title: Ankle to brachial pressure index in normal subjects and trained cyclists with exercise-induced leg pain.
abstract: OBJECTIVE
  This study compared ankle to brachial pressure indices (ABPI) before and after maximal exercise in three groups in order to investigate maximal exercise testing and ABPI as a useful procedure for the differential diagnosis of exercise-induced leg pain (EILP) in athletes.
  
  
  METHODS
  ABPI measurements were taken before and after cycle ergometer exercise to volitional exhaustion or reproduction of symptoms in three groups: 1) untrained individuals (N = 10, 3 female, 7 male; age 35 +/- 5 yr (mean +/- SD)); 2) trained cyclists (N = 10, 3 female, 7 male; age, 30 +/- 5 yr); and 3) symptomatic group of trained cyclists, complaining of EILP (N = 12, 2 female, 10 male; age, 35 +/- 9 yr).
  
  
  RESULTS
  Resting blood pressure indices were similar in all groups. ABPI were reduced (P < 0.05) in all groups after exercise. No differences between left and right legs were noted in the elite and untrained groups; however, a significant difference (P < 0.05) was noted between the nonsymptomatic (0.79 +/- 0.10) and symptomatic (0.61 +/- 0.20) legs in the subjects with EILP. Despite these group results, only three subjects in the symptomatic group met the published criteria (index of < 0.5) for endofibrosis of the external iliac artery. All positive ABPI tests were subsequently confirmed via arteriogram.
  
  
  CONCLUSIONS
  Maximal exercise testing combined with ABPI measurement is a simple noninvasive procedure that may be useful for the examination of EILP. The results of this study suggest that, in cases with unilateral symptoms, a between-leg ABPI difference of 0.18 (at the first minute of recovery) may be considered as a useful additional diagnostic criterion.
authors.affiliation: Department of Physiotherapy, Nottingham Nuffield Hospital, Woodthorpe, Nottingham NG5 3FZ, England, UK. alan.taylor@nuffieldhospitals.org.uk
authors.forename: A J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: K P
authors.initials: KP
authors.lastname: George
mesh_terms: D000328:Adult; D000842:Ankle / Q000098:blood supply; D001642:Bicycling / Q000293:injuries* / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D001916:Brachial Artery / Q000502:physiology; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D007866:Leg / Q000098:blood supply; D007869:Leg Injuries / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000503:physiopathology; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000503:physiopathology; D012016:Reference Values; D012146:Rest