Association between physical activity level and ankle-branchial index in patients with risk factors of peripheral arterial disease

Hanna Agnieszka Juchniewicz, Anna Lubkowska



Introduction: Peripheral arterial disease (PAD) causes a three-fold increase in risk of mortality and major cardiovascular events. PAD is typically diagnosed with ankle-branchial index (ABI) ≤0.90. World Health Organization recommends to address behavioural risk factors to prevent further burden of cardiovascular diseases. Purpose: The aim of this study was to examine correlation between physical activity level and ABI among patients with risk factors of PAD and ABI in normal range or ABI indicating some or moderate arterial disease. Methods: 71 patients who were over 65 years old and had minimum of two additional PAD risk factors were recruited. Physical activity level was measured by International Physical Activity Questionnaire, walking ability was assessed by 6-minute Walking Test (6MWT). Results: Mean ABI was in normal range (1.08, SD 0.15). Mean Body Mass Index of the group indicated obesity (30.6, SD 5.5 kg/m2). Among modifiable PAD risk factors, hypertension and dyslipidaemia were the most prevalent. Most of the participants (62%) were moderately active. Mean total physical activity was 5310.2 MET-min per week. The average person has been sitting for around 5 hours per day. The mean result of 6MWT was 432.2 meters (SD 103.4). Following correlations were observed: between total physical activity level and ABI (r=0.17), between walking ability and ABI (r=0.39), sitting time and ABI (r=-0.32). Conclusions: older people with PAD risk factors could benefit from everyday walking and housework. Incorporating walking while transportation can exert PAD prevention effect. Sitting time should be avoided. These recommendations apply not only for patients with some or moderate PAD, but also for older individuals with normal range ABI, but with PAD risk factors.


cardiovascular diseases; peripheral artery disease; physical activity; preventive medicine; walking

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WHO. Cardiovascular diseases (CVDs) [updated 17.05.2017. Available from:

Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329-40.

Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, Chambless LE, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. Jama. 2008;300(2):197-208.

Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. Jama. 2001;286(11):1317-24.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33 Suppl 1:S1-75.

Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(14):1555-70.

Lyu X, Li S, Peng S, Cai H, Liu G, Ran X. Intensive walking exercise for lower extremity peripheral arterial disease: A systematic review and meta-analysis. J Diabetes. 2016;8(3):363-77.

Hagstromer M, Oja P, Sjostrom M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr. 2006;9(6):755-62.

Erratum: ATS Statement: Guidelines for the Six-Minute Walk Test. Am J Respir Crit Care Med. 2016;193(10):1185.

Bellet RN, Adams L, Morris NR. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness--a systematic review. Physiotherapy. 2012;98(4):277-86.

Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004;110(6):738-43.

Markanday S, Brennan S, Gould H, Pasco J. Sex-differences in Reasons for Non-Participation at Recruitment: Geelong Osteoporosis Study. BMC research notes. 2013;6.

Organisation WH. Obesity and overweight [updated 16.02.2018. Available from:

WHO. Obesity: Data and statistics [Available from:

Hales C, Fryar C, Carroll M, Freedman D, Ogden C. Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016. JAMA. 2018;319(16).

Pasco J, Holloway K, Dobbins A, Kotowicz M, Williams L, Brennan S. Body Mass Index and Measures of Body Fat for Defining Obesity and Underweight: A Cross-Sectional, Population-Based Study. BMC obesity. 2014;1.

NHLBI. Managing Overweight and Obesity in Adults: Systematic Evidence Review from the Obesity Expert Panel 2013. Available from:

Nishida C, Ko G, Kumanyika S. Body Fat Distribution and Noncommunicable Diseases in Populations: Overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist-Hip Ratio. European journal of clinical nutrition. 2010;64(1).

Chang C, Huang K, Chan D, Wu C, Lin C, Hsiung C, et al. The Impacts of Sarcopenia and Obesity on Physical Performance in the Elderly. Obesity research & clinical practice. 2015;9(3).

Cassar K, Bachoo P, Ford I, Greaves M, Brittenden J. Markers of Coagulation Activation, Endothelial Stimulation and Inflammation in Patients With Peripheral Arterial Disease. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2005;29(2).

Zhang X, Devlin H, Smith B, Imperatore G, Thomas W, Lobelo F, et al. Effect of Lifestyle Interventions on Cardiovascular Risk Factors Among Adults Without Impaired Glucose Tolerance or Diabetes: A Systematic Review and Meta-Analysis. PloS one. 2017;12(5).

Johnson S, Eurich D, Lytvyak E, Mladenovic A, Taylor L, Johnson J, et al. Walking and Type 2 Diabetes Risk Using CANRISK Scores Among Older Adults. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2017;42(1).

Parmenter B, Dieberg G, Phipps G, Smart N. Exercise Training for Health-Related Quality of Life in Peripheral Artery Disease: A Systematic Review and Meta-Analysis. Vascular medicine (London, England). 2015;20(1).

Dopheide J, Rubrech J, Trumpp A, Geissler P, Zeller G, Schnorbus B, et al. Supervised Exercise Training in Peripheral Arterial Disease Increases Vascular Shear Stress and Profunda Femoral Artery Diameter. European journal of preventive cardiology. 2017;24(2).

Gardner A, Parker D, Montgomery P, Scott K, Blevins S. Efficacy of Quantified Home-Based Exercise and Supervised Exercise in Patients With Intermittent Claudication: A Randomized Controlled Trial. Circulation. 2011;123(5).

Laufs U, Werner N, Link A, Endres M, Wassmann S, Jürgens K, et al. Physical Training Increases Endothelial Progenitor Cells, Inhibits Neointima Formation, and Enhances Angiogenesis. Circulation. 2004;109(2).

Hamburg N, Balady G. Exercise Rehabilitation in Peripheral Artery Disease: Functional Impact and Mechanisms of Benefits. Circulation. 2011;123(1).

Parsons T, Sartini C, Ellins E, Halcox J, Smith K, Ash S, et al. Objectively Measured Physical Activity and Sedentary Behaviour and Ankle Brachial Index: Cross-sectional and Longitudinal Associations in Older Men. Atherosclerosis. 2016;247.

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