Lower Extremity Performance Is Associated with Daily Life Physical Activity in Individuals with and without Peripheral Arterial Disease

McDermott, Mary M.; Greenland, Philip; Ferrucci, Luigi; Criqui, Michael H.; Liu, Kiang; Sharma, Leena; Chan, Cheeling; Celic, Lillian; Priyanath, Aparna; Guralnik, Jack M.

doi:10.1046/j.1532-5415.2002.50055.x

Cited by 75 publications

(66 citation statements)

References 30 publications

(60 reference statements)

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“…The present study corroborates these results, since physical activity was negatively associated with diabetes and hypertension. The association between physical activity and walking capacity concurs with previous studies that reported lower levels of physical activity in patients with poor walking capacity [3,19,37]. It has been hypothesized that patients with poor walking capacity present claudication symptoms earlier and at a lower intensity, and they cut down on physical activity in order to avoid these symptoms.…”

Section: Discussionsupporting

confidence: 82%

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Barriers to Physical Activity in Patients with Intermittent Claudication

et al. 2014

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Section: Discussionsupporting

confidence: 82%

“…In Brazil, PAD affects 21.6 % of the elderly population [2]. A common symptom of PAD is intermittent claudication (IC) that leads to impaired walking ability [3] and reduced quality of life [4]. Claudication symptoms reduce the level of physical activity [5][6][7], and PAD is associated with an increased risk of mortality [8].…”

Section: Introductionmentioning

confidence: 99%

Barriers to Physical Activity in Patients with Intermittent Claudication

et al. 2014

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“…Previous studies demonstrate that better performance on objective measures of lower extremity functioning is associated with higher physical activity levels and lower rates of mobility loss in persons with PAD (16,17). Higher levels of physical activity are associated with lower mortality in persons with PAD (12).…”

Section: Discussionmentioning

confidence: 96%

Prognostic Value of Functional Performance for Mortality in Patients With Peripheral Artery Disease

McDermott¹,

Tian²,

Liu³

et al. 2008

Journal of the American College of Cardiology

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140

157

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“…21 This exercise limitation is associated with marked impairments in daily physical activity as assessed by questionnaire and daily energy expenditure. 24,25 Patients with PAD also have an accelerated functional decline over time that is related to the underlying hemodynamic severity of the disease in the leg. 26 The primary treatment goal for all patients with PAD is cardiovascular risk reduction, whereas on the basis of the above considerations, an additional goal is to improve exercise performance, daily functional activity, and quality of life.…”

Section: Severity Of the Exercise Impairmentmentioning

confidence: 99%

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Hiatt¹,

Armstrong²,

Larson³

et al. 2015

Circulation Research

127

118

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P eripheral artery disease (PAD) is initiated by atherogenic mechanisms common to all major vascular territories but encompasses several distinctly important clinical sequelae.1 The global burden of PAD is large and rising, with substantial morbidity and mortality found in high-, middle-, and low-income countries. 2 The atherosclerotic occlusive disease underlying PAD is associated with an exercise limitation in the majority of patients, whereas the classic symptoms of intermittent claudication, ischemic rest pain, and ischemic ulceration are less common manifestations. 3 Patients with PAD are also at increased risk of myocardial infarction, ischemic stroke, heart failure, renovascular hypertension, and vascular death reflecting the systemic atherosclerotic burden. [4][5][6] The epidemiology of Peripheral Artery Disease Compendium© 2015 American Heart Association, Inc. The diagnosis of PAD can be ascertained by simple hemodynamic measurements, in particular, the ankle-brachial index (ABI), a test performed by measuring the systolic blood pressure in each arm and the dorsalis pedis and posterior tibial arteries of each ankle. The highest of the dorsalis pedis or posterior tibial artery pressures is the numerator of the ABI specific to each leg, whereas the highest arm pressure on either side is the denominator. A ratio of <0.90 in either leg is considered hemodynamic evidence of PAD. 16 When imaged, PAD can be characterized as one or more arterial stenoses or occlusions involving the distal aorta, iliac, femoral, popliteal, or tibial arteries. 17The underlying mechanisms responsible for the functional limitations in PAD are hemodynamic in origin, which affects the supply of oxygen and substrates to metabolically active tissue: skeletal muscle in the case of intermittent claudication and skin and subcutaneous tissues in the case of critical leg ischemia. However, additional pathophysiologic mechanisms contribute to the limb manifestations, where a reduction in blood flow alone does not fully account for the exercise limitation. Recent research into the pathophysiology of this exercise limitation has identified several important sequelae resultant from the chronic hemodynamic deficit. These changes affecting the vasculature and skeletal muscle distal to the primary hemodynamic lesions likely contribute to the mechanisms of exercise limitation in PAD. These advances are reviewed here with an additional focus on identifying possible future therapeutic strategies. Symptomatic Manifestations and Exercise Limitations in PADIn the coronary circulation, plaque rupture leading to acute ischemic events is a common clinical presentation; in PAD, progressive atherosclerosis leading to chronic stenosis and occlusion, often in series, in the arteries supplying the lower extremities dominates the symptomatic manifestations.6 Limb SymptomsPatients with PAD may present with a range of limb symptoms. Most patients are either asymptomatic or have atypical limb symptoms during exercise, whereas only a third have typical symptoms of c...

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Lower Extremity Performance Is Associated with Daily Life Physical Activity in Individuals with and without Peripheral Arterial Disease

Cited by 75 publications

References 30 publications

Barriers to Physical Activity in Patients with Intermittent Claudication

Barriers to Physical Activity in Patients with Intermittent Claudication

Prognostic Value of Functional Performance for Mortality in Patients With Peripheral Artery Disease

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

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