title: Physical Activity Improves Borderline Ankle-Brachial Index Values in a Cardiovascular Risk Population.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) is an underdiagnosed and undertreated disease because it remains asymptomatic for so long. The ankle-brachial index (ABI) is a valid method for detecting PAD in lower extremities. ABI ≤0.90 indicates incident PAD. Recent studies have found that subjects with borderline ABI values (0.91-1.00) have increased mortality rates. The objective of our 7-year follow-up study was to investigate the progression of PAD in borderline ABI subjects, who underwent a multifactorial cardiovascular intervention.
  
  
  METHODS
  A total of 193 subjects with borderline ABI were examined in 2005-2006. None of them had previously diagnosed diabetes, cardiovascular or renal disease or intermittent claudication. They were given conventional treatment for multiple risk factors of cardiovascular diseases (hypertension, hypercholesterolemia, elevated blood glucose, smoking, and overweight). Sixty-four percent of these subjects (n = 123) attended a follow-up visit in 2012.
  
  
  RESULTS
  Of the 123 subjects with borderline ABI (mean age 59.0 ± 6.5 years, 62% female) at baseline, 18 (15%, 95% confidence intervals [CI]: 9%-22%) developed incident PAD during the follow-up. The mean ABI was 0.97 ± 0.03 at baseline and 1.01 ± 0.12 at 7-year follow-up visit. The change in mean ABI was +0.04 (95% CI: 0.03-0.07), P < 0.001. ABI improved significantly in 25 (20%) subjects. In multivariate ordered logistic regression analyses high and even moderate leisure-time physical activity (LTPA; odds ratio 6.15; 95% CI: 1.99-19.1) predicted a rise in ABI in comparison to low LTPA.
  
  
  CONCLUSIONS
  Physical activity seems to improve significantly ABI values among men and women with borderline ABI (0.91-1.00).
authors.affiliation: Department of General Practice, University of Turku, Turku, Finland; Department of Surgery, Satakunta Hospital District, Pori, Finland. Electronic address: arto.heikkila@fimnet.fi.
authors.forename: Arto
authors.initials: A
authors.lastname: Heikkilä
authors.affiliation: Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Maarit
authors.initials: M
authors.lastname: Venermo
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Department of Surgery, Satakunta Hospital District, Pori, Finland.
authors.forename: Pertti
authors.initials: P
authors.lastname: Aarnio
authors.affiliation: Department of General Practice, University of Turku, Turku, Finland; Department of Primary Care, Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Korhonen
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D015444:Exercise; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome