title: The effect of exercise training on ankle-brachial index in type 2 diabetes.
abstract: BACKGROUND
  Though being physically active has associated with a healthier ankle-brachial index (ABI) in observational studies, ABI usually does not change with exercise training in patients with peripheral artery disease (PAD). Less is known about the effect of exercise training on ABI in patients without PAD but at high risk due to the presence of type 2 diabetes (T2DM).
  
  
  METHODS
  Participants (n = 140) with uncomplicated T2DM, and without known cardiovascular disease or PAD, aged 40-65 years, were randomized to supervised aerobic and resistance training 3 times per week for 6 months or to a usual care control group. ABI was measured before and after the intervention.
  
  
  RESULTS
  Baseline ABI was 1.02 ± 0.02 in exercisers and 1.03 ± 0.01 in controls (p = 0.57). At 6 months, exercisers vs. controls improved ABI by 0.04 ± 0.02 vs. -0.03 ± 0.02 (p = 0.001). This change was driven by an increase in ankle pressures (p < 0.01) with no change in brachial pressures (p = 0.747). In subgroup analysis, ABI increased in exercisers vs. controls among those with baseline ABI <1.0 (0.14 ± 0.03 vs. 0.02 ± 0.02, p = 0.004), but not in those with a baseline ABI ≥1.0 (p = 0.085). The prevalence of ABI between 1.0 and 1.3 increased from 63% to 78% in exercisers and decreased from 62% to 53% in controls. Increased ABI correlated with decreased HbA1c, systolic and diastolic blood pressure, but the effect of exercise on ABI change remained significant after adjustment for these changes (β = 0.061, p = 0.004).
  
  
  CONCLUSIONS
  These data suggest a possible role for exercise training in the prevention or delay of PAD in T2DM, particularly among those starting with an ABI <1.0. Clinicaltrials.gov Registry Number: NCT00212303.
authors: University of Pittsburgh, Department of Health and Physical Activity, PA, USA. bbarone@pitt.edu
authors: Bethany
authors: B
authors: Barone Gibbs
authors: Devon A
authors: DA
authors: Dobrosielski
authors: Andrew D
authors: AD
authors: Althouse
authors: Kerry J
authors: KJ
authors: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000517:prevention & control; D055070:Resistance Training; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: Ankle-brachial index; Exercise; Peripheral artery disease; Type 2 diabetes
references: Am J Epidemiol. 2001 Apr 1;153(7):666-72
references: 11282794
references: Atherosclerosis. 2006 Nov;189(1):61-9
references: 16620828
references: Diabetes Care. 2010 Dec;33(12):e147-67
references: 21115758
references: Am J Prev Med. 2007 Apr;32(4):328-33
references: 17383564
references: Circulation. 2006 Jan 24;113(3):388-93
references: 16432070
references: Arch Intern Med. 1979 Aug;139(8):857-61
references: 464698
references: Med Sci Sports Exerc. 2007 Dec;39(12):2107-16
references: 18046181
references: Diabetes Care. 2002 May;25(5):894-9
references: 11978687
references: N Engl J Med. 2008 Oct 9;359(15):1565-76
references: 18784091
references: JAMA. 2009 Jan 14;301(2):165-74
references: 19141764
references: J Gen Intern Med. 2012 Nov;27(11):1453-9
references: 22610907
references: Am J Epidemiol. 1997 Jun 1;145(11):977-86
references: 9169906
references: Ann Intern Med. 2002 Jun 18;136(12):873-83
references: 12069561
references: Eur J Vasc Endovasc Surg. 2001 Jun;21(6):502-7
references: 11397023
references: Atherosclerosis. 2005 Jun;180(2):389-97
references: 15910867
references: Med Sci Sports Exerc. 2004 Mar;36(3):533-53
references: 15076798
references: J Am Coll Cardiol. 2001 Sep;38(3):860-6
references: 11527646
references: J Vasc Surg. 2011 Aug;54(2):427-32, 432.e1-4
references: 21664093
references: CMAJ. 2006 Mar 14;174(6):801-9
references: 16534088
references: Circulation. 2004 Aug 10;110(6):738-43
references: 15262830
references: Eur J Prev Cardiol. 2012 Dec;19(6):1333-56
references: 22637740
references: Eur J Prev Cardiol. 2012 Oct;19(5):1005-33
references: 22637741
references: Hypertens Res. 2005 Apr;28(4):315-21
references: 16138561
references: Diabet Med. 2010 Jan;27(1):4-14
references: 20121883
references: Circulation. 2012 Dec 11;126(24):2890-909
references: 23159553
references: JAMA. 2003 May 21;289(19):2560-72
references: 12748199
references: Cochrane Database Syst Rev. 2008 Oct 08;(4):CD000990
references: 18843614
references: J Epidemiol Community Health. 1993 Dec;47(6):475-80
references: 8120503
references: Atherosclerosis. 2012 Oct;224(2):446-53
references: 22889573
references: Exerc Sport Sci Rev. 2009 Oct;37(4):196-202
references: 19955869
references: Circulation. 2011 Jan 4;123(1):87-97
references: 21200015