Obesity Decreases Time to Claudication and Delays Post-Exercise Hemodynamic Recovery in Elderly Peripheral Arterial Disease Patients

Abstract

Background: Althoughobesity is usually observed in peripheral arterial disease (PAD) patients, the effects of the association between these diseases on walking capacity are not well documented. Objective: The main objectives of this study were to determine the effects of obesity on exercise tolerance and post-exercise hemodynamic recovery in elderly PAD patients. Methods: 46 patients with stable symptoms of intermittent claudication were classified according to their body mass index (BMI) into normal group (NOR) = BMI <28.0 and obese or in risk of obesity group (OBE) = BMI ≥28.0. All patients performed a progressive graded treadmill test. During exercise, ventilatory responses were evaluated and pre- and post-exercise ankle and arm blood pressures were measured. Results: Exercise tolerance and oxygen consumption at total walking time were similar between OBE and NOR. However, OBE showed a lower claudication time (309 ± 151 vs. 459 ± 272 s, p = 0.02) with a similar oxygen consumption at this time. In addition, OBE presented a longer time for ankle brachial index recovery after exercise (7.8 ± 2.8 vs. 6.3 ± 2.6 min, p = 0.02). Conclusion: Obesity in elderly PAD patients decreased time to claudication, and delayed post-exercise hemodynamic recovery. These results suggest that muscle metabolic demand, and not total workload, is responsible for the start of the claudication and maximal exercise tolerance in PAD patients. Moreover, claudication duration might be responsible for the time needed to a complete hemodynamic recovery after exercise.

Changes in Function After a 6-Month Walking Intervention in Patients With Intermittent Claudication Who Are Obese or Nonobese

“…9-11 Over 60% of individuals with PAD are overweight or obese. 12 Obesity is one of the leading causes of disability in older adults without PAD.…”

“…15 While both obesity and PAD appear to be independent threats to mobility function, they appear to work additively to maximize disability. Individuals who are obese and diagnosed with PAD claudicate more quickly with activity, 9 require longer time to recover after exercise, 9 and also experience greater declines in calf muscle area, six-minute walk distance, and gait speed than normal weight individuals with PAD. 9-11 …”

The role of nutrition and body composition in peripheral arterial disease

“…To date, 18 studies of the effects of obesity on the incidence and progression of PAD have been carried out. 18,103–119 However, the methods used to assess body composition in these studies were not consistent. Eight studies used only BMI, 18,103–109 and ten studies used BMI and abdominal adiposity.…”

“…18,103–119 However, the methods used to assess body composition in these studies were not consistent. Eight studies used only BMI, 18,103–109 and ten studies used BMI and abdominal adiposity. 110–119 Only one study 112 used DEXA body density scans rather than body circumference measurements to assess abdominal adiposity.…”

“…103,104,106,108,109,111,113,115,116 All but three of the studies showed that greater total obesity (as measured by BMI) was associated with a greater frequency of adverse PAD-related outcomes. 110,115,117 Of the eight studies in which only BMI was assessed, data from five studies showed that total obesity increased the risk of adverse outcomes, such as a more-rapid decline in peak walking distance 109,111 or a cardiovascular event.…”