title: The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study.
abstract: BACKGROUND
  The ankle brachial index (ABI) is a noninvasive, reliable measure of lower-extremity ischemia. However, the relationship between ABI and lower-extremity function has not been well studied.
  
  
  OBJECTIVE
  To describe the association between the ABI and lower-extremity function.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  3 academic medical centers in the Chicago area.
  
  
  METHODS
  740 men and women (460 with peripheral arterial disease).
  
  
  METHODS
  Accelerometer-measured physical activity over 7 days, 6-minute walk, 4-m walking velocity, standing balance, and ABI.
  
  
  RESULTS
  33% of participants with peripheral arterial disease had intermittent claudication. Fewer than 40% of participants with an ABI less than 0.40 walked continuously for 6 minutes compared with more than 95% of participants with an ABI between 1.00 and 1.50. Compared with an ABI of 1.10 to 1.50, an ABI less than 0.50 was associated with shorter distance walked in 6 minutes (beta-regression coefficient = -523 ft [95% CI, -592 to -454 ft]; P < 0.001), less physical activity (beta = -514.8 activity units [CI, -657 to -373 activity units]; P < 0.001), slower 4-m walking velocity (beta = -0.21 m/s [CI, -0.27 to -0.15 m/s]; P < 0.001), and less likelihood of maintaining a tandem stand for 10 seconds (odds ratio, 0.37 [CI, 0.18 to 0.76]; P = 0.007), after adjustment for typical confounders. Associations between ABI and function were stronger than associations between leg symptoms and function.
  
  
  CONCLUSIONS
  The ABI, a noninvasive test that can be performed in a medical office, is more closely associated with leg function in persons with peripheral arterial disease than is intermittent claudication or other leg symptoms. These data support the use of the ABI to identify abnormal lower-extremity function.
authors.affiliation: Feinberg School of Medicine at Northwestern University and Catholic Health Partners, Chicago, Illinois, USA.
authors.forename: Mary McGrae
authors.initials: MM
authors.lastname: McDermott
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Lillian
authors.initials: L
authors.lastname: Celic
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: Cheeling
authors.initials: C
authors.lastname: Chan
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Martin
authors.forename: Joseph
authors.initials: J
authors.lastname: Schneider
authors.forename: William H
authors.initials: WH
authors.lastname: Pearce
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Taylor
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Clark
mesh_terms: D000368:Aged; D000842:Ankle / Q000098:blood supply*; D001795:Blood Pressure Determination / Q000379:methods*; D001916:Brachial Artery / Q000502:physiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology; D007866:Leg / Q000098:blood supply / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D012044:Regression Analysis; D016138:Walking / Q000502:physiology