosocial status in CR settings and to develop and implement psycho-behavioral interventions and support.Study limitationsMSC were self-reported and no further clinical or imaging assessment was undertaken. However, any misclassification was probably non-differential and, since our purpose was to study the association between CHD and MSC status and not causation, we do not expect this to have a significant impact on the study's internal validity.Self-reporting physical activity through questionnaires has been widely used in several observational studies, although low precision and sensitivity to change might introduce measurement biases and differential misclassifications.<a class="elsevierStyleCrossRef" href="#bib0300">30</a> Ideally, objective measurements using biaxial or triaxial accelerometers would minimize these concerns, but cost and applicability in daily clinical practice excluded this option. On the other hand, the results and the direction associations found between physical activity, functional capacity and anthropometric characteristics indicate that the chosen instrument is measuring physical activity appropriately in this setting.In addition to the aforementioned limitations, this was a single-center cross-sectional study of young, mostly male CHD patients, so its results cannot be extrapolated to CHD populations with different characteristics.ConclusionsMore than a quarter of CHD patients enrolled in CR programs report MSC, which are associated with a worse CV risk factor profile, lower levels of physical activity and functional capacity, and unfavorable psycho-emotional and quality of life scores. This subgroup of CR patients is particularly susceptible to prolonged disability from CHD, productivity losses, and early retirement. Aside from indirect costs, they are also at increased risk for CHD recurrence and need for further medical assistance and revascularization procedures. Addressing MSC in a secondary prevention setting might be beneficial, coupling standard exercise training programs with activity and exercise modifications, modalities, and individualized exercise counseling.Further research is needed to determine if and how MSC affect the health benefits of CR, and which interventions and program designs are best suited to minimize the deleterious effects of MSC on CV health.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres439415" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec462605" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres439416" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec462604" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction and Objectives" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Participants" ] 2 => array:3 [ "identificador" => "sec0025" "titulo" => "Outcome measures" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Sociodemographic and clinical characteristics" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Physical activity and functional capacity" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Musculoskeletal complaints" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Psychosocial factors" ] ] ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0055" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Prevalence of musculoskeletal complaints and cardiovascular risk profile" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Physical activity and functional capacity" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Psychosocial status and quality of life" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Increased risk for cardiovascular risk factors according to musculoskeletal complaint status" ] ] ] 7 => array:2 [ "identificador" => "sec0080" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0085" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusions" ] 10 => array:3 [ "identificador" => "sec0095" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0100" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0105" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0110" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0115" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-06-06" "fechaAceptado" => "2014-08-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec462605" "palabras" => array:3 [ 0 => "Coronary disease" 1 => "Musculoskeletal pain" 2 => "Physical activity" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec462604" "palabras" => array:3 [ 0 => "Doença coronária" 1 => "Dor músculo-esquelética" 2 => "Atividade física" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo assess the prevalence of musculoskeletal complaints and their association with risk factor profile and functional and psychosocial status in patients on a cardiac rehabilitation program. MethodsIn this cross-sectional study of 449 patients admitted within three months of an acute coronary syndrome, patients were divided into those with (MSC+) and those without (MSC−) musculoskeletal complaints. The Hospital Anxiety and Depression Scale and the Short Form 36 Health Survey were used to assess psychosocial status and quality of life, and the International Physical Activity Questionnaire for physical activity. Functional capacity was estimated from exercise testing. ResultsMusculoskeletal pain was present in 119 patients (27%), mainly in the lower limbs (56%). MSC+ were older (mean 56.5±9.9 vs. 53.2±9.5 years; p<0.001) and more frequently women (20.2% vs. 9.1%; p<0.001). MSC+ had a higher prevalence of dyslipidemia (68.6% vs. 51.2%; p<0.001), hypertension (51.7% vs. 35.5%; p<0.001), obesity (29.4% vs. 17.9%; p<0.001) and metabolic syndrome (44.5% vs. 31.5%; p<0.001). MSC+ showed higher body mass index and waist circumference, and lower physical activity levels (p<0.05), as well as lower functional capacity (8.6±2.2 vs. 9.6±2.1 MET; p<0.05), higher scores for depression (6 [3–9] vs. 3 [1–7]; p<0.05) and anxiety (7 [3–10] vs. 5 [2–8]; p<0.05), and lower scores for physical (44.1±8.7 vs. 47.6±7.6; p<0.05) and mental (39.2±13.0 vs. 44.0±13.0; p<0.05) quality of life. ConclusionsMusculoskeletal complaints are common in cardiac rehabilitation and predict lower levels of physical activity, worse cardiovascular risk factor profile, and poorer functional capacity and psychosocial status, irrespective of age and gender." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "Objetivodeterminar a prevalência da dor músculo-esquelética e sua associação com perfil de risco cardiovascular, estado funcional e psicossocial em doentes admitidos num programa de reabilitação cardíaca Métodosestudo transversal de 449 doentes admitidos nos primeiros três meses após síndroma coronária aguda. Os doentes foram categorizados em grupo com (MSC+) e sem (MSC-) dor músculo-esquelética. O estado psicossocial e a qualidade foram avaliadas com as escalas HADS e SF36 e a atividade física com o IPAQ. Capacidade funcional foi estimada com prova de esforço basal. ResultadosDor músculo-esquelética estava presente em 119 (27%), maioritariamente nos membros inferiores (56%). MSC+ eram mais velhos [média(DP): 56,5±9,9 versus 53,2±9,5; p<0.001] e mais frequentemente mulheres [20,2% versus 9,1%; p<0,001]. MSC+ apresentavam maior prevalência de dislipidemia (68,6% versus 51,2%; p<0,001), hipertensão arterial (51,7% versus 35,5%; p<0,001), obesidade (29,4% versus 17,9%; p<0,001) e síndroma metabólica (44,5% versus 31,5%; p<0,001). MSC+ mostravam maiores índice de massa corporal e perímetro abdominal e menor atividade física (p<0,005). MSC+ tinham menor capacidade funcional [8,6±2,2 versus 9,6±2,1 MET; p<0,05], maior prevalência de sintomas depressivos [6(3-9) versus 3(1-7); p<0,05] e ansiosos [7(3-10) versus 5(2-8); p<0,05], e menor qualidade de vida física [44,1±8,7 versus 47,6±7,6; p<0,05] e mental [39,2±13,0 versus 44,0±13,0; p<0,05]. ConclusãoDor músculo-esquelética associa-se a menores níveis de atividade física, pior capacidade funcional, pior perfil de risco cardiovascular e a um estado psicossocial mais adverso." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "BMI: body mass index; CHD: coronary heart disease; CV: cardiovascular; MSC−: patients without musculoskeletal complaints; MSC+: patients with musculoskeletal complaints; P50 (P25–P75): median (interquartile range); SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total sample (n=449) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC− (n=330) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC+ (n=119) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Sociodemographic variables</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54.1±9.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53.2±9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56.5±9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Female, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (12.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (20.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Years of education, P50 (P25–P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (4–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (4–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (4–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.92 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Actively working, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">253 (56.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">199 (60.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (45.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Married, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">381 (84.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">285 (86.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97 (80.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">CV risk factors</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Previous history of CHD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75 (16.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 (22.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dyslipidemia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">250 (55.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">169 (51.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81 (68.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">178 (39.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">117 (35.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 (51.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 (18.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 (17.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (20.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Family history of CHD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">125 (28.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91 (27.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (28.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Active smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">250 (55.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">194 (58.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 (43.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pack-years, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45.0±27.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.0±25.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54.7±31.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI ≥30 kg/m2, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94 (21.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (29.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Metabolic syndrome, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">157 (35.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">104 (31.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 (44.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab685932.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic characteristics and cardiovascular risk factors in the different groups and the total sample." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ACEI: angiotensin-converting enzyme inhibitors; ARA: aldosterone receptor antagonists; BNP: brain natriuretic peptide; MSC−: patients without musculoskeletal complaints; MSC+: patients with musculoskeletal complaints; P50 (P25–P75): median (interquartile range); STEMI: ST-segment elevation myocardial infarction." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total sample (n=449) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC− (n=330) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC+ (n=119) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Acute coronary syndrome</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">STEMI, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">222 (49.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">173 (52.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (41.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Left ventricular dysfunction, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">138 (30.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 (31.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (27.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Peak troponin I (ng/ml); P50 (P25–P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (2.8–16.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.5 (3.5–6.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (1.34–52.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Admission BNP (pg/ml); P50 (P25–P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.5 (37.2–217.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.6 (37–210) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 (30–228) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Medication</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Beta-blockers, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">396 (88.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">289 (87.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107 (91.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diuretics, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (6.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (7.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.42 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ACEI/ARA, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">349 (77.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">252 (76.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 (82.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Nitrates, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Antidiabetics, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 (17.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (17.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (18.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Antiplatelets, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">437 (97.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">322 (97.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 (97.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab685931.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Acute coronary event characteristics and medication use in the different groups and the total sample." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "BMI: body mass index; HADS: Hospital Anxiety and Depression Scale; MET: metabolic equivalents estimated from the IPAQ; P50 (P25–P75): median (interquartile range); P50 (P25–P75): median (interquartile range); SD: standard deviation, SF-36: Short Form 36 Health Survey." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total sample (n=449) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC− (n=330) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC+ (n=119) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Anthropometric</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight (kg), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75.2±11.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74.6±12.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76.7±11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI (kg/m2), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.1±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.8±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.0±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Waist circumference (cm), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95.6±9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94.9±9.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.5±9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Functional capacity (exercise test)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Maximum duration (min:sec), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">08:47±02:15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9:05±2:09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">07:57±02:21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MET, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.4±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.6±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.6±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Maximum heart rate (bpm), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">136.0±20.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">138.0±20.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">130.2±19.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">% predicted heart rate, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82.0±10.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82.7±10.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80.2±10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Physical activity</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MET-min/week, P50 (P25–P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99 (0–569.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">148.5 (0–594) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0–428.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Anxiety and depression (HADS)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anxiety score, P50 (P25–P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (2.2–9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (2–8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (3–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anxiety score ≥8, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">145 (32.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99 (30.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 (39.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Depression score, P50 (P25–P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (1–8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (1–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (3–9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Depression score ≥8, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">113 (25.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 (21.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Quality of life (SF-36)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Physical summary score, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46.7±8.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.6±7.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44.1±8.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mental summary score, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.8±13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44.0±13.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39.2±13.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab685929.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Anthropometric characteristics, functional capacity, physical activity and psychosocial status in the different groups and the total sample." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "BMI: body mass index; CI: confidence interval; CV: cardiovascular; OR: odds ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CV risk factors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crude OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adjusted OR<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.95 (1.27–3.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.68 (1.08–2.62) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.16 (1.37–3.42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.10 (1.34–3.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.20 (0.70–2.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.97 (0.55–1.71) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI >30 kg/m2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.91 (1.17–3.10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.84 (1.10–3.06) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Abdominal obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.61 (1.61–4.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.31 (1.41–3.77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Metabolic syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.88 (1.21–2.92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.68 (1.06–2.65) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Physical inactivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.62 (1.33–5.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.44 (1.25–4.74) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab685930.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Adjusted for age and gender." ] ] ] "descripcion" => array:1 [ "en" => "Association between musculoskeletal complaints and major cardiovascular risk factors (n=449)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.J. Murray" 1 => "T. Vos" 2 => "R. Lozano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(12)61689-4" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2012" "volumen" => "380" "paginaInicial" => "2197" "paginaFinal" => "2223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245608" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Lozano" 1 => "M. Naghavi" 2 => "K. Foreman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(12)61728-0" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2012" "volumen" => "380" "paginaInicial" => "2095" "paginaFinal" => "2128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245604" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0165" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart disease and stroke statistics – 2013 update: a report from the American Heart Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.S. Go" 1 => "D. Mozaffarian" 2 => "V.L. Roger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0b013e31828124ad" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2013" "volumen" => "127" "paginaInicial" => "e6" "paginaFinal" => "e245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23239837" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0170" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arthritis as a potential barrier to physical activity among adults with heart disease – United States, 2005 and, 2007" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Centers for Disease Control and Prevention" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Morb Mortal Wkly Rep (MMWR)" "fecha" => "2009" "volumen" => "58" "paginaInicial" => "165" "paginaFinal" => "169" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0175" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory markers in patients with coronary artery disease with and without inflammatory rheumatic disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "U.M. Breland" 1 => "I. Hollan" 2 => "K. Saatvedt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2010" "volumen" => "49" "paginaInicial" => "1118" "paginaFinal" => "1127" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0180" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COX-2 selective non-steroidal anti-inflammatory drugs and risk of serious coronary heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W.A. Ray" 1 => "C.M. Stein" 2 => "J.R. Daugherty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(02)11131-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2002" "volumen" => "360" "paginaInicial" => "1071" "paginaFinal" => "1073" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12383990" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0185" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age does not determine the physical, functional and psychosocial response to a cardiac rehabilitation program" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Rocha" 1 => "V. Araujo" 2 => "F. Parada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2011" "volumen" => "30" "paginaInicial" => "479" "paginaFinal" => "507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21800478" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0190" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults – the evidence report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "National Institutes of Health" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Obes Res" "fecha" => "1998" "volumen" => "6" "numero" => "Suppl 2" "paginaInicial" => "51S" "paginaFinal" => "209S" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9813653" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0195" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International physical activity questionnaire: 12-country reliability and validity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.L. Craig" 1 => "A.L. Marshall" 2 => "M. Sjostrom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1249/01.MSS.0000078924.61453.FB" "Revista" => array:6 [ "tituloSerie" => "Med Sci Sports Exerc" "fecha" => "2003" "volumen" => "35" "paginaInicial" => "1381" "paginaFinal" => "1395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12900694" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0200" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W.L. Haskell" 1 => "I.M. Lee" 2 => "R.R. Pate" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.107.185649" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2007" "volumen" => "116" "paginaInicial" => "1081" "paginaFinal" => "1093" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17671237" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0205" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise standards for testing and training: a scientific statement from the American Heart Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.F. Fletcher" 1 => "P.A. Ades" 2 => "P. Kligfield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0b013e31829b5b44" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2013" "volumen" => "128" "paginaInicial" => "873" "paginaFinal" => "934" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23877260" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0210" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Questionnaire development: an examination of the Nordic Musculoskeletal questionnaire" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.E. Dickinson" 1 => "K. Campion" 2 => "A.F. Foster" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Appl Ergon" "fecha" => "1992" "volumen" => "23" "paginaInicial" => "197" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15676868" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0215" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cross-cultural adaptation of the Nordic musculoskeletal questionnaire" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.N. Barros" 1 => "N.M. Alexandre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int Nurs Rev" "fecha" => "2003" "volumen" => "50" "paginaInicial" => "101" "paginaFinal" => "108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12752909" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0220" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Hospital Anxiety and Depression Scale depression subscale, but not the Beck Depression Inventory-Fast Scale, identifies patients with acute coronary syndrome at elevated risk of 1-year mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Doyle" 1 => "H.M. McGee" 2 => "D. De La Harpe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpsychores.2005.09.004" "Revista" => array:6 [ "tituloSerie" => "J Psychosom Res" "fecha" => "2006" "volumen" => "60" "paginaInicial" => "461" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16650586" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0225" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The hospital anxiety and depression scale" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.P. Snaith" 1 => "A.S. Zigmond" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Br Med J" "fecha" => "1986" "volumen" => "292" "paginaInicial" => "344" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0230" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physical and mental component summaries score of the SF-36 in coronary patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Soto" 1 => "I. Failde" 2 => "S. Marquez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Qual Life Res" "fecha" => "2005" "volumen" => "14" "paginaInicial" => "759" "paginaFinal" => "768" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16022068" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0235" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of the SF-36 version 2 in the United Kingdom" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Jenkinson" 1 => "S. Stewart-Brown" 2 => "S. 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Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2004" "paginaInicial" => "CD003331" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0275" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and impact of musculoskeletal comorbidities in cardiac rehabilitation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Marzolini" 1 => "H. Candelaria" 2 => "P. 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Downie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Sports Med" "fecha" => "1993" "volumen" => "27" "paginaInicial" => "101" "paginaFinal" => "106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8358578" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0285" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dose-response issues concerning physical activity and health: an evidence-based symposium" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y.K. Kesaniemi" 1 => "E. Danforth Jr." 2 => "M.D. Jensen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Med Sci Sports Exerc" "fecha" => "2001" "volumen" => "33" "numero" => "6 Suppl" "paginaInicial" => "S351" "paginaFinal" => "S358" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11427759" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0290" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.E. Garber" 1 => "B. Blissmer" 2 => "M.R. 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Original Article

Musculoskeletal complaints in cardiac rehabilitation: Prevalence and impact on cardiovascular risk factor profile and functional and psychosocial status

Dor músculo-esquelética em reabilitação cardíaca: prevalência e impacto no perfil de risco cardiovascular e estado funcional e psicossocial

José Afonso Rochaa,

Corresponding author

afonsomrocha@gmail.com

Corresponding author.

, Thomas G. Allisonb, José Miguel Santoalhac, Vítor Araújod, Fernando Parada Pereirac, Maria Júlia Macield

a Centro Hospitalar São João, Porto, Portugal

b Department of Internal Medicine, Cardiovascular Diseases, Mayo Clinic, USA

c Department of Physical, Rehabilitation Medicine, Centro Hospitalar São João, Porto, Portugal

d Department of Cardiology, Centro Hospitalar São João, Porto, Portugal

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        "titulo" => "Dor m&#250;sculo-esquel&#233;tica em reabilita&#231;&#227;o card&#237;aca&#58; preval&#234;ncia e impacto no perfil de risco cardiovascular e estado funcional e psicossocial"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction and Objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite recent advances in both revascularization procedures and drug therapy&#44; coronary heart disease &#40;CHD&#41; remains the major cause of death and disability worldwide&#44; and is expected to remain so for at least the next 20 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a> Population aging&#44; together with a sharp decrease in case fatality&#44; have resulted in a growing population of CHD survivors who&#44; over time&#44; frequently develop significant disability&#44; restrictions in work and social participation&#44; and need for continuous medical assistance&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of musculoskeletal complaints &#40;MSC&#41; also increases with age and is a major cause of disability and functional impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> It has been shown that CHD patients have double the risk of suffering from arthritis and 30&#37; higher probability of being physically inactive compared to the general population&#44; even adjusting for age&#44; gender&#44; race&#47;ethnicity&#44; education level&#44; and body mass index &#40;BMI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> However&#44; several mechanisms may contribute to this association&#44; particularly restricted physical activity&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> unhealthy lifestyles&#44; low-grade inflammatory activation&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> and prolonged use of anti-inflammatory drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Cardiac rehabilitation &#40;CR&#41; offers an excellent opportunity for identification and early management of MSC&#44; helping to overcome barriers that restrict activity and providing individualized exercise programs&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our objectives were&#58; &#40;1&#41; to assess the prevalence of MSC in patients undergoing CR&#59; &#40;2&#41; to study the association between MSC and cardiovascular &#40;CV&#41; risk profile and functional and psychosocial status&#59; and &#40;3&#41; to estimate the increased prevalence of different CV risk factors due to the presence of MSC&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a single-center hospital-based cross-sectional study&#46; The CR program took place in a cardiac rehabilitation unit&#46; Enrollment in CR was voluntary after referral from the attending cardiologist during the initial hospitalization&#46; Written informed consent was obtained from all patients at program enrollment&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Participants</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were considered eligible for CR if&#44; in the three months before referral&#44; they had one of the following&#58; acute coronary syndrome&#44; percutaneous coronary intervention &#40;PCI&#41; or coronary artery bypass grafting &#40;CABG&#41;&#46; Exclusion criteria followed the standard recommendations for phase II CR programs<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&#58; patients were excluded if they were considered unable to safely engage in exercise sessions &#40;due to neuromuscular&#44; orthopedic or cognitive impairment&#41;&#44; had uncontrolled diabetes or unfavorable blood pressure response to exercise&#44; ejection fraction &#60;30&#37;&#44; New York Heart Association functional class &#8805;3&#44; complex ventricular or supraventricular arrhythmias&#44; or high-grade atrioventricular block&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Of a total of 487 patients initially approached for CR participation&#44; 38 &#40;7&#46;8&#37;&#41; refused to participate due to various constraints &#40;accessibility 22&#59; resumption of work 10&#59; financial issues 6&#41;&#46; A secondary analysis showed that&#44; compared to those undergoing CR&#44; those who did not attend the CR sessions were more frequently women &#40;9 &#91;16&#46;7&#37;&#93; vs&#46; 54 &#91;12&#46;0&#37;&#93;&#44; p&#61;0&#46;03&#41; and were more likely to present previous CHD &#40;37&#46;8&#37; vs&#46; 16&#46;8&#59; p&#60;0&#46;05&#41;&#44; hypertension &#40;52&#46;6&#37; vs&#46; 39&#46;7&#37;&#44; p&#61;0&#46;05&#41;&#44; and active smoking &#40;71&#46;4&#37; vs&#46; 55&#46;7&#37;&#59; p&#60;0&#46;05&#41;&#46; No between-group differences were detected in age&#44; BMI&#44; waist circumference&#44; or prevalence of diabetes&#44; dyslipidemia&#44; or metabolic syndrome&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Outcome measures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sociodemographic and clinical characteristics</span><p id="par0040" class="elsevierStylePara elsevierViewall">Sociodemographic characteristics were assessed through a structured questionnaire and included marital status&#44; years of education&#44; and work status&#46; Information regarding the index event&#44; revascularization procedure&#44; CV risk factors&#44; cardiac medications&#44; and comorbidities were obtained from medical records&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Anthropometric parameters &#40;weight&#44; height&#44; BMI and waist circumference&#41; were measured at baseline in accordance with the recommendations of the US National Institutes of Health&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Physical activity and functional capacity</span><p id="par0050" class="elsevierStylePara elsevierViewall">Leisure time physical activity was assessed using the International Physical Activity Questionnaire&#44; measured in metabolic equivalents &#40;MET&#41;-min&#47;week&#46; Only non-professional physical activities and those lasting at least 15 min were included in the analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> We used a cut-off of 600 MET-min&#47;week &#40;30 min&#47;day&#44; 7 days&#47;week&#41; of moderate intensity physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Functional capacity was estimated from baseline symptom-limited maximal exercise using the standard Bruce protocol&#44; and quantified by the amount of work performed in multiples of resting oxygen uptake &#40;defined as 1 MET&#61;3&#46;5 ml oxygen per kg body weight per min&#41;&#46; Standard tables were used to convert treadmill grade and speed into estimated MET levels&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Musculoskeletal complaints</span><p id="par0060" class="elsevierStylePara elsevierViewall">MSC were characterized using an interviewer-administered Portuguese version of the Nordic Musculoskeletal Questionnaire&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#44;13</span></a> This consists of 40 questions regarding location &#40;nine body areas&#58; neck&#44; shoulders&#44; elbows&#44; wrist&#47;hands&#44; mid and low back&#44; hips&#47;thighs&#44; knee&#44; ankles&#47;feet&#41;&#44; duration &#40;last 12 months&#59; last 7 days&#41; and pain intensity &#40;numeric scale&#41;&#46; Since we aimed to establish the influence of long-standing MSC on CV risk factors and functional and psychosocial status&#44; all patients reporting pain in the last 12 months were included in the analysis&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Psychosocial factors</span><p id="par0065" class="elsevierStylePara elsevierViewall">The Hospital Anxiety and Depression Scale was used to assess the presence and severity of anxiety and depressive symptoms&#46; It has been validated and used extensively in CHD research&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Each domain consists of seven questions&#44; scored between 0 &#40;no symptoms&#41; and 3 &#40;severe symptoms&#41;&#44; with a total score ranging between 0 and 21&#46; A cut-off of 8 in either domain was used to define clinical anxiety and depression&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The Short Form 36 Health Survey &#40;SF-36&#44; version 2&#41;&#44; which is widely used and validated for CHD populations&#44; was used to measure both physical and mental dimensions of quality of life&#46; It consists of eight categories&#44; four in each domain &#40;physical and mental&#41;&#44; to provide physical and mental health summary scores&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;17</span></a> Scores in each category range between 0 &#40;worst&#41; and 100 &#40;best&#41; quality of life&#46; Scores are presented after standardization through linear transformations to achieve a mean score of 50 and standard deviation of 10&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">The patients were divided into those with &#40;MSC&#43;&#41; and those without &#40;MSC&#8722;&#41; musculoskeletal complaints&#46; Between-group comparisons were made using the standard t test and the Mann-Whitney test for normal and non-normal continuous variables&#44; respectively&#46; Categorical variables were compared using the chi-square test&#46; Binomial logistic regression was used to assess the prevalence of categorical CV risk factors through categories of MSC&#44; with adjustment for age and gender&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">The study sample consisted of 449 patients&#44; mostly male &#40;88&#46;0&#37;&#41;&#44; with low educational level &#40;&#60;9 years of education&#58; 44&#46;0&#37;&#41;&#44; married &#40;85&#46;0&#37;&#41;&#44; and actively working &#40;57&#46;0&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Almost half presented with ST-segment elevation myocardial infarction &#40;49&#46;0&#37;&#41;&#44; with 83&#46;0&#37; undergoing PCI&#44; 49&#46;0&#37; CABG &#40;9&#46;4&#37;&#41;&#44; and 7&#46;0&#37; receiving only medical treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; There were no differences between groups regarding cardioprotective drug use &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Prevalence of musculoskeletal complaints and cardiovascular risk profile</span><p id="par0085" class="elsevierStylePara elsevierViewall">Of the study sample&#44; 119 &#40;26&#46;5&#37;&#41; patients had MSC&#44; 68 &#40;58&#46;0&#37;&#41; in the lower limbs&#44; 40 &#40;34&#46;0&#37;&#41; in the spine and nine &#40;7&#46;7&#37;&#41; in the upper limbs&#46; Among those with lower limb complaints&#44; the majority reported knee pain &#40;46&#59; 68&#46;7&#37;&#41; or ankle&#47;foot pain &#40;14&#59; 20&#46;3&#37;&#41;&#46; Mean reported visual analog scale pain score was 4&#46;2&#177;1&#46;2 &#40;range 1&#8211;9&#41;&#46; Patients reporting MSC were older&#44; more frequently women&#44; and had a worse CV risk factor profile&#44; with higher prevalences of dyslipidemia&#44; hypertension&#44; overweight&#44; and metabolic syndrome&#46; Despite a higher proportion of active smokers in the MSC&#8722; group&#44; pack-year history was higher in MSC&#43;&#44; probably reflecting older age in the latter&#46; No differences were found regarding diabetes or family history of CHD &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The MSC&#43; group showed higher BMI and more abdominal obesity &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Physical activity and functional capacity</span><p id="par0090" class="elsevierStylePara elsevierViewall">MSC&#43; patients were less active&#44; with 65&#37; reporting less than 600 MET-min&#47;week&#44; compared to 44&#37; in the MSC&#8722; group &#40;p&#60;0&#46;05&#41;&#46; Functional capacity was&#44; on average&#44; 10&#37; lower in MSC&#43; compared to MSC&#8722; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Psychosocial status and quality of life</span><p id="par0095" class="elsevierStylePara elsevierViewall">Symptoms of depression and anxiety were more prevalent and of greater severity in MSC&#43;&#44; with 36&#46;0&#37; MSC&#43; and 21&#46;0&#37; MSC&#8722; patients presenting clinical depression &#40;p&#60;0&#46;05&#41;&#44; and 39&#46;0&#37; MSC&#43; and 30&#46;0&#37; MSC&#8722; having clinical anxiety &#40;p&#61;0&#46;06&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Both physical and mental dimensions of quality of life were significantly lower in MSC&#43; patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Increased risk for cardiovascular risk factors according to musculoskeletal complaint status</span><p id="par0100" class="elsevierStylePara elsevierViewall">Univariate logistic regression showed that MSC&#43; patients had double the risk of having hypertension&#44; dyslipidemia&#44; and obesity &#40;both general and visceral&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; Physical inactivity was 2&#46;4 times more prevalent in MSC&#43; compared to MSC&#8722; patients&#46; Even after adjustment for age and gender&#44; MSC status remained a strong predictor of CV risk factors&#44; except for diabetes&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">MSC and CHD are common chronic conditions associated with significant disability and use of healthcare resources&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> In this study we showed that MSC are not only common in the CHD population but are also associated with lower levels of physical activity and a worse CV risk factor profile&#44; estimated functional capacity&#44; and psychosocial status&#44; irrespective of age and gender&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The prevalence of MSC has been shown to be higher in CHD patients than in the general population&#46; The US Centers for Disease Control estimated that the age and gender-adjusted prevalence of arthritis was 57&#46;4&#37; in CHD patients compared to 27&#46;4&#37; in the general population&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> while Marzollini et al&#46; reported a 56&#46;0&#37; prevalence of MSC in a multicenter cross-sectional study of 1803 CHD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> The lower prevalence found in our study &#40;27&#46;0&#37;&#41; is probably related to age-related referral bias commonly seen in CR&#44; especially under-representation of older patients&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Physical inactivity has been linked to increased risk for CHD in several prospective cohort studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#44;22</span></a> An aggregate analysis of prospective primary prevention studies looking at physical activity levels and CV mortality found a median risk reduction of up to 40&#37; in more compared to less active subjects&#44; irrespective of age&#44; gender and race&#47;ethnicity&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> Our results confirm the cumulative negative effect of CHD and MSC on physical activity levels&#44; with an almost 30&#37; increase in the prevalence of physical inactivity compared to CHD patients without MSC&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> Moreover&#44; reduced physical activity translates into lower functional capacity&#44; which in turn is linked to higher CV morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Clustering of adverse CV risk factors has been described in patients with MSC&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;19&#44;25</span></a> Our study&#44; like others&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> confirms that patients with MSC are older&#44; more sedentary and more frequently dyslipidemic and hypertensive compared with those without MSC&#46; Exercise training exerts beneficial effects in both prevention and treatment of CHD and MSC&#46; However&#44; the impact of exercise on CV risk factor burden is controversial&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#44;27</span></a> Despite a clear dose-response curve between exercise and cardiometabolic risk factors&#44; the magnitude of the effect appears modest and highly variable according to individual and exercise program characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Methodological difficulties regarding study design&#44; patient selection&#44; lack of standardization of exercise and physical activity protocols&#44; and heterogeneity of instruments for measuring physical activity &#40;including self-reported questionnaires&#44; logbooks&#44; pedometers and triaxial accelerometers&#41; hinder conclusions regarding optimal dose and type of exercise for CV prevention&#46; Since age and gender are related to CV risk factors&#44; CHD&#44; and MSC&#44; we used an age- and gender-adjusted logistic regression model to obtain a clearer picture of the influence of MSC status on prevalence of classical risk factors&#46; The study results confirm our prior assumption of an association of MSC with a worse CV risk factor profile&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Both chronic pain due to musculoskeletal disturbances and CHD have a considerable impact on the psychosocial dimension of quality of life&#46; The Longitudinal Aging Study Amsterdam followed 2285 individuals aged 55&#8211;85 for up to six years and found an increased risk for depression in both cardiac &#40;&#43;33&#37;&#41; and musculoskeletal &#40;&#43;36&#37;&#41; cases&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Our study replicated both the incidence of depression in CHD and the cumulative effect of coexisting CHD and MSC&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">It is therefore recommended to systematically assess psychosocial status in CR settings and to develop and implement psycho-behavioral interventions and support&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Study limitations</span><p id="par0135" class="elsevierStylePara elsevierViewall">MSC were self-reported and no further clinical or imaging assessment was undertaken&#46; However&#44; any misclassification was probably non-differential and&#44; since our purpose was to study the association between CHD and MSC status and not causation&#44; we do not expect this to have a significant impact on the study&#39;s internal validity&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Self-reporting physical activity through questionnaires has been widely used in several observational studies&#44; although low precision and sensitivity to change might introduce measurement biases and differential misclassifications&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> Ideally&#44; objective measurements using biaxial or triaxial accelerometers would minimize these concerns&#44; but cost and applicability in daily clinical practice excluded this option&#46; On the other hand&#44; the results and the direction associations found between physical activity&#44; functional capacity and anthropometric characteristics indicate that the chosen instrument is measuring physical activity appropriately in this setting&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In addition to the aforementioned limitations&#44; this was a single-center cross-sectional study of young&#44; mostly male CHD patients&#44; so its results cannot be extrapolated to CHD populations with different characteristics&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusions</span><p id="par0150" class="elsevierStylePara elsevierViewall">More than a quarter of CHD patients enrolled in CR programs report MSC&#44; which are associated with a worse CV risk factor profile&#44; lower levels of physical activity and functional capacity&#44; and unfavorable psycho-emotional and quality of life scores&#46; This subgroup of CR patients is particularly susceptible to prolonged disability from CHD&#44; productivity losses&#44; and early retirement&#46; Aside from indirect costs&#44; they are also at increased risk for CHD recurrence and need for further medical assistance and revascularization procedures&#46; Addressing MSC in a secondary prevention setting might be beneficial&#44; coupling standard exercise training programs with activity and exercise modifications&#44; modalities&#44; and individualized exercise counseling&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Further research is needed to determine if and how MSC affect the health benefits of CR&#44; and which interventions and program designs are best suited to minimize the deleterious effects of MSC on CV health&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Ethical disclosures</span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Protection of human and animal subjects</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Confidentiality of data</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Right to privacy and informed consent</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Abstract"
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          "titulo" => "Resumo"
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          "titulo" => "Introduction and Objectives"
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              "titulo" => "Outcome measures"
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                  "identificador" => "sec0030"
                  "titulo" => "Sociodemographic and clinical characteristics"
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                  "titulo" => "Physical activity and functional capacity"
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                  "identificador" => "sec0040"
                  "titulo" => "Musculoskeletal complaints"
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                  "titulo" => "Psychosocial factors"
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              "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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            0 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Prevalence of musculoskeletal complaints and cardiovascular risk profile"
            ]
            1 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Physical activity and functional capacity"
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              "identificador" => "sec0070"
              "titulo" => "Psychosocial status and quality of life"
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            3 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Increased risk for cardiovascular risk factors according to musculoskeletal complaint status"
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          "titulo" => "Discussion"
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              "titulo" => "Protection of human and animal subjects"
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              "titulo" => "Confidentiality of data"
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              "titulo" => "Right to privacy and informed consent"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-06-06"
    "fechaAceptado" => "2014-08-25"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec462605"
          "palabras" => array:3 [
            0 => "Coronary disease"
            1 => "Musculoskeletal pain"
            2 => "Physical activity"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec462604"
          "palabras" => array:3 [
            0 => "Doen&#231;a coron&#225;ria"
            1 => "Dor m&#250;sculo-esquel&#233;tica"
            2 => "Atividade f&#237;sica"
          ]
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the prevalence of musculoskeletal complaints and their association with risk factor profile and functional and psychosocial status in patients on a cardiac rehabilitation program&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this cross-sectional study of 449 patients admitted within three months of an acute coronary syndrome&#44; patients were divided into those with &#40;MSC&#43;&#41; and those without &#40;MSC&#8722;&#41; musculoskeletal complaints&#46; The Hospital Anxiety and Depression Scale and the Short Form 36 Health Survey were used to assess psychosocial status and quality of life&#44; and the International Physical Activity Questionnaire for physical activity&#46; Functional capacity was estimated from exercise testing&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Musculoskeletal pain was present in 119 patients &#40;27&#37;&#41;&#44; mainly in the lower limbs &#40;56&#37;&#41;&#46; MSC&#43; were older &#40;mean 56&#46;5&#177;9&#46;9 vs&#46; 53&#46;2&#177;9&#46;5 years&#59; p&#60;0&#46;001&#41; and more frequently women &#40;20&#46;2&#37; vs&#46; 9&#46;1&#37;&#59; p&#60;0&#46;001&#41;&#46; MSC&#43; had a higher prevalence of dyslipidemia &#40;68&#46;6&#37; vs&#46; 51&#46;2&#37;&#59; p&#60;0&#46;001&#41;&#44; hypertension &#40;51&#46;7&#37; vs&#46; 35&#46;5&#37;&#59; p&#60;0&#46;001&#41;&#44; obesity &#40;29&#46;4&#37; vs&#46; 17&#46;9&#37;&#59; p&#60;0&#46;001&#41; and metabolic syndrome &#40;44&#46;5&#37; vs&#46; 31&#46;5&#37;&#59; p&#60;0&#46;001&#41;&#46; MSC&#43; showed higher body mass index and waist circumference&#44; and lower physical activity levels &#40;p&#60;0&#46;05&#41;&#44; as well as lower functional capacity &#40;8&#46;6&#177;2&#46;2 vs&#46; 9&#46;6&#177;2&#46;1 MET&#59; p&#60;0&#46;05&#41;&#44; higher scores for depression &#40;6 &#91;3&#8211;9&#93; vs&#46; 3 &#91;1&#8211;7&#93;&#59; p&#60;0&#46;05&#41; and anxiety &#40;7 &#91;3&#8211;10&#93; vs&#46; 5 &#91;2&#8211;8&#93;&#59; p&#60;0&#46;05&#41;&#44; and lower scores for physical &#40;44&#46;1&#177;8&#46;7 vs&#46; 47&#46;6&#177;7&#46;6&#59; p&#60;0&#46;05&#41; and mental &#40;39&#46;2&#177;13&#46;0 vs&#46; 44&#46;0&#177;13&#46;0&#59; p&#60;0&#46;05&#41; quality of life&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Musculoskeletal complaints are common in cardiac rehabilitation and predict lower levels of physical activity&#44; worse cardiovascular risk factor profile&#44; and poorer functional capacity and psychosocial status&#44; irrespective of age and gender&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
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            "titulo" => "Results"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">determinar a preval&#234;ncia da dor m&#250;sculo-esquel&#233;tica e sua associa&#231;&#227;o com perfil de risco cardiovascular&#44; estado funcional e psicossocial em doentes admitidos num programa de reabilita&#231;&#227;o card&#237;aca</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">estudo transversal de 449 doentes admitidos nos primeiros tr&#234;s meses ap&#243;s s&#237;ndroma coron&#225;ria aguda&#46; Os doentes foram categorizados em grupo com &#40;MSC&#43;&#41; e sem &#40;MSC-&#41; dor m&#250;sculo-esquel&#233;tica&#46; O estado psicossocial e a qualidade foram avaliadas com as escalas HADS e SF36 e a atividade f&#237;sica com o IPAQ&#46; Capacidade funcional foi estimada com prova de esfor&#231;o basal&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Dor m&#250;sculo-esquel&#233;tica estava presente em 119 &#40;27&#37;&#41;&#44; maioritariamente nos membros inferiores &#40;56&#37;&#41;&#46; MSC&#43; eram mais velhos &#91;m&#233;dia&#40;DP&#41;&#58; 56&#44;5&#177;9&#44;9 <span class="elsevierStyleItalic">versus</span> 53&#44;2&#177;9&#44;5&#59; p&#60;0&#46;001&#93; e mais frequentemente mulheres &#91;20&#44;2&#37; <span class="elsevierStyleItalic">versus</span> 9&#44;1&#37;&#59; p&#60;0&#44;001&#93;&#46; MSC&#43; apresentavam maior preval&#234;ncia de dislipidemia &#40;68&#44;6&#37; <span class="elsevierStyleItalic">versus</span> 51&#44;2&#37;&#59; p&#60;0&#44;001&#41;&#44; hipertens&#227;o arterial &#40;51&#44;7&#37; <span class="elsevierStyleItalic">versus</span> 35&#44;5&#37;&#59; p&#60;0&#44;001&#41;&#44; obesidade &#40;29&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 17&#44;9&#37;&#59; p&#60;0&#44;001&#41; e s&#237;ndroma metab&#243;lica &#40;44&#44;5&#37; <span class="elsevierStyleItalic">versus</span> 31&#44;5&#37;&#59; p&#60;0&#44;001&#41;&#46; MSC&#43; mostravam maiores &#237;ndice de massa corporal e per&#237;metro abdominal e menor atividade f&#237;sica &#40;p&#60;0&#44;005&#41;&#46; MSC&#43; tinham menor capacidade funcional &#91;8&#44;6&#177;2&#44;2 <span class="elsevierStyleItalic">versus</span> 9&#44;6&#177;2&#44;1 MET&#59; p&#60;0&#44;05&#93;&#44; maior preval&#234;ncia de sintomas depressivos &#91;6&#40;3-9&#41; <span class="elsevierStyleItalic">versus</span> 3&#40;1-7&#41;&#59; p&#60;0&#44;05&#93; e ansiosos &#91;7&#40;3-10&#41; <span class="elsevierStyleItalic">versus</span> 5&#40;2-8&#41;&#59; p&#60;0&#44;05&#93;&#44; e menor qualidade de vida f&#237;sica &#91;44&#44;1&#177;8&#44;7 <span class="elsevierStyleItalic">versus</span> 47&#44;6&#177;7&#44;6&#59; p&#60;0&#44;05&#93; e mental &#91;39&#44;2&#177;13&#44;0 <span class="elsevierStyleItalic">versus</span> 44&#44;0&#177;13&#44;0&#59; p&#60;0&#44;05&#93;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Dor m&#250;sculo-esquel&#233;tica associa-se a menores n&#237;veis de atividade f&#237;sica&#44; pior capacidade funcional&#44; pior perfil de risco cardiovascular e a um estado psicossocial mais adverso&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; CHD&#58; coronary heart disease&#59; CV&#58; cardiovascular&#59; MSC&#8722;&#58; patients without musculoskeletal complaints&#59; MSC&#43;&#58; patients with musculoskeletal complaints&#59; P50 &#40;P25&#8211;P75&#41;&#58; median &#40;interquartile range&#41;&#59; SD&#58; standard deviation&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total sample &#40;n&#61;449&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC&#8722; &#40;n&#61;330&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC&#43; &#40;n&#61;119&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sociodemographic variables</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#46;1&#177;9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#46;2&#177;9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#46;5&#177;9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;12&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;20&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Years of education&#44; P50 &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;4&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;4&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;4&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Actively working&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">253 &#40;56&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">199 &#40;60&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;45&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Married&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">381 &#40;84&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">285 &#40;86&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 &#40;80&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">CV risk factors</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous history of CHD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 &#40;16&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;14&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">250 &#40;55&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">169 &#40;51&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81 &#40;68&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">178 &#40;39&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 &#40;35&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61 &#40;51&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 &#40;18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Family history of CHD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">125 &#40;28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91 &#40;27&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;28&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Active smoking&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">250 &#40;55&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">194 &#40;58&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;43&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pack-years&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#46;0&#177;27&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;0&#177;25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#46;7&#177;31&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;30 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94 &#40;21&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Metabolic syndrome&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">157 &#40;35&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">104 &#40;31&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#40;44&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ACEI&#58; angiotensin-converting enzyme inhibitors&#59; ARA&#58; aldosterone receptor antagonists&#59; BNP&#58; brain natriuretic peptide&#59; MSC&#8722;&#58; patients without musculoskeletal complaints&#59; MSC&#43;&#58; patients with musculoskeletal complaints&#59; P50 &#40;P25&#8211;P75&#41;&#58; median &#40;interquartile range&#41;&#59; STEMI&#58; ST-segment elevation myocardial infarction&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total sample &#40;n&#61;449&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC&#8722; &#40;n&#61;330&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC&#43; &#40;n&#61;119&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Acute coronary syndrome</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>STEMI&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">222 &#40;49&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173 &#40;52&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;41&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left ventricular dysfunction&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;30&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;27&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peak troponin I &#40;ng&#47;ml&#41;&#59; P50 &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;2&#46;8&#8211;16&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;5 &#40;3&#46;5&#8211;6&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;1&#46;34&#8211;52&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Admission BNP &#40;pg&#47;ml&#41;&#59; P50 &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;5 &#40;37&#46;2&#8211;217&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;6 &#40;37&#8211;210&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;30&#8211;228&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Medication</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blockers&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">396 &#40;88&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">289 &#40;87&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107 &#40;91&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diuretics&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACEI&#47;ARA&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">349 &#40;77&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">252 &#40;76&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;82&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nitrates&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Antidiabetics&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;17&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;18&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Antiplatelets&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">437 &#40;97&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">322 &#40;97&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;97&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Acute coronary event characteristics and medication use in the different groups and the total sample&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; HADS&#58; Hospital Anxiety and Depression Scale&#59; MET&#58; metabolic equivalents estimated from the IPAQ&#59; P50 &#40;P25&#8211;P75&#41;&#58; median &#40;interquartile range&#41;&#59; P50 &#40;P25&#8211;P75&#41;&#58; median &#40;interquartile range&#41;&#59; SD&#58; standard deviation&#44; SF-36&#58; Short Form 36 Health Survey&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total sample &#40;n&#61;449&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC&#8722; &#40;n&#61;330&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MSC&#43; &#40;n&#61;119&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Anthropometric</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Weight &#40;kg&#41;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#46;2&#177;11&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#46;6&#177;12&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#46;7&#177;11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;1&#177;3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;8&#177;3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;0&#177;3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Waist circumference &#40;cm&#41;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#46;6&#177;9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&#46;9&#177;9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#46;5&#177;9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Functional capacity &#40;exercise test&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Maximum duration &#40;min&#58;sec&#41;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">08&#58;47&#177;02&#58;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#58;05&#177;2&#58;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">07&#58;57&#177;02&#58;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MET&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;4&#177;2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;6&#177;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;6&#177;2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Maximum heart rate &#40;bpm&#41;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136&#46;0&#177;20&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138&#46;0&#177;20&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">130&#46;2&#177;19&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#37; predicted heart rate&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#46;0&#177;10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#46;7&#177;10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#46;2&#177;10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Physical activity</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MET-min&#47;week&#44; P50 &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99 &#40;0&#8211;569&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">148&#46;5 &#40;0&#8211;594&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#8211;428&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Anxiety and depression &#40;HADS&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anxiety score&#44; P50 &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;2&#46;2&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;2&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;3&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anxiety score &#8805;8&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">145 &#40;32&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99 &#40;30&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;39&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Depression score&#44; P50 &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;3&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Depression score &#8805;8&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 &#40;25&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70 &#40;21&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Quality of life &#40;SF-36&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Physical summary score&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#46;7&#177;8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#46;6&#177;7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;1&#177;8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mental summary score&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;8&#177;13&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;0&#177;13&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#46;2&#177;13&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Anthropometric characteristics&#44; functional capacity&#44; physical activity and psychosocial status in the different groups and the total sample&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; CI&#58; confidence interval&#59; CV&#58; cardiovascular&#59; OR&#58; odds ratio&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CV risk factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crude OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adjusted OR<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;95 &#40;1&#46;27&#8211;3&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;68 &#40;1&#46;08&#8211;2&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;16 &#40;1&#46;37&#8211;3&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;10 &#40;1&#46;34&#8211;3&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;20 &#40;0&#46;70&#8211;2&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;97 &#40;0&#46;55&#8211;1&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">BMI &#62;30 kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;91 &#40;1&#46;17&#8211;3&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;84 &#40;1&#46;10&#8211;3&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Abdominal obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;61 &#40;1&#46;61&#8211;4&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;31 &#40;1&#46;41&#8211;3&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
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        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disability-adjusted life years &#40;DALYs&#41; for 291 diseases and injuries in 21 regions&#44; 1990&#8211;2010&#58; a systematic analysis for the Global Burden of Disease Study 2010"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;J&#46; Murray"
                            1 => "T&#46; Vos"
                            2 => "R&#46; Lozano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(12)61689-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2012"
                        "volumen" => "380"
                        "paginaInicial" => "2197"
                        "paginaFinal" => "2223"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245608"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010&#58; a systematic analysis for the Global Burden of Disease Study 2010"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Lozano"
                            1 => "M&#46; Naghavi"
                            2 => "K&#46; Foreman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(12)61728-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2012"
                        "volumen" => "380"
                        "paginaInicial" => "2095"
                        "paginaFinal" => "2128"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245604"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heart disease and stroke statistics &#8211; 2013 update&#58; a report from the American Heart Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;S&#46; Go"
                            1 => "D&#46; Mozaffarian"
                            2 => "V&#46;L&#46; Roger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e31828124ad"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "127"
                        "paginaInicial" => "e6"
                        "paginaFinal" => "e245"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23239837"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arthritis as a potential barrier to physical activity among adults with heart disease &#8211; United States&#44; 2005 and&#44; 2007"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Centers for Disease Control and Prevention"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Morb Mortal Wkly Rep &#40;MMWR&#41;"
                        "fecha" => "2009"
                        "volumen" => "58"
                        "paginaInicial" => "165"
                        "paginaFinal" => "169"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory markers in patients with coronary artery disease with and without inflammatory rheumatic disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "U&#46;M&#46; Breland"
                            1 => "I&#46; Hollan"
                            2 => "K&#46; Saatvedt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2010"
                        "volumen" => "49"
                        "paginaInicial" => "1118"
                        "paginaFinal" => "1127"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COX-2 selective non-steroidal anti-inflammatory drugs and risk of serious coronary heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46;A&#46; Ray"
                            1 => "C&#46;M&#46; Stein"
                            2 => "J&#46;R&#46; Daugherty"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(02)11131-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2002"
                        "volumen" => "360"
                        "paginaInicial" => "1071"
                        "paginaFinal" => "1073"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12383990"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age does not determine the physical&#44; functional and psychosocial response to a cardiac rehabilitation program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Rocha"
                            1 => "V&#46; Araujo"
                            2 => "F&#46; Parada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2011"
                        "volumen" => "30"
                        "paginaInicial" => "479"
                        "paginaFinal" => "507"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21800478"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical guidelines on the identification&#44; evaluation&#44; and treatment of overweight and obesity in adults &#8211; the evidence report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "National Institutes of Health"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Obes Res"
                        "fecha" => "1998"
                        "volumen" => "6"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "51S"
                        "paginaFinal" => "209S"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9813653"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International physical activity questionnaire&#58; 12-country reliability and validity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;L&#46; Craig"
                            1 => "A&#46;L&#46; Marshall"
                            2 => "M&#46; Sjostrom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1249/01.MSS.0000078924.61453.FB"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Sci Sports Exerc"
                        "fecha" => "2003"
                        "volumen" => "35"
                        "paginaInicial" => "1381"
                        "paginaFinal" => "1395"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12900694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical activity and public health&#58; updated recommendation for adults from the American College of Sports Medicine and the American Heart Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46;L&#46; Haskell"
                            1 => "I&#46;M&#46; Lee"
                            2 => "R&#46;R&#46; Pate"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.107.185649"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2007"
                        "volumen" => "116"
                        "paginaInicial" => "1081"
                        "paginaFinal" => "1093"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17671237"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exercise standards for testing and training&#58; a scientific statement from the American Heart Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;F&#46; Fletcher"
                            1 => "P&#46;A&#46; Ades"
                            2 => "P&#46; Kligfield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e31829b5b44"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "128"
                        "paginaInicial" => "873"
                        "paginaFinal" => "934"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23877260"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Questionnaire development&#58; an examination of the Nordic Musculoskeletal questionnaire"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;E&#46; Dickinson"
                            1 => "K&#46; Campion"
                            2 => "A&#46;F&#46; Foster"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Appl Ergon"
                        "fecha" => "1992"
                        "volumen" => "23"
                        "paginaInicial" => "197"
                        "paginaFinal" => "201"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15676868"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cross-cultural adaptation of the Nordic musculoskeletal questionnaire"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;N&#46; Barros"
                            1 => "N&#46;M&#46; Alexandre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Nurs Rev"
                        "fecha" => "2003"
                        "volumen" => "50"
                        "paginaInicial" => "101"
                        "paginaFinal" => "108"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12752909"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Hospital Anxiety and Depression Scale depression subscale&#44; but not the Beck Depression Inventory-Fast Scale&#44; identifies patients with acute coronary syndrome at elevated risk of 1-year mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Doyle"
                            1 => "H&#46;M&#46; McGee"
                            2 => "D&#46; De La Harpe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpsychores.2005.09.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Psychosom Res"
                        "fecha" => "2006"
                        "volumen" => "60"
                        "paginaInicial" => "461"
                        "paginaFinal" => "467"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16650586"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The hospital anxiety and depression scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;P&#46; Snaith"
                            1 => "A&#46;S&#46; Zigmond"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Br Med J"
                        "fecha" => "1986"
                        "volumen" => "292"
                        "paginaInicial" => "344"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical and mental component summaries score of the SF-36 in coronary patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Soto"
                            1 => "I&#46; Failde"
                            2 => "S&#46; Marquez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Qual Life Res"
                        "fecha" => "2005"
                        "volumen" => "14"
                        "paginaInicial" => "759"
                        "paginaFinal" => "768"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16022068"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of the SF-36 version 2 in the United Kingdom"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Jenkinson"
                            1 => "S&#46; Stewart-Brown"
                            2 => "S&#46; Petersen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Epidemiol Commun Health"
                        "fecha" => "1999"
                        "volumen" => "53"
                        "paginaInicial" => "46"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reliability and validity in measuring physical and mental health construct of the Portuguese version of MOS SF-36"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Severo"
                            1 => "A&#46;C&#46; Santos"
                            2 => "C&#46; Lopes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Med Port"
                        "fecha" => "2006"
                        "volumen" => "19"
                        "paginaInicial" => "281"
                        "paginaFinal" => "287"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17328844"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
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                        "paginaFinal" => "862"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22424936"
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                      "titulo" => "Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Suaya"
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                            2 => "S&#46;L&#46; Normand"
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                        ]
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                        "tituloSerie" => "Circulation"
                        "fecha" => "2007"
                        "volumen" => "116"
                        "paginaInicial" => "1653"
                        "paginaFinal" => "1662"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17893274"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
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                      "titulo" => "Physical activity during leisure time and primary prevention of coronary heart disease&#58; an updated meta-analysis of cohort studies"
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                        "tituloSerie" => "Eur J Cardiovasc Prev Rehabil"
                        "fecha" => "2008"
                        "volumen" => "15"
                        "paginaInicial" => "247"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18525378"
                            "web" => "Medline"
                          ]
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                ]
              ]
            ]
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                0 => array:2 [
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                      "titulo" => "Association of physical activity with all-cause and cardiovascular mortality&#58; a systematic review and meta-analysis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "F&#46; Muller-Riemenschneider"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "doi" => "10.1097/HJR.0b013e3282f55e09"
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                        "tituloSerie" => "Eur J Cardiovasc Prev Rehabil"
                        "fecha" => "2008"
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                        "paginaInicial" => "239"
                        "paginaFinal" => "246"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18525377"
                            "web" => "Medline"
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              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Physical activity and cardiovascular health&#58; lessons learned from epidemiological studies across age&#44; gender&#44; and race&#47;ethnicity"
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                        0 => array:2 [
                          "etal" => false
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                    ]
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                        "tituloSerie" => "Circulation"
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                        "paginaInicial" => "743"
                        "paginaFinal" => "752"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20713909"
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                ]
              ]
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              "etiqueta" => "24"
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                    0 => array:2 [
                      "titulo" => "Exercise based rehabilitation for heart failure"
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              ]
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                        "tituloSerie" => "J Cardiopulm Rehabil Prev"
                        "fecha" => "2010"
                        "volumen" => "30"
                        "paginaInicial" => "391"
                        "paginaFinal" => "400"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20571432"
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                  ]
                ]
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                          "etal" => true
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                        "tituloSerie" => "Br J Sports Med"
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                        "paginaInicial" => "101"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8358578"
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                  ]
                ]
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                      "titulo" => "Dose-response issues concerning physical activity and health&#58; an evidence-based symposium"
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                        "tituloSerie" => "Med Sci Sports Exerc"
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                        "numero" => "6 Suppl"
                        "paginaInicial" => "S351"
                        "paginaFinal" => "S358"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11427759"
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                        "paginaFinal" => "1359"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21694556"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2014.08.021

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	2	10
2024 October	32	35	67
2024 September	34	22	56
2024 August	37	25	62
2024 July	36	24	60
2024 June	34	21	55
2024 May	30	22	52
2024 April	27	20	47
2024 March	28	17	45
2024 February	27	21	48
2024 January	21	26	47
2023 December	19	17	36
2023 November	40	28	68
2023 October	24	15	39
2023 September	28	17	45
2023 August	23	12	35
2023 July	26	8	34
2023 June	21	14	35
2023 May	24	22	46
2023 April	10	5	15
2023 March	19	22	41
2023 February	21	23	44
2023 January	16	9	25
2022 December	19	25	44
2022 November	28	28	56
2022 October	27	13	40
2022 September	19	38	57
2022 August	28	31	59
2022 July	22	39	61
2022 June	24	23	47
2022 May	15	37	52
2022 April	24	19	43
2022 March	28	34	62
2022 February	19	15	34
2022 January	25	23	48
2021 December	13	30	43
2021 November	26	27	53
2021 October	26	38	64
2021 September	19	28	47
2021 August	22	27	49
2021 July	18	25	43
2021 June	21	20	41
2021 May	22	22	44
2021 April	49	26	75
2021 March	41	17	58
2021 February	56	13	69
2021 January	74	16	90
2020 December	29	3	32
2020 November	18	10	28
2020 October	16	10	26
2020 September	39	5	44
2020 August	12	6	18
2020 July	43	4	47
2020 June	34	9	43
2020 May	32	5	37
2020 April	33	8	41
2020 March	27	9	36
2020 February	28	16	44
2020 January	32	14	46
2019 December	30	9	39
2019 November	18	7	25
2019 October	34	7	41
2019 September	18	8	26
2019 August	34	6	40
2019 July	23	8	31
2019 June	19	12	31
2019 May	30	7	37
2019 April	33	12	45
2019 March	19	9	28
2019 February	33	20	53
2019 January	39	3	42
2018 December	33	11	44
2018 November	103	4	107
2018 October	450	18	468
2018 September	90	16	106
2018 August	45	9	54
2018 July	27	7	34
2018 June	37	10	47
2018 May	35	19	54
2018 April	37	3	40
2018 March	38	11	49
2018 February	24	3	27
2018 January	34	7	41
2017 December	46	5	51
2017 November	29	7	36
2017 October	44	15	59
2017 September	31	20	51
2017 August	36	22	58
2017 July	31	15	46
2017 June	36	8	44
2017 May	37	9	46
2017 April	28	14	42
2017 March	19	20	39
2017 February	31	4	35
2017 January	18	3	21
2016 December	34	9	43
2016 November	18	3	21
2016 October	32	3	35
2016 September	23	8	31
2016 August	5	2	7
2016 July	20	6	26
2016 June	7	4	11
2016 May	12	5	17
2016 April	26	2	28
2016 March	29	5	34
2016 February	35	10	45
2016 January	36	6	42
2015 December	25	4	29
2015 November	21	4	25
2015 October	35	10	45
2015 September	33	7	40
2015 August	31	9	40
2015 July	22	0	22
2015 June	13	2	15
2015 May	30	12	42
2015 April	22	10	32
2015 March	37	11	48
2015 February	1	1	2

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