title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: CMRI Metabolic Research Center; University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK 73117, USA. andrew-gardner@ouhsc.edu
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Gardner
authors.forename: Polly S
authors.initials: PS
authors.lastname: Montgomery
authors.forename: Azhar
authors.initials: A
authors.lastname: Afaq
mesh_terms: D000368:Aged; D000842:Ankle / Q000098:blood supply; D015142:Baltimore; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010146:Pain / Q000209:etiology* / Q000503:physiopathology; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000503:physiopathology*; D005082:Physical Exertion; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016138:Walking