Introduction Peripheral arterial disease (PAD) is a marker of cardiovascular morbidity, causing disability, loss of mobility and poor quality of life, manifesting clinically in the form of intermittent claudication (IC). Physical exercise increases the distance walked and improves quality of life. The aim of our study will be increased walking distance prolonging the time of onset of pain in patients with symptomatic PAD (IC).
Methods and analysis This study will be performed in Mataro Hospital’s vascular surgery service and School of Health Sciences, TecnoCampus. This population comes from 15 primary healthcare centres of North Barcelona, Spain (450 000 inhabitants).
This study will be a four-group parallel, longitudinal, randomised controlled trial, blind to analysis. The main primary outcome of this study will be the improvement in pain-free walking distance. Others primary objectives are and improvement in functional status, quality of life and Ankle-Brachial Index (ABI). Secondary outcomes will be the analysis of cardiorespiratory fitness, evaluation of muscle fitness, determine the maintenance of primary objectives at 6 and 12 months. We will be included 124 patients (31 per group). The changes of the outcome (Barthel, SF-12, VascQOL-6, ABI) of the three intervention groups vs the control group at 3, 6 and 12 months will be compared, both continuously (linear regression) and categorically (logistic regression). A person who has not performed at least 75% of the training will be considered to have not completed the intervention.
Ethics and dissemination The study will be conducted according to the Declaration of Helsinki. It was approved by the Ethics Committee of the Research Institute Primary Health IDIAP Jordi Gol (20/035 P), Barcelona 6 October 2020. Informed consent will be obtained from all patients before the start of the study. We will disseminate results through academic papers and conference presentations.

The Frail-VIG index and the Braden scale are validated instruments for assessing frailty and the risk of developing dependency-related skin lesions respectively. The Frail-VIG index is a multidimensional instrument that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. OBJECTIVE: Our aim was to investigate the convergent and discriminative validity of the Frail-VIG index with regard to Braden scale value. METHODS: We carried out a cross-sectional study in 2 primary health care centres of the Catalan Institute of Health, Barcelona (Spain). Participants in the study were all people included under a home care programme during the year 2018. No exclusion criteria were applied. We used the Frail-VIG index to measure frailty and the Braden scale to measure the risk of developing pressure ulcers. Trained nurses administered both instruments during face-to-face assessments in a participant’s home during usual care. The relationships between both instruments were examined using Pearson’s correlation coefficient. RESULTS: Four hundred and twelve participants were included. Frail-VIG score and Braden scale value were negatively correlated (r=-0.597; P<.0001). Non-frail people had a lower risk of developing dependency-related skin lesions than moderate to severe frail people. The Braden scale value declined significantly as the Frail-VIG index score increased. CONCLUSIONS: Frail-VIG index demonstrated a convergent validity with the Braden scale. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with a higher and lower risk of developing. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.

Thyroid hormones may be a risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis. The aim of this study is to investigate the relationship between thyroid stimulating hormone (TSH) levels, NAFLD, and liver fibrosis in the general population. A descriptive cross-sectional study was performed in subjects aged 18-75 years randomly selected from primary care centers between 2012 and 2016. Each subject underwent clinical evaluation, physical examination, blood tests and transient elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with NAFLD and fibrosis. We included 2452 subjects (54 +/- 12 years; 61% female). Subjects with TSH >= 2.5 mu IU/mL were significantly associated with obesity, atherogenic dyslipidemia, metabolic syndrome (MetS), hypertransaminasemia and altered cholesterol and triglycerides. The prevalence of NAFLD and liver fibrosis was significantly higher in subjects with TSH >= 2.5 (mu IU/mL). We found a 1.5 times increased risk of NAFLD, 1.8 and 2.3 times increased risk of liver fibrosis for cut-off points of >= 8.0 kPa and >= 9.2 kPa, respectively, in subjects with TSH >= 2.5 mu IU/mL compared with TSH < 2.5 mu IU/mL (control group), independent of the presence of MetS. These findings remained significant when stratifying TSH, with values >= 10 mu IU/mL.

Alterations in thyroid function may contribute to the development of liver fibrosis especially in subjects with non-alcoholic fatty liver disease. This study aimed to investigate the risk of liver fibrosis according to low-normal thyroid function in the general population. We performed a descriptive cross-sectional study in subjects from 18-75 years randomly selected from 16 primary health care centers from 2017-2019. Each subject underwent clinical evaluation, physical examination, blood analysis and transient hepatic elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with fibrosis. We included 1096 subjects (60 +/- 11 years; 61% women); 70% had strict-normal thyroid function and 30% had low-normal thyroid function. Low-normal thyroid function was associated with a higher liver stiffness (LS) values: 5.2 vs. 4.8 kPa (p = 0.001) and a greater prevalence of fibrosis: 6.1 vs. 3% (p = 0.016) and 4.3 vs. 2.1% (p = 0.044) for the cut-off points of >= 8.0 kPa and >= 9.2 kPa, respectively. After adjustment for potential confounding factors, the risk of fibrosis in subjects with low-normal thyroid function was OR 1.54 (p = 0.213). In conclusion, low-normal thyroid function is associated with higher LS values and a greater risk of liver fibrosis in the general population, being dependent on other metabolic factors.