Factors predicting walking tolerance in patients with peripheral vascular disease

Parr, Bridget M; Derman, Wayne; Noakes, Timothy D.

doi:10.1016/j.jsams.2008.12.133

Cited by 15 publications

(28 citation statements)

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“…13 However, other studies found no association between ABI and walking distance. [14][15][16][17] In this study, caffeine increased MWD by 20% and PWD by 25% in the nonoperated patients. In a systematic review of drug therapy to PAD patients, cilostazol, naftidrofuryl oxalate, and pentoxifylline increased MWD and PWD by 25% and 13%, 60% and 49%, and 11% and 9%, respectively.…”

Section: Discussionsupporting

confidence: 53%

The Effect of Caffeine in Patients with Intermittent Claudication Was Independent of the Degree of Peripheral Ischemia—A Secondary Analysis of a Randomized Clinical Trial

GuptaParul

MomsenAnne-Mette

NoragerCharlotte

et al. 2015

Journal of Caffeine Research

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Background: Caffeine intake increases walking endurance in patients with peripheral arterial disease (PAD). This study evaluated whether the caffeine effect was correlated with the degree of PAD and whether revascularization affected the walking endurance enhancing effect following caffeine. Patients and methods: We used data from a previously reported randomized crossover study of 83 outpatients with intermittent claudication. Patients received placebo and caffeine at an interval of 1 week and undertook a treadmill test to measure pain-free walking distance (PWD) and maximum walking distance (MWD). This was repeated 3 months later in 47 nonoperatively treated patients and 36 patients who underwent revascularization. The degree of PAD was estimated by ankle-brachial index (ABI). Data were analyzed using a mixed model with subject-specific random intercepts. Results: For MWD, the correlation between caffeine effect and ABI was a mean [95% confidence interval; CI] of -0.14 [CI -0.71-0.44], and for PWD it was -0.02 [CI -0.75-0.70]. Caffeine increased MWD by 20% [CI 7-32] and 15% [CI -0.04-29] in nonoperative and operative patients, respectively. This difference in caffeine effect between nonoperative and operative patients was not significant ( p = 0.6). Similarly, the difference in caffeine effect on PWD between the nonoperative and operative group was not statistically significant ( p = 0.12). Conclusions: The walking-enhancing effect of caffeine was not significantly associated with the severity of PAD.

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Section: Discussionsupporting

confidence: 53%

The Effect of Caffeine in Patients with Intermittent Claudication Was Independent of the Degree of Peripheral Ischemia—A Secondary Analysis of a Randomized Clinical Trial

GuptaParul

MomsenAnne-Mette

NoragerCharlotte

et al. 2015

Journal of Caffeine Research

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“…Several studies that included only PAD participants reported that lower ABI values are not associated with greater functional limitations. [93][94][95] These prior studies were limited by small sample sizes, by exclusion of functional measures other than treadmill walking performance, and by exclusion of participants without classic symptoms of intermittent claudication. [93][94][95] In other studies of patients with PAD, both with and without intermittent claudication symptoms, strong and independent associations of lower ABI values were observed with poorer 6-minute walk performance, slower walking velocity at usual and fastest pace, greater limitation in maximum treadmill walking performance, and lower Walking Impairment Questionnaire distance score.…”

Section: The Abi and Functional Impairment And Declinementioning

confidence: 99%

“…[93][94][95] These prior studies were limited by small sample sizes, by exclusion of functional measures other than treadmill walking performance, and by exclusion of participants without classic symptoms of intermittent claudication. [93][94][95] In other studies of patients with PAD, both with and without intermittent claudication symptoms, strong and independent associations of lower ABI values were observed with poorer 6-minute walk performance, slower walking velocity at usual and fastest pace, greater limitation in maximum treadmill walking performance, and lower Walking Impairment Questionnaire distance score. 90,96,97 No prospective studies in cohorts restricted to patients with PAD have demonstrated that lower ABI values are associated with a faster decline in functioning.…”

Section: The Abi and Functional Impairment And Declinementioning

confidence: 99%

Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,373

827

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T he ankle-brachial index (ABI) is the ratio of the systolic blood pressure (SBP) measured at the ankle to that measured at the brachial artery. Originally described by Winsor 1 in 1950, this index was initially proposed for the noninvasive diagnosis of lower-extremity peripheral artery disease (PAD). 2,3 Later, it was shown that the ABI is an indicator of atherosclerosis at other vascular sites and can serve as a prognostic marker for cardiovascular events and functional impairment, even in the absence of symptoms of PAD. 4 -6 Rationale for Standardization of the ABIThe current lack of standards for measurement and calculation of the ABI leads to discrepant results with significant impact from clinical, public health, and economic standpoints. Indeed, the estimated prevalence of PAD may vary substantially according to the mode of ABI calculation. [7][8][9] In a review of 100 randomly selected reports using the ABI, multiple variations in technique were identified, including the position of the patient during measurement, the sizes of the arm and leg cuffs, the location of the cuff on the extremity, the method of pulse detection over the brachial artery and at the ankles, whether the arm and ankle pressures were measured bilaterally, which ankle pulses were used, and whether a single or replicate measures were obtained. 10 There is controversy about what ABI threshold should be used to diagnose PAD. The ABI threshold most commonly used is Յ0.90 based on studies reporting Ͼ90% sensitivity and specificity to detect PAD compared with angiography. 2,3 These studies were limited in that they included mostly older white men with PAD or who were at high risk for PAD and compared them with a younger healthy group. A recent metaanalysis of 8 studies of diverse populations, including diabetic patients, confirmed a high specificity but lower sensitivity (at best Ͻ80%) than that reported in earlier studies. 11 Similar to other vascular markers such as carotid intimamedia thickness 12 or coronary artery calcium score, 13 standardization of the techniques used to measure the ABI and the calculation and interpretation of its values is necessary. Aims and ScopeThe goals for this document are to provide a comprehensive review of the relevant literature on the measurement of the The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 10, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional repri...

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“…Impaired functional performance is associated with poor quality of life, 3,4 and increased exercise endurance has been shown to positively affect quality of life measures and perception of health in this patient population. 5 The ankle-brachial index (ABI), a non-invasive measure of severity of atherosclerotic burden, does not reliably predict the degree of functional impairment observed in PAD patients, [6][7][8][9] and the pathophysiology of impaired functional performance in patients with PAD is not completely understood. In healthy adults, exercise performance is related to arterial stiffness 10 and endothelial dysfunction; 11 there is evidence to suggest that aerobic exercise can reduce arterial stiffness and improve endothelial function.…”

Section: Introductionmentioning

confidence: 99%

Arterial dysfunction and functional performance in patients with peripheral artery disease: A review

2011

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Functional performance influences quality of life in individuals with peripheral artery disease (PAD) and is also a powerful prognostic marker in these patients. The pathophysiology of impaired functional performance in patients with PAD is incompletely understood. The severity of atherosclerotic burden, non-invasively assessed by the ankle-brachial index (ABI), does not reliably predict the degree of functional impairment observed in PAD patients. We review associations of measures of arterial function (arterial stiffness and endothelial dysfunction) with functional performance in PAD patients, and also review potential therapies for arterial stiffness and endothelial dysfunction that could improve functional performance in PAD. Recent studies suggest that measures of arterial function, such as arterial stiffness and endothelial function, are associated with exercise performance in the setting of PAD. These studies have provided new insights into (1) the pathophysiology of functional impairment in PAD, (2) mechanisms of strategies known to be effective such as walking programs, and (3) potential new therapeutic interventions for improving functional performance. Thus, therapies aimed at arterial 'de-stiffening' and improving endothelial function (such as aerobic exercise, statins and angiotensinconverting enzyme inhibitors) may improve functional performance in patients with PAD; however, further investigations are needed.

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Factors predicting walking tolerance in patients with peripheral vascular disease

Cited by 15 publications

References 0 publications

The Effect of Caffeine in Patients with Intermittent Claudication Was Independent of the Degree of Peripheral Ischemia—A Secondary Analysis of a Randomized Clinical Trial

The Effect of Caffeine in Patients with Intermittent Claudication Was Independent of the Degree of Peripheral Ischemia—A Secondary Analysis of a Randomized Clinical Trial

Measurement and Interpretation of the Ankle-Brachial Index

Arterial dysfunction and functional performance in patients with peripheral artery disease: A review

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