Exercise performance in patients with peripheral arterial disease who have different types of exertional leg pain

Abstract

Objective: This study compared the exercise performance of patients with peripheral arterial disease (PAD) who have different types of exertional leg pain.

Methods: Patients with PAD were classified into one of four groups according to the San Diego Claudication Questionnaire: intermittent claudication (n = 406), atypical exertional leg pain causing patients to stop (n = 125), atypical exertional leg pain in which patients were able to continue walking (n = 81), and leg pain on exertion and rest (n = 103). Patients were assessed on the primary outcome measures of ankle-brachial index (ABI), treadmill exercise measures, and ischemic window.

Results: All patients experienced leg pain consistent with intermittent claudication during a standardized treadmill test. The mean (+/- SD) initial claudication distance (ICD) was similar (P = .642) among patients with intermittent claudication (168 +/- 160 meters), atypical exertional leg pain causing patients to stop (157 +/- 130 meters), atypical exertional leg pain in which patients were able to continue walking (180 +/- 149 meters), and leg pain on exertion and rest (151 +/- 136 meters). The absolute claudication distance (ACD) was similar (P = .648) in the four respective groups (382 +/- 232, 378 +/- 237, 400 +/- 245, and 369 +/- 236 meters). Similarly, the ischemic window, expressed as the area under the curve (AUC) after treadmill exercise, was similar (P = .863) in these groups (189 +/- 137, 208 +/- 183, 193 +/- 143, and 199 +/- 119 AUC).

Conclusion: PAD patients with different types of exertional leg pain, all limited by intermittent claudication during a standardized treadmill test, were remarkably similar in ICD, ACD, and ischemic window. Thus, the presence of ambulatory symptoms should be of primary clinical concern in evaluating PAD patients regardless of whether they are consistent with classic intermittent claudication.