Advertisement

Physical activity and peripheral artery disease: Two prospective cohort studies and a systematic review

      Highlights

      • Physical activity is a modifiable risk factor for cardiovascular disease.
      • Individuals with a diagnosis of peripheral artery disease (PAD) tend to be less physically active, regardless of whether activity was self-reported or measured objectively.
      • The findings from the longitudinal studies suggest that more intense physical activity is associated with lower risk of developing PAD.

      Abstract

      Background and aims

      Physical activity is a modifiable risk factor for cardiovascular disease and an important therapy in individuals with intermittent claudication. However, its role in the development of peripheral artery disease (PAD) is unclear. We have examined the evidence of the association between physical activity and development of PAD.

      Methods

      We searched PubMed, EMBASE and CINAHL Plus in August 2018 for original studies of physical activity and PAD. Studies reporting prevalence or incidence of PAD by categories of physical activity (an amount of activity per unit of time) were included. In addition, we analysed unpublished individual-level data from two register-linked cohort studies, Finnish Public Sector Study (n = 63,924) and Whitehall II (n = 10,200). Due to heterogeneity in the assessment of physical activity and PAD, we provide a qualitative synthesis of the findings.

      Results

      Evidence from 18 studies (15 cross-sectional/case-control and 7 prospective studies) of the association between physical activity and PAD in total of 152,188 participants, including 3971 PAD patients, suggests that individuals with a diagnosis or clinical findings of PAD were less physically active, regardless of whether activity was self-reported or measured using accelerometers. The findings from the longitudinal studies point to more intense physical activity being associated with lower odds of developing PAD; however, the study-specific findings lacked power to precisely estimate this relationship.

      Conclusions

      Individuals with PAD were less physically active than those without PAD. The longitudinal findings suggest that physical activity decreases the risk of PAD, although better powered studies are needed to confirm this.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fowkes F.G.
        • Rudan D.
        • Rudan I.
        • Aboyans V.
        • Denenberg J.O.
        • McDermott M.M.
        • Norman P.E.
        • Sampson U.K.
        • Williams L.J.
        • Mensah G.A.
        • 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: 1329-1340
        • Mahoney E.M.
        • Wang K.
        • Keo H.H.
        • Duval S.
        • Smolderen K.G.
        • Cohen D.J.
        • Steg G.
        • Bhatt D.L.
        • Hirsch A.T.
        Reduction of Atherothrombosis for Continued Health Registry I: vascular hospitalization rates and costs in patients with peripheral artery disease in the United States.
        Circ Cardiovasc Qual Outcomes. 2010; 3: 642-651
        • Hirsch A.T.
        • Hartman L.
        • Town R.J.
        • Virnig B.A.
        National health care costs of peripheral arterial disease in the Medicare population.
        Vasc. Med. 2008; 13: 209-215
        • Piepoli M.F.
        • Hoes A.W.
        • Agewall S.
        • Albus C.
        • Brotons C.
        • Catapano A.L.
        • Cooney M.T.
        • Corra U.
        • Cosyns B.
        • Deaton C.
        • et al.
        European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the european association for cardiovascular prevention & rehabilitation (EACPR).
        Eur. Heart J. 2016; 37 (2016): 2315-2381
        • Alzamora M.T.
        • Fores R.
        • Baena-Diez J.M.
        • Pera G.
        • Toran P.
        • Sorribes M.
        • Vicheto M.
        • Reina M.D.
        • Sancho A.
        • Albaladejo C.
        • et al.
        The peripheral arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population.
        BMC Public Health. 2010; 10: 38
        • Tunstall-Pedoe H.
        • Peters S.A.E.
        • Woodward M.
        • Struthers A.D.
        • Belch J.J.F.
        Twenty-year predictors of peripheral arterial disease compared with coronary heart disease in the scottish heart health extended cohort (SHHEC).
        J. Am. Heart Assoc. 2017; 6
        • Wahid A.
        • Manek N.
        • Nichols M.
        • Kelly P.
        • Foster C.
        • Webster P.
        • Kaur A.
        • Smith C.F.
        • Wilkins E.
        • Rayner M.
        • et al.
        Quantifying the association between physical activity and cardiovascular disease and diabetes: a systematic review and meta-analysis.
        J. Am. Heart Assoc. 2016; 5
        • Hageman D.
        • Fokkenrood H.J.
        • Gommans L.N.
        • van den Houten M.M.
        • Teijink J.A.
        Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication.
        Cochrane Database Syst. Rev. 2018; 4: CD005263
        • Lane R.
        • Harwood A.
        • Watson L.
        • Leng G.C.
        Exercise for intermittent claudication.
        Cochrane Database Syst. Rev. 2017; 12: CD000990
        • Ruiz Comellas A.
        • Pera G.
        • Baena Diez J.M.
        • Heras A.
        • Alzamora Sas M.T.
        • Fores Raurell R.
        • Toran Monserrat P.
        • Mundet Tuduri X.
        The relationship between physical activity in leasure time and the ankle-brachial index in a general Spanish population: the ARTPER study. [Spanish].
        Med. Clínica. 2015; 145: 419-426
        • Parmenter B.J.
        • Dieberg G.
        • Smart N.A.
        Exercise training for management of peripheral arterial disease: a systematic review and meta-analysis.
        Sports Med. 2015; 45: 231-244
        • Berard A.M.
        • Bedel A.
        • Le Trequesser R.
        • Freyburger G.
        • Nurden A.
        • Colomer S.
        • Guerin V.
        • Vergnes M.C.
        • Becker F.
        • Camelot G.
        • et al.
        Novel risk factors for premature peripheral arterial occlusive disease in non-diabetic patients: a case-control study.
        PLoS One. 2013; 8 (no pagination): e37882
        • Chen J.
        • Mohler I.E.R.
        • Xie D.
        • Shlipak M.G.
        • Townsend R.R.
        • Appel L.J.
        • Raj D.S.
        • Ojo A.O.
        • Schreiber M.J.
        • Strauss L.F.
        • et al.
        Risk factors for peripheral arterial disease among patients with chronic kidney disease.
        Am. J. Cardiol. 2012; 110: 136-141
        • Collins T.C.
        • Slovut D.P.
        • Newton R.
        • Johnson W.D.
        • Larrivee S.
        • Patterson J.
        • Johnston J.A.
        • Correa A.
        Ideal cardiovascular health and peripheral artery disease in african Americans: results from the jackson heart study.
        Prev. Med. Rep. 2017; 7: 20-25
        • Delaney J.A.
        • Jensky N.E.
        • Criqui M.H.
        • Whitt-Glover M.C.
        • Lima J.A.
        • Allison M.A.
        The association between physical activity and both incident coronary artery calcification and ankle brachial index progression: the multi-ethnic study of atherosclerosis.
        Atherosclerosis. 2013; 230: 278-283
        • Engstrom G.
        • Ogren M.
        • Hedblad B.
        • Wollmer P.
        • Janzon L.
        Asymptomatic leg atherosclerosis is reduced by regular physical activity. Longitudinal results from the cohort "men born in 1914.
        Eur. J. Vasc. Endovasc. Surg. 2001; 21: 502-507
        • Kulinski J.P.
        • Sanghavi M.
        • Ayers C.R.
        • Das S.R.
        • Banerjee S.
        • Berry J.D.
        • Addo T.
        • De Lemos J.A.
        • Kumbhani D.J.
        Association between low ankle-brachial index and accelerometer-derived sedentary and exercise time in the asymptomatic general population.
        Vasc. Med. 2015; 20: 332-338
        • Lakshmanan R.
        • Hyde Z.
        • Jamrozik K.
        • Hankey G.J.
        • Norman P.E.
        Population-based observational study of claudication in older men: the Health in Men Study.
        Med. J. Aust. 2010; 192: 641-645
        • Loprinzi P.D.
        Physical activity and peripheral arterial disease among patients with coronary artery disease or congestive heart failure.
        Int. J. Cardiol. 2016; 207: 110-111
        • Loprinzi P.D.
        • Abbott K.
        Association of diabetic peripheral arterial disease and objectively-measured physical activity: NHANES 2003-2004.
        J. Diabetes Metab. Disord. 2014; 13 (no pagination)(63)
        • Lopez-Laguna N.
        • Martinez-Gonzalez M.A.
        • Toledo E.
        • Babio N.
        • Sorli J.V.
        • Ros E.
        • Munoz M.A.
        • Estruch R.
        • Lapetra J.
        • Munoz-Bravo C.
        • et al.
        Risk of peripheral artery disease according to a healthy lifestyle score: the PREDIMED study.
        Atherosclerosis. 2018; 275: 133-140
        • Maggio M.
        • Cattabiani C.
        • Lauretani F.
        • Artoni A.
        • Bandinelli S.
        • Schiavi G.
        • Vignali A.
        • Volpi R.
        • Ceresini G.
        • Lippi G.
        • et al.
        The relationship between sex hormones, sex hormone binding globulin and peripheral artery disease in older persons.
        Atherosclerosis. 2012; 225: 469-474
        • McDermott M.M.
        • Greenland P.
        • Ferrucci L.
        • Criqui M.H.
        • Liu K.
        • Sharma L.
        • Chan C.
        • Celic L.
        • Priyanath A.
        • Guralnik J.M.
        Lower extremity performance is associated with daily life physical activity in individuals with and without peripheral arterial disease.
        J. Am. Geriatr. Soc. 2002; 50: 247-255
        • Parsons T.J.
        • Sartini C.
        • Ellins E.A.
        • Halcox J.P.
        • Smith K.E.
        • Ash S.
        • Lennon L.T.
        • Wannamethee S.G.
        • Lee I.M.
        • Whincup P.H.
        • et al.
        Objectively measured physical activity and sedentary behaviour and ankle brachial index: cross-sectional and longitudinal associations in older men.
        Atherosclerosis. 2016; 247: 28-34
        • Sieminski D.J.
        • Gardner A.W.
        The relationship between free-living daily physical activity and the severity of peripheral arterial occlusive disease.
        Vasc. Med. 1997; 2: 286-291
        • Siscovick D.S.
        • Fried L.
        • Mittelmark M.
        • Rutan G.
        • Bild D.
        • O'Leary D.H.
        Exercise intensity and subclinical cardiovascular disease in the elderly. The Cardiovascular Health Study.
        Am. J. Epidemiol. 1997; 145: 977-986
        • Tapp R.J.
        • Balkau B.
        • Shaw J.E.
        • Valensi P.
        • Cailleau M.
        • Eschwege E.
        • Group D.S.
        Association of glucose metabolism, smoking and cardiovascular risk factors with incident peripheral arterial disease: the DESIR study.
        Atherosclerosis. 2007; 190: 84-89
        • Wilson A.M.
        • Sadrzadeh-Rafie A.H.
        • Myers J.
        • Assimes T.
        • Nead K.T.
        • Higgins M.
        • Gabriel A.
        • Olin J.
        • Cooke J.P.
        Low lifetime recreational activity is a risk factor for peripheral arterial disease.
        J. Vasc. Surg. 2011; 54: 427-432
        • Linares-del Rey M.
        • Vela-Desojo L.
        • Cano-de la Cuerda R.
        Mobile phone applications in Parkinson's disease: a systematic review.
        Neurologia. 2019; 34: 38-54