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including endothelial dysfunction&#44; vascular wall inflammation&#44; and arterial stiffness related indexes &#40;e&#46;g&#46; aortic PWV and AIx&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;16</span></a> In contrast to chronic exercise&#44; an acute bout of exercise increases transiently AIx both in healthy subjects&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> Also in cardiovascular disease patients&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> a single bout of aerobic exercise of moderate intensity increased proximal arterial stiffness expressed by increases in carotid systolic blood pressure&#44; pulse pressure &#40;PP&#41; and PP amplification&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">If the aerobic exercise is known to acutely increase PWV&#44; central pressures and AIx&#44; less is know regarding isodynamic exercise&#46; In fact&#44; the hemodynamic parameters and energy cost in isodynamic activities has been widely described in a variety of individuals&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;24</span></a> nevertheless&#44; to our best knowledge&#44; few studies exist exploring the acute effects of exercise combining static and dynamic muscle actions on arterial stiffness&#46; This is a topic of particular interest considering that numerous tasks of daily living include isodynamic exercise&#44; such as walking with backpack carriage or with hand load carriage&#44; which combines dynamic and isometric muscle actions&#46; External load carriage has applications in physical training&#44; recreational activities&#44; and the prevention and rehabilitation of cardiovascular diseases&#46; Nonetheless&#44; the impact of walking while carrying a load on the upper limbs &#40;aerobic exercise plus upper limb isometric contractions&#41; on derived measures of central pressure and AIx is poorly understood&#46; Due to the lack of definite data regarding this particular kind of exercise&#44; it was decided to perform the present study in healthy young subjects&#46; Therefore&#44; the present study was designed to assess the impact of treadmill walking with load carriage on derived measures of central pressure and AIx in young healthy subjects&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">Fourteen healthy male volunteers &#40;age 31&#46;0 &#177; 1&#46;0 years&#44; weight 81&#46;2 &#177; 3&#46;1 kg&#44; height 174&#46;5 &#177; 1&#46;2 cm&#44; body mass index 26&#46;6 &#177; 0&#46;9 kg&#47;m<span class="elsevierStyleSup">2</span>&#41; participated in this study&#46; Participants were excluded according to the following criteria&#58; athletes&#44; smokers&#44; on any medication&#44; and previous history of hypertension&#44; renal dysfunction or any known cardiovascular or metabolic disease as assessed by medical history&#46; The local ethics committee approved the present study&#46; All participants provided written informed consent and all procedures were conducted according to the Declaration of Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedures</span><p id="par0030" class="elsevierStylePara elsevierViewall">Subjects reported to the laboratory on two occasions&#58; they were asked to walk for ten minutes on a treadmill &#40;H&#47;P&#47;Cosmos Quasar 4&#46;0 &#8211; Nussdorf&#44; Germany&#41; at a speed of 5 km&#47;h carrying no load during one session and carrying a load of 10&#37; of their body mass during the other&#46; The load was carried on both upper limbs in two water carboys with handle&#46; Both sessions were separated by one week&#44; and the order of the protocols was randomly assigned&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The walking speed of 5 km&#47;h was chosen because it is a comfortably walking speed for the majority humans&#46; The duration of the walk and the weight of extra load was set to reproduce a real life situation such as the transport of groceries from supermarket to home&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Assessment procedures for pulse wave analysis were standardized according to the recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In brief&#44; all subjects were evaluated at the same time of day in a quiet room and the temperature in the two sessions was maintained at 22<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Before sessions&#44; subjects rested seated in a quiet environment for fifteen minutes&#46; Subjects were told to avoid intense or exhaustive exercise 48 h prior to the beginning and during the study period&#46; No meal or caffeine was allowed within three hours before measurements&#46; Speaking and sleeping were not allowed during measurements&#46; The same well-trained investigator performed all procedures&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Measurements</span><p id="par0045" class="elsevierStylePara elsevierViewall">Height and weight were measured using a stadiometer and a scale&#44; respectively&#46; Body mass index was calculated as weight &#40;kg&#41; divided by height &#40;m&#41; squared&#46; Peripheral SBP and diastolic blood pressure &#40;DBP&#41; were measured using an automatic device &#40;Pressmate BP-10&#44; Colin&#44; Mediana Technologies Corporation&#44; San Antonio&#44; TX&#44; USA&#41;&#46; Patients sat down resting their right arm on a table so the brachial artery was level with the heart&#46; Two measurements were then obtained and their average was recorded&#46; If there was more than 5 mmHg of difference between the two readings&#44; one more reading was obtained for average&#46; Peripheral blood pressures were recorded before and immediately after each session&#46; Peripheral mean BP was determined as DBP&#43;&#91;&#40;SBP&#8722;DBP&#41;&#47;3&#93;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Heart rate &#40;HR&#41; was continuously measured during exercise via a telemetric system &#40;Polar Electro Oy&#44; Kempele&#44; Finland&#41;&#46; Oxygen uptake &#40;VO<span class="elsevierStyleInf">2</span>&#41; was measured during exercise using a breath-by-breath metabolic system &#40;Cosmed K4b2&#44; Cosmed&#44; Rome&#44; Italy&#41;&#46; The HR and metabolic variables were averaged at each 60-second interval and VO<span class="elsevierStyleInf">2</span> and HR at steady-state was determined for each test by manually extracting the metabolic steady-state data&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> The VO<span class="elsevierStyleInf">2</span> and HR values for each subject were obtained by averaging a minimum of three minutes of data&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Pulse wave analysis was performed at baseline &#40;after a period of 15-min rest&#41; and immediately after each exercise session using the SphygmoCor &#40;model SCOR-Px&#59; Atcor Medical&#44; Sydney&#44; Australia&#41; as previously described&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;17&#44;18</span></a> In brief&#44; subjects were seated with the forearm in supine position&#46; The pulse on the right radial artery was initially found using the index finger&#46; Then&#44; the SphygmoCor probe was applied firmly onto the right radial artery applying gentle pressure to flatten but not occlude the radial artery&#46; Once a strong and reproducible waveform was obtained&#44; the probe was kept in this position&#44; and subsequent waveforms were acquired for at least 10 seconds and saved for analysis&#46; The SphygmoCor software generated an averaged central &#40;aortic&#41; waveform&#44; which was used for the determination of aortic AIx&#46; AIx is an indicator of wave reflection&#44; expressing the degree of aortic pressure augmentation relative to central PP&#46; The software also calculated central SBP&#44; augmentation pressure&#44; mean BP&#44; aortic PP&#44; and augmentation pressure&#46; Since the AIx is affected by changes in heart rate&#44; AIx at a HR of 75 beats per min &#40;AIx&#64;75&#41; was also calculated&#46; In order to obtain high-quality waveforms and to enhance the accuracy of measurements&#44; only values whose operator index exceeded 90&#37; were used&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS version 17&#46;0 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46; The normality of data distribution was tested with the Shapiro&#8211;Wilk test&#46; Data were normally distributed and presented as means &#177; SE&#46; The paired Student t-test was used to test for differences between exercise sessions in the VO<span class="elsevierStyleInf">2</span> and HR during exercise&#46; A repeated-measures analysis of variance &#40;exercise session X time&#41; was used to analyze AIx&#64;75 bpm&#44; central and peripheral BP&#44; augmentation pressure&#44; aortic PP&#44; and augmentation pressure values&#46; When a significant interaction was observed&#44; within-group comparisons between time points and between-group comparisons at each time point were performed using Bonferroni post hoc analysis&#46; Effect size was measured using partial eta-squared&#46; p&#60;0&#46;05 was considered indicative of statistical significance&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">At rest &#40;e&#46;g&#46; before exercise sessions&#41;&#44; there were no significant differences in any of the variables assessed &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Steady-state VO<span class="elsevierStyleInf">2</span> &#40;16&#46;5 &#177; 0&#46;4 Vs&#46;13&#46;8 &#177; 0&#46;4 mL&#47;kg&#47;min&#44; p&#60;0&#46;05&#41; and HR &#40;115&#46;0 &#177; 3&#46;3 Vs&#46; 99&#46;1 &#177; 3&#46;2 beats&#47;min&#44; p&#60;0&#46;05&#41; were significantly higher during the exercise session carrying a load of 10&#37; of subjects&#8217; body weight in comparison to the session without carrying load&#46; The evolution of VO<span class="elsevierStyleInf">2</span> during each session is provided in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Both protocols increased peripheral SBP&#44; peripheral mean BP&#44; central SBP and aortic PP&#46; Although&#44; the repeated-measures ANOVA revealed a main effect of the exercise session on peripheral SBP &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;10&#46;210&#44; p&#61;0&#46;007&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;440&#93;&#44; central SBP &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;7&#46;626&#44; p&#61;0&#46;016&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;370&#93;&#44; and aortic PP &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;7&#46;150&#44; p&#61;0&#46;019&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;355&#93;&#44; indicating that the change induced by the exercise session was higher when walking carrying extra load &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; A main effect of the exercise session was also observed in the augmentation pressure &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;6&#46;811&#44; p&#61;0&#46;022&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;344&#93;&#46; Regarding AIx&#64;75 bpm &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; it was significantly elevated in comparison to baseline values only following the session carrying a load of 10&#37; of the subjects&#8217; body weight &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;6&#46;007&#44; p&#61;0&#46;029&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;316&#93;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The main finding of the present study was that a daily living task&#44; such as walking while carrying a load on the upper limbs&#44; induces an acute increase on derived measures of central pressure and AIx&#44; an index of wave reflection and arterial stiffness&#44; assessed by applanation tonometry&#46; As expected&#44; the session encompassing external load carriage produced a more intense physiologic stimulus compared to the walking without carriage session&#44; expressed by the differences in VO<span class="elsevierStyleInf">2</span> and HR during sessions&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">These results suggest that the isometric component of the upper limbs augments the arterial stiffness&#44; since only the protocol encompassing load carriage significantly increased AIx&#64;75 beats&#47;min&#46; These results are comparable with previous studies reporting increased AIx after isometric exercises&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> This increase seems to be related to the elevated sympathetic vasoconstrictor tone and circulatory arrest during isometric exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Nevertheless&#44; mean arterial pressure was similar after both sessions&#44; indicating that changes in blood pressure&#44; which is a critical variable in the evaluation of arterial stiffness and related measures per se cannot fully explain the differences observed in AIx&#64;75 beats&#47;min&#46; Lydakis et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> investigated the acute effects of isometric fatiguing handgrip on indices of central arterial stiffness&#46; Subjects performed isometric handgrip at 40&#37; of maximal voluntary contraction until they were unable to maintain that tension&#46; The authors observed a significant increase in central SBP&#44; central DBP&#44; central PP&#44; and AIx at the end of the isometric exercise&#46; It has also been reported that an acute bout of resistance exercise&#44; performed at 60&#37; of the one repetition maximum&#44; increased carotid-femoral pulse wave velocity and AIx&#64;75 beats&#47;min in young healthy men&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The increase observed in AIx&#64;75 beats&#47;min in the present study is less pronounce comparetive to that observed by Yoon<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> also in young healthy men&#46; Collier et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> compared the acute effects of resistance exercise and aerobic exercise on arterial stiffness&#46; They assessed PWV pre exercise&#44; 40 and 60 minutes post exercise and found an increase in pulse wave velocity only after resistance exercise&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The present study has some limitations&#46; It was not measured carotid-femoral pulse wave velocity&#44; also called aortic PWV&#44; which is considered the &#8220;gold standard&#8221; non-invasive measure of aortic wall stiffness&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It was used pulse wave analysis and the generalized transfer function to generate central waveforms to assess the effects of isodynamic exercise on arterial stiffness in order to reduce the time elapsing between the end of the exercise and the assessment&#44; as it is less time consuming&#46; Nevertheless&#44; Alx has been shown to be also an independent predictive value for cardiovascular events and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Additionally&#44; clinical significance of the present findings is yet to be determined&#44; since this study was conducted in healthy young adults&#46; Thus&#44; the logical consequence of the present study will be the replication of its procedures and exercise protocols in subjects with conditions elevating arterial stiffness such as hypertension&#46; This seems relevant since an inverse correlation between time to ischemia during treadmill exercise testing and arterial stiffness in coronary artery disease patients was reported&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study shows that an every day activity combining dynamic and isometric exercise&#44; such as walking while carrying a load on the upper limbs induces an acute increase on derived measures of central pressure and AIx&#44; an index of wave reflection and arterial stiffness&#44; assessed by applanation tonometry&#46; It should be emphasized that this increase was observed in young healthy male subjects&#46; Nevertheless&#44; in the absence of definitive data regarding the impact of isodynamic exercise in patients with elevated arterial stiffness&#44; caution should be used when prescribing isodynamic exercise for those where increasing afterload may increase the risk of a cardiovascular event&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical disclosures</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of human and animal subjects</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The study examined the effects of treadmill walking with load carriage on derived measures of central pressure and augmentation index in young healthy subjects&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methodology</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Fourteen male subjects &#40;age 31&#46;0 &#177; 1&#46;0 years&#41; volunteered in this study&#46; Subjects walked 10 minutes on a treadmill at a speed of 5 km&#47;h carrying no load during one session and a load of 10&#37; of their body weight on both upper limbs in two water carboys with handle during the other session&#46; Pulse wave analysis was performed at rest and immediately after exercise in the radial artery of the right upper limb by applanation tonometry&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The main result indicates that walking with load carriage sharply increased augmentation index at 75 bpm &#40;&#8722;5&#46;5 &#177; 2&#46;2 to &#8722;1&#46;4 &#177; 2&#46;2&#37; vs&#46; &#8722;5&#46;2 &#177; 2&#46;8 to &#8722;5&#46;5 &#177; 2&#46;1&#37;&#44; p&#60;0&#46;05&#41;&#44; and also induced twice as high increments in central pulse pressure &#40;7&#46;4 &#177; 1&#46;5 vs&#46; 3&#46;1 &#177; 1&#46;4 mmHg&#44; p&#60;0&#46;05&#41; and peripheral &#40;20&#46;5 &#177; 2&#46;7 vs&#46; 10&#46;3 &#177; 2&#46;5 mmHg&#44; p&#60;0&#46;05&#41; and central systolic pressure &#40;14&#46;7 &#177; 2&#46;1 vs&#46; 7&#46;4 &#177; 2&#46;0 mmHg&#44; p&#60;0&#46;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Walking with additional load of 10&#37; of their body weight &#40;aerobic exercise accompanied by upper limb isometric contraction&#41; increases derived measures of central pressure and augmentation index&#44; an index of wave reflection and arterial stiffness&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O presente estudo avaliou os efeitos de caminhar na passadeira rolante transportando uma carga adicional nos membros superiores em par&#226;metros derivados de press&#227;o central e &#237;ndice de aumenta&#231;&#227;o de jovens aparentemente saud&#225;veis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Metodologia</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">14 sujeitos do sexo masculino &#40;idade de 31&#44;0 &#177; 1&#44;0 anos&#41; participaram no estudo&#46; Os sujeitos caminharam 10 minutos na passadeira rolante a uma velocidade de 5 km&#47;h&#44; sendo que numa sess&#227;o n&#227;o transportaram carga adicional e noutra sess&#227;o transportando 10&#37; do seu peso corporal nos membros superiores em dois garraf&#245;es de &#225;gua&#46; A an&#225;lise da onda de pulso foi efetuada em repouso e imediatamente ap&#243;s o exerc&#237;cio na art&#233;ria radial do membro superior direito por tonometria de aplana&#231;&#227;o&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Os principais resultados indicam que caminhar transportando peso nos membros superiores aumenta marcadamente o &#237;ndice de aumenta&#231;&#227;o a 75 batimentos por minuto &#40;&#8722;5&#44;5 &#177; 2&#44;2 para &#8722;1&#44;4 &#177; 2&#44; 2&#37; <span class="elsevierStyleItalic">versus</span> &#8722;5&#44;2 &#177; 2&#44;8 para &#8722;5&#46;5 &#177; 2&#44;1&#37;&#44; p&#60;0&#44;05&#41;&#44; a press&#227;o de pulso central &#40;7&#44;4 &#177; 1&#44;5 <span class="elsevierStyleItalic">versus</span> 3&#44;1 &#177; 1&#44;4 mmHg&#44; p&#60;0&#44;05&#41;&#44; a press&#227;o de pulso perif&#233;rica &#40;20&#44;5 &#177; 2&#44;7 <span class="elsevierStyleItalic">versus</span> 10&#44;3 &#177; 2&#44;5 mmHg&#44; p&#60;0&#44;05&#41; e a press&#227;o sist&#243;lica central &#40;14&#44;7 &#177; 2&#44;1 <span class="elsevierStyleItalic">versus</span> 7&#44;4 &#177; 2&#44;0 mmHg&#44; p&#60;0&#44;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Caminhar transportando uma carga adicional de 10&#37; do peso corporal nos membros superiores &#40;exerc&#237;cio aer&#243;bio acompanhado de contra&#231;&#227;o isom&#233;trica dos m&#250;sculos dos membros superiores&#41; aumenta medidas derivadas da press&#227;o central e o &#237;ndice de aumenta&#231;&#227;o&#44; um &#237;ndice de reflex&#227;o da onda e rigidez arterial&#46;</p>"
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AIx&#58; augmentation index&#59; DBP&#58; diastolic blood pressure&#59; PP&#58; pulse pressure&#59; SBP&#58; systolic blood pressure&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Rest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Post&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Change&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Rest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Post&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Change&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">148&#46;3 &#177; 4&#46;3<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">20&#46;5 &#177; 2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">128&#46;0 &#177; 3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138&#46;3 &#177; 3&#46;6<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;3 &#177; 2&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;7 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;3 &#177; 1&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">7&#46;6 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">73&#46;2 &#177; 2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">77&#46;1 &#177; 1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#46;9 &#177; 1&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mean BP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">89&#46;0 &#177; 3&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">100&#46;8 &#177; 2&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8 &#177; 3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;4 &#177; 3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;1 &#177; 2&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;5 &#177; 1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&#46;8 &#177; 1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&#46;5 &#177; 2&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;7 &#177; 2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&#46;5 &#177; 2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114&#46;9 &#177; 2&#46;7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;4 &#177; 2&#46;0<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aortic PP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;2 &#177; 1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;6 &#177; 1&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;4 &#177; 1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3 &#177; 1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;4 &#177; 1&#46;4<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1 &#177; 1&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Augmentation pressure &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;1&#46;0 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8722;0&#46;3 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;7 &#177; 0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;0&#46;1 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;6 &#177; 0&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AIx&#64;75 beats&#47;min &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                      "titulo" => "Arterial stiffness predicts cardiovascular outcome in a low-to-moderate cardiovascular risk population&#58; the EDIVA &#40;Estudo de DIstensibilidade VAscular&#41; project"
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                        0 => array:2 [
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                            0 => "J&#46; Maldonado"
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Original Article
Treadmill walking with load carriage increases aortic pressure wave reflection
Caminhar na passadeira rolante com transporte de peso aumenta a reflexão da onda de pressão aórtica
Fernando Ribeiroa,b,
Autor para correspondência
, Nórton L. Oliveirab, Joana Piresb, Alberto J. Alvesb,c, José Oliveirab
a School of Health Sciences, University of Aveiro, Aveiro, Portugal
b Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
c Higher Institute of Educational Sciences, Felgueiras, Portugal
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and reduced coronary perfusion&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In fact&#44; arterial stiffness is an important factor in the balance between the myocardial blood supply and the demand&#44; with implications to myocardial work capacity impacting on exercise capacity and cardiovascular risk&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The &#8220;gold standard&#8221; non-invasive measure of aortic wall stiffness is the carotid-femoral pulse wave velocity &#40;cf-PWV&#41;&#44; also called aortic pulse wave velocity &#40;PWV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Aortic PWV has been suggested as a strong and independent predictor of cardiovascular and all-cause mortality in subjects with coronary artery disease&#44; renal disease&#44; hypertension&#44; or diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;8</span></a> Another measure related to arterial stiffness can be derived from the analysis of pulse wave in peripheral arteries&#44; such as the radial artery&#44; using applanation tonometry&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9</span></a> This noninvasive method provides an index of pulse-wave reflection and arterial stiffness&#44; called augmentation index &#40;AIx&#41;&#44; which reflects the degree of aortic pressure augmentation relative to central pulse pressure&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9</span></a> AIx denotes the difference in amplitude between incident and reflected pulse waves expressed as a percentage of pulse pressure&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Likewise aortic PWV&#44; AIx has been shown to be an independent predictor of cardiovascular events and mortality in cardiovascular patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;10&#8211;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Exercise training alone or incorporated in a cardiac rehabilitation program promotes positive effects on several aspects&#44; including endothelial dysfunction&#44; vascular wall inflammation&#44; and arterial stiffness related indexes &#40;e&#46;g&#46; aortic PWV and AIx&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;16</span></a> In contrast to chronic exercise&#44; an acute bout of exercise increases transiently AIx both in healthy subjects&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> Also in cardiovascular disease patients&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> a single bout of aerobic exercise of moderate intensity increased proximal arterial stiffness expressed by increases in carotid systolic blood pressure&#44; pulse pressure &#40;PP&#41; and PP amplification&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">If the aerobic exercise is known to acutely increase PWV&#44; central pressures and AIx&#44; less is know regarding isodynamic exercise&#46; In fact&#44; the hemodynamic parameters and energy cost in isodynamic activities has been widely described in a variety of individuals&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;24</span></a> nevertheless&#44; to our best knowledge&#44; few studies exist exploring the acute effects of exercise combining static and dynamic muscle actions on arterial stiffness&#46; This is a topic of particular interest considering that numerous tasks of daily living include isodynamic exercise&#44; such as walking with backpack carriage or with hand load carriage&#44; which combines dynamic and isometric muscle actions&#46; External load carriage has applications in physical training&#44; recreational activities&#44; and the prevention and rehabilitation of cardiovascular diseases&#46; Nonetheless&#44; the impact of walking while carrying a load on the upper limbs &#40;aerobic exercise plus upper limb isometric contractions&#41; on derived measures of central pressure and AIx is poorly understood&#46; Due to the lack of definite data regarding this particular kind of exercise&#44; it was decided to perform the present study in healthy young subjects&#46; Therefore&#44; the present study was designed to assess the impact of treadmill walking with load carriage on derived measures of central pressure and AIx in young healthy subjects&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">Fourteen healthy male volunteers &#40;age 31&#46;0 &#177; 1&#46;0 years&#44; weight 81&#46;2 &#177; 3&#46;1 kg&#44; height 174&#46;5 &#177; 1&#46;2 cm&#44; body mass index 26&#46;6 &#177; 0&#46;9 kg&#47;m<span class="elsevierStyleSup">2</span>&#41; participated in this study&#46; Participants were excluded according to the following criteria&#58; athletes&#44; smokers&#44; on any medication&#44; and previous history of hypertension&#44; renal dysfunction or any known cardiovascular or metabolic disease as assessed by medical history&#46; The local ethics committee approved the present study&#46; All participants provided written informed consent and all procedures were conducted according to the Declaration of Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedures</span><p id="par0030" class="elsevierStylePara elsevierViewall">Subjects reported to the laboratory on two occasions&#58; they were asked to walk for ten minutes on a treadmill &#40;H&#47;P&#47;Cosmos Quasar 4&#46;0 &#8211; Nussdorf&#44; Germany&#41; at a speed of 5 km&#47;h carrying no load during one session and carrying a load of 10&#37; of their body mass during the other&#46; The load was carried on both upper limbs in two water carboys with handle&#46; Both sessions were separated by one week&#44; and the order of the protocols was randomly assigned&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The walking speed of 5 km&#47;h was chosen because it is a comfortably walking speed for the majority humans&#46; The duration of the walk and the weight of extra load was set to reproduce a real life situation such as the transport of groceries from supermarket to home&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Assessment procedures for pulse wave analysis were standardized according to the recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In brief&#44; all subjects were evaluated at the same time of day in a quiet room and the temperature in the two sessions was maintained at 22<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Before sessions&#44; subjects rested seated in a quiet environment for fifteen minutes&#46; Subjects were told to avoid intense or exhaustive exercise 48 h prior to the beginning and during the study period&#46; No meal or caffeine was allowed within three hours before measurements&#46; Speaking and sleeping were not allowed during measurements&#46; The same well-trained investigator performed all procedures&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Measurements</span><p id="par0045" class="elsevierStylePara elsevierViewall">Height and weight were measured using a stadiometer and a scale&#44; respectively&#46; Body mass index was calculated as weight &#40;kg&#41; divided by height &#40;m&#41; squared&#46; Peripheral SBP and diastolic blood pressure &#40;DBP&#41; were measured using an automatic device &#40;Pressmate BP-10&#44; Colin&#44; Mediana Technologies Corporation&#44; San Antonio&#44; TX&#44; USA&#41;&#46; Patients sat down resting their right arm on a table so the brachial artery was level with the heart&#46; Two measurements were then obtained and their average was recorded&#46; If there was more than 5 mmHg of difference between the two readings&#44; one more reading was obtained for average&#46; Peripheral blood pressures were recorded before and immediately after each session&#46; Peripheral mean BP was determined as DBP&#43;&#91;&#40;SBP&#8722;DBP&#41;&#47;3&#93;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Heart rate &#40;HR&#41; was continuously measured during exercise via a telemetric system &#40;Polar Electro Oy&#44; Kempele&#44; Finland&#41;&#46; Oxygen uptake &#40;VO<span class="elsevierStyleInf">2</span>&#41; was measured during exercise using a breath-by-breath metabolic system &#40;Cosmed K4b2&#44; Cosmed&#44; Rome&#44; Italy&#41;&#46; The HR and metabolic variables were averaged at each 60-second interval and VO<span class="elsevierStyleInf">2</span> and HR at steady-state was determined for each test by manually extracting the metabolic steady-state data&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> The VO<span class="elsevierStyleInf">2</span> and HR values for each subject were obtained by averaging a minimum of three minutes of data&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Pulse wave analysis was performed at baseline &#40;after a period of 15-min rest&#41; and immediately after each exercise session using the SphygmoCor &#40;model SCOR-Px&#59; Atcor Medical&#44; Sydney&#44; Australia&#41; as previously described&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;17&#44;18</span></a> In brief&#44; subjects were seated with the forearm in supine position&#46; The pulse on the right radial artery was initially found using the index finger&#46; Then&#44; the SphygmoCor probe was applied firmly onto the right radial artery applying gentle pressure to flatten but not occlude the radial artery&#46; Once a strong and reproducible waveform was obtained&#44; the probe was kept in this position&#44; and subsequent waveforms were acquired for at least 10 seconds and saved for analysis&#46; The SphygmoCor software generated an averaged central &#40;aortic&#41; waveform&#44; which was used for the determination of aortic AIx&#46; AIx is an indicator of wave reflection&#44; expressing the degree of aortic pressure augmentation relative to central PP&#46; The software also calculated central SBP&#44; augmentation pressure&#44; mean BP&#44; aortic PP&#44; and augmentation pressure&#46; Since the AIx is affected by changes in heart rate&#44; AIx at a HR of 75 beats per min &#40;AIx&#64;75&#41; was also calculated&#46; In order to obtain high-quality waveforms and to enhance the accuracy of measurements&#44; only values whose operator index exceeded 90&#37; were used&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS version 17&#46;0 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46; The normality of data distribution was tested with the Shapiro&#8211;Wilk test&#46; Data were normally distributed and presented as means &#177; SE&#46; The paired Student t-test was used to test for differences between exercise sessions in the VO<span class="elsevierStyleInf">2</span> and HR during exercise&#46; A repeated-measures analysis of variance &#40;exercise session X time&#41; was used to analyze AIx&#64;75 bpm&#44; central and peripheral BP&#44; augmentation pressure&#44; aortic PP&#44; and augmentation pressure values&#46; When a significant interaction was observed&#44; within-group comparisons between time points and between-group comparisons at each time point were performed using Bonferroni post hoc analysis&#46; Effect size was measured using partial eta-squared&#46; p&#60;0&#46;05 was considered indicative of statistical significance&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">At rest &#40;e&#46;g&#46; before exercise sessions&#41;&#44; there were no significant differences in any of the variables assessed &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Steady-state VO<span class="elsevierStyleInf">2</span> &#40;16&#46;5 &#177; 0&#46;4 Vs&#46;13&#46;8 &#177; 0&#46;4 mL&#47;kg&#47;min&#44; p&#60;0&#46;05&#41; and HR &#40;115&#46;0 &#177; 3&#46;3 Vs&#46; 99&#46;1 &#177; 3&#46;2 beats&#47;min&#44; p&#60;0&#46;05&#41; were significantly higher during the exercise session carrying a load of 10&#37; of subjects&#8217; body weight in comparison to the session without carrying load&#46; The evolution of VO<span class="elsevierStyleInf">2</span> during each session is provided in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Both protocols increased peripheral SBP&#44; peripheral mean BP&#44; central SBP and aortic PP&#46; Although&#44; the repeated-measures ANOVA revealed a main effect of the exercise session on peripheral SBP &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;10&#46;210&#44; p&#61;0&#46;007&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;440&#93;&#44; central SBP &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;7&#46;626&#44; p&#61;0&#46;016&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;370&#93;&#44; and aortic PP &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;7&#46;150&#44; p&#61;0&#46;019&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;355&#93;&#44; indicating that the change induced by the exercise session was higher when walking carrying extra load &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; A main effect of the exercise session was also observed in the augmentation pressure &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;6&#46;811&#44; p&#61;0&#46;022&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;344&#93;&#46; Regarding AIx&#64;75 bpm &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; it was significantly elevated in comparison to baseline values only following the session carrying a load of 10&#37; of the subjects&#8217; body weight &#91;F<span class="elsevierStyleInf">&#40;1&#44;13&#41;</span>&#61;6&#46;007&#44; p&#61;0&#46;029&#44; &#951;<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">p</span>&#61;0&#46;316&#93;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The main finding of the present study was that a daily living task&#44; such as walking while carrying a load on the upper limbs&#44; induces an acute increase on derived measures of central pressure and AIx&#44; an index of wave reflection and arterial stiffness&#44; assessed by applanation tonometry&#46; As expected&#44; the session encompassing external load carriage produced a more intense physiologic stimulus compared to the walking without carriage session&#44; expressed by the differences in VO<span class="elsevierStyleInf">2</span> and HR during sessions&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">These results suggest that the isometric component of the upper limbs augments the arterial stiffness&#44; since only the protocol encompassing load carriage significantly increased AIx&#64;75 beats&#47;min&#46; These results are comparable with previous studies reporting increased AIx after isometric exercises&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> This increase seems to be related to the elevated sympathetic vasoconstrictor tone and circulatory arrest during isometric exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Nevertheless&#44; mean arterial pressure was similar after both sessions&#44; indicating that changes in blood pressure&#44; which is a critical variable in the evaluation of arterial stiffness and related measures per se cannot fully explain the differences observed in AIx&#64;75 beats&#47;min&#46; Lydakis et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> investigated the acute effects of isometric fatiguing handgrip on indices of central arterial stiffness&#46; Subjects performed isometric handgrip at 40&#37; of maximal voluntary contraction until they were unable to maintain that tension&#46; The authors observed a significant increase in central SBP&#44; central DBP&#44; central PP&#44; and AIx at the end of the isometric exercise&#46; It has also been reported that an acute bout of resistance exercise&#44; performed at 60&#37; of the one repetition maximum&#44; increased carotid-femoral pulse wave velocity and AIx&#64;75 beats&#47;min in young healthy men&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The increase observed in AIx&#64;75 beats&#47;min in the present study is less pronounce comparetive to that observed by Yoon<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> also in young healthy men&#46; Collier et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> compared the acute effects of resistance exercise and aerobic exercise on arterial stiffness&#46; They assessed PWV pre exercise&#44; 40 and 60 minutes post exercise and found an increase in pulse wave velocity only after resistance exercise&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The present study has some limitations&#46; It was not measured carotid-femoral pulse wave velocity&#44; also called aortic PWV&#44; which is considered the &#8220;gold standard&#8221; non-invasive measure of aortic wall stiffness&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It was used pulse wave analysis and the generalized transfer function to generate central waveforms to assess the effects of isodynamic exercise on arterial stiffness in order to reduce the time elapsing between the end of the exercise and the assessment&#44; as it is less time consuming&#46; Nevertheless&#44; Alx has been shown to be also an independent predictive value for cardiovascular events and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Additionally&#44; clinical significance of the present findings is yet to be determined&#44; since this study was conducted in healthy young adults&#46; Thus&#44; the logical consequence of the present study will be the replication of its procedures and exercise protocols in subjects with conditions elevating arterial stiffness such as hypertension&#46; This seems relevant since an inverse correlation between time to ischemia during treadmill exercise testing and arterial stiffness in coronary artery disease patients was reported&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study shows that an every day activity combining dynamic and isometric exercise&#44; such as walking while carrying a load on the upper limbs induces an acute increase on derived measures of central pressure and AIx&#44; an index of wave reflection and arterial stiffness&#44; assessed by applanation tonometry&#46; It should be emphasized that this increase was observed in young healthy male subjects&#46; Nevertheless&#44; in the absence of definitive data regarding the impact of isodynamic exercise in patients with elevated arterial stiffness&#44; caution should be used when prescribing isodynamic exercise for those where increasing afterload may increase the risk of a cardiovascular event&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical disclosures</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of human and animal subjects</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The study examined the effects of treadmill walking with load carriage on derived measures of central pressure and augmentation index in young healthy subjects&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methodology</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Fourteen male subjects &#40;age 31&#46;0 &#177; 1&#46;0 years&#41; volunteered in this study&#46; Subjects walked 10 minutes on a treadmill at a speed of 5 km&#47;h carrying no load during one session and a load of 10&#37; of their body weight on both upper limbs in two water carboys with handle during the other session&#46; Pulse wave analysis was performed at rest and immediately after exercise in the radial artery of the right upper limb by applanation tonometry&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The main result indicates that walking with load carriage sharply increased augmentation index at 75 bpm &#40;&#8722;5&#46;5 &#177; 2&#46;2 to &#8722;1&#46;4 &#177; 2&#46;2&#37; vs&#46; &#8722;5&#46;2 &#177; 2&#46;8 to &#8722;5&#46;5 &#177; 2&#46;1&#37;&#44; p&#60;0&#46;05&#41;&#44; and also induced twice as high increments in central pulse pressure &#40;7&#46;4 &#177; 1&#46;5 vs&#46; 3&#46;1 &#177; 1&#46;4 mmHg&#44; p&#60;0&#46;05&#41; and peripheral &#40;20&#46;5 &#177; 2&#46;7 vs&#46; 10&#46;3 &#177; 2&#46;5 mmHg&#44; p&#60;0&#46;05&#41; and central systolic pressure &#40;14&#46;7 &#177; 2&#46;1 vs&#46; 7&#46;4 &#177; 2&#46;0 mmHg&#44; p&#60;0&#46;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Walking with additional load of 10&#37; of their body weight &#40;aerobic exercise accompanied by upper limb isometric contraction&#41; increases derived measures of central pressure and augmentation index&#44; an index of wave reflection and arterial stiffness&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O presente estudo avaliou os efeitos de caminhar na passadeira rolante transportando uma carga adicional nos membros superiores em par&#226;metros derivados de press&#227;o central e &#237;ndice de aumenta&#231;&#227;o de jovens aparentemente saud&#225;veis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Metodologia</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">14 sujeitos do sexo masculino &#40;idade de 31&#44;0 &#177; 1&#44;0 anos&#41; participaram no estudo&#46; Os sujeitos caminharam 10 minutos na passadeira rolante a uma velocidade de 5 km&#47;h&#44; sendo que numa sess&#227;o n&#227;o transportaram carga adicional e noutra sess&#227;o transportando 10&#37; do seu peso corporal nos membros superiores em dois garraf&#245;es de &#225;gua&#46; A an&#225;lise da onda de pulso foi efetuada em repouso e imediatamente ap&#243;s o exerc&#237;cio na art&#233;ria radial do membro superior direito por tonometria de aplana&#231;&#227;o&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Os principais resultados indicam que caminhar transportando peso nos membros superiores aumenta marcadamente o &#237;ndice de aumenta&#231;&#227;o a 75 batimentos por minuto &#40;&#8722;5&#44;5 &#177; 2&#44;2 para &#8722;1&#44;4 &#177; 2&#44; 2&#37; <span class="elsevierStyleItalic">versus</span> &#8722;5&#44;2 &#177; 2&#44;8 para &#8722;5&#46;5 &#177; 2&#44;1&#37;&#44; p&#60;0&#44;05&#41;&#44; a press&#227;o de pulso central &#40;7&#44;4 &#177; 1&#44;5 <span class="elsevierStyleItalic">versus</span> 3&#44;1 &#177; 1&#44;4 mmHg&#44; p&#60;0&#44;05&#41;&#44; a press&#227;o de pulso perif&#233;rica &#40;20&#44;5 &#177; 2&#44;7 <span class="elsevierStyleItalic">versus</span> 10&#44;3 &#177; 2&#44;5 mmHg&#44; p&#60;0&#44;05&#41; e a press&#227;o sist&#243;lica central &#40;14&#44;7 &#177; 2&#44;1 <span class="elsevierStyleItalic">versus</span> 7&#44;4 &#177; 2&#44;0 mmHg&#44; p&#60;0&#44;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Caminhar transportando uma carga adicional de 10&#37; do peso corporal nos membros superiores &#40;exerc&#237;cio aer&#243;bio acompanhado de contra&#231;&#227;o isom&#233;trica dos m&#250;sculos dos membros superiores&#41; aumenta medidas derivadas da press&#227;o central e o &#237;ndice de aumenta&#231;&#227;o&#44; um &#237;ndice de reflex&#227;o da onda e rigidez arterial&#46;</p>"
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AIx&#58; augmentation index&#59; DBP&#58; diastolic blood pressure&#59; PP&#58; pulse pressure&#59; SBP&#58; systolic blood pressure&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Rest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Post&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Change&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Rest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Post&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Change&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">148&#46;3 &#177; 4&#46;3<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">20&#46;5 &#177; 2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">128&#46;0 &#177; 3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138&#46;3 &#177; 3&#46;6<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;3 &#177; 2&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;7 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;3 &#177; 1&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">7&#46;6 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">73&#46;2 &#177; 2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">77&#46;1 &#177; 1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#46;9 &#177; 1&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mean BP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">89&#46;0 &#177; 3&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">100&#46;8 &#177; 2&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8 &#177; 3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;4 &#177; 3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;1 &#177; 2&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;5 &#177; 1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&#46;8 &#177; 1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&#46;5 &#177; 2&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;7 &#177; 2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&#46;5 &#177; 2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114&#46;9 &#177; 2&#46;7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;4 &#177; 2&#46;0<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aortic PP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;2 &#177; 1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;6 &#177; 1&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;4 &#177; 1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3 &#177; 1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;4 &#177; 1&#46;4<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1 &#177; 1&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Augmentation pressure &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;1&#46;0 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8722;0&#46;3 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;7 &#177; 0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;0&#46;1 &#177; 1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;6 &#177; 0&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AIx&#64;75 beats&#47;min &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                      "titulo" => "Arterial stiffness predicts cardiovascular outcome in a low-to-moderate cardiovascular risk population&#58; the EDIVA &#40;Estudo de DIstensibilidade VAscular&#41; project"
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                        0 => array:2 [
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                            0 => "J&#46; Maldonado"
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2023 Fevereiro 83 20 103
2023 Janeiro 18 14 32
2022 Dezembro 57 22 79
2022 Novembro 55 32 87
2022 Outubro 39 14 53
2022 Setembro 29 58 87
2022 Agosto 49 31 80
2022 Julho 41 34 75
2022 Junho 20 32 52
2022 Maio 24 36 60
2022 Abril 30 30 60
2022 Maro 41 44 85
2022 Fevereiro 24 20 44
2022 Janeiro 24 25 49
2021 Dezembro 18 32 50
2021 Novembro 29 29 58
2021 Outubro 26 36 62
2021 Setembro 31 33 64
2021 Agosto 26 33 59
2021 Julho 37 27 64
2021 Junho 31 11 42
2021 Maio 33 23 56
2021 Abril 61 36 97
2021 Maro 54 20 74
2021 Fevereiro 66 19 85
2021 Janeiro 53 8 61
2020 Dezembro 26 8 34
2020 Novembro 35 11 46
2020 Outubro 24 14 38
2020 Setembro 54 25 79
2020 Agosto 18 6 24
2020 Julho 38 6 44
2020 Junho 33 6 39
2020 Maio 41 8 49
2020 Abril 38 6 44
2020 Maro 39 8 47
2020 Fevereiro 99 40 139
2020 Janeiro 40 5 45
2019 Dezembro 28 11 39
2019 Novembro 28 4 32
2019 Outubro 40 3 43
2019 Setembro 25 5 30
2019 Agosto 20 7 27
2019 Julho 47 12 59
2019 Junho 28 11 39
2019 Maio 44 14 58
2019 Abril 23 19 42
2019 Maro 48 12 60
2019 Fevereiro 58 10 68
2019 Janeiro 46 8 54
2018 Dezembro 72 10 82
2018 Novembro 154 19 173
2018 Outubro 350 10 360
2018 Setembro 109 12 121
2018 Agosto 46 15 61
2018 Julho 53 2 55
2018 Junho 88 7 95
2018 Maio 149 8 157
2018 Abril 135 4 139
2018 Maro 144 13 157
2018 Fevereiro 94 7 101
2018 Janeiro 39 18 57
2017 Dezembro 129 13 142
2017 Novembro 46 13 59
2017 Outubro 25 8 33
2017 Setembro 46 15 61
2017 Agosto 54 13 67
2017 Julho 35 9 44
2017 Junho 46 14 60
2017 Maio 29 11 40
2017 Abril 8 40 48
2017 Maro 16 25 41
2017 Fevereiro 16 6 22
2017 Janeiro 29 3 32
2016 Dezembro 19 6 25
2016 Novembro 22 6 28
2016 Outubro 40 5 45
2016 Setembro 11 5 16
2016 Agosto 8 3 11
2016 Julho 8 6 14
2016 Junho 2 6 8
2016 Maio 27 5 32
2016 Abril 29 2 31
2016 Maro 43 15 58
2016 Fevereiro 49 19 68
2016 Janeiro 32 8 40
2015 Dezembro 40 13 53
2015 Novembro 29 8 37
2015 Outubro 44 9 53
2015 Setembro 40 12 52
2015 Agosto 36 9 45
2015 Julho 38 5 43
2015 Junho 28 8 36
2015 Maio 36 15 51
2015 Abril 40 7 47
2015 Maro 16 13 29
2015 Fevereiro 31 12 43
2015 Janeiro 23 10 33
2014 Dezembro 37 21 58
2014 Novembro 35 10 45
2014 Outubro 79 23 102
2014 Setembro 84 45 129
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