Daily ambulatory activity monitoring in patients with peripheral artery disease

Abstract

Background: Peripheral artery disease (PAD) is characterized by arterial lesions of the lower extremities. Patients with PAD present ambulatory dysfunction due to intermittent claudication, limiting daily physical activity and increasing morbidity. Therefore, objectively measured daily ambulation is a clinically relevant outcome in these patients. Objective: To quantify daily ambulation with a step activity monitor (Step Watch 3 TM ; Cyma Inc., Mountlake Terrace, WA, USA) in patients with PAD. Major findings: Patients with claudication ambulate less each day than controls, as they take 1081 fewer strides (1 stride52 steps) and spend 48 fewer minutes ambulating each day. The cadence obtained during endurance ambulation (maximum cadences for 60, 30, and 20 continuous minutes of ambulation) and short bouts of ambulation (maximum cadence for continuous minutes of ambulation and for the minute having the single highest cadence value each day) is also lower in patients. Demographic factors and comorbid conditions, particularly sex, dyslipidemia, abdominal obesity, and the number of components of metabolic syndrome, affect the ambulatory activity patterns of patients with claudication. Conclusions: Patients with claudication perform a lower amount of daily ambulatory activities and lower intense physical activities than controls, which is impaired further by comorbid conditions. The clinical implication is that patients with claudication should not only be advised to walk more during each day, but to do so at a cadence that is higher than their self-selected slower cadence. This approach will increase total daily exercise volume by increasing both the duration as well as the intensity of ambulation.

Barriers to Physical Activity in Patients with Intermittent Claudication

“…Previous studies in subjects without PAD have shown that more advanced age is associated with lower levels of physical activity, which have been attributed to changes in lifestyle after retirement, and the occurrence of comorbid conditions [32][33][34]. Studies in IC patients have suggested that those with comorbid conditions such as diabetes, ischemic heart disease, hypertension, and hyperlipidemia have low levels of physical activity [9,35,36]. The present study corroborates these results, since physical activity was negatively associated with diabetes and hypertension.…”

“…In response to these causes, a recent review reported that walking capacity and comorbid conditions are associated with low levels of physical activity in IC patients [9]. Furthermore, studies in other populations, such as diabetics and patients with comorbid musculoskeletal pain and depression, have shown an inverse relationship between physical activity levels and personal [12,13] and environmental barriers [14,15], such as lack of time, lack of motivation, low income, lack of places to perform physical activity, and poor weather conditions [16].…”

“…Unsupervised physical activity programs were created for IC patients, as a way of increasing physical activity and improving walking capacity, physical fitness, and quality of life [7,9], However, many patients with IC remain poorly active and with low engagement in these programs [10]. In a recent study, adherence to an unsupervised training program involving walking was, at the end of a 3-month follow-up, only 16 % in patients with IC [11].…”

Physical Activity Levels in Peripheral Artery Disease Patients

“…The ABI, considered one of the best prognostic indexes in PAD, 22 and walking capacity, a main clinical marker of PAD associated with endothelial function 23 inflammation 24 and several clinical indicators, 2,25 were not associated with the meeting of physical activity recommendations. These results are not surprising, since ABI 26 and walking capacity have been poorly associated with physical activity in patients with PAD. 27…”

Physical activity monitors: clinical and research applications

“…For example, Shephard and Aoyagi 2 suggest that the minimum habitual physical activity level for elderly individuals to maintain health may be substantially less than that inferred from self-report measures. Gardner et al 3 reviewed objective physical activity data in patients with peripheral arterial disease and concluded that not only are these patients deficient in the volume of activity they take, but that they should be encouraged to walk at a faster cadence (i.e. steps/minute).…”