The Ankle Brachial Index Is Associated with Leg Function and Physical Activity: The Walking and Leg Circulation Study

  1. Mary McGrae McDermott, MD;
  2. Philip Greenland, MD;
  3. Kiang Liu, PhD;
  4. Jack M. Guralnik, MD, PhD;
  5. Lillian Celic, BS;
  6. Michael H. Criqui, MD, MPH;
  7. Cheeling Chan, MS;
  8. Gary J. Martin, MD;
  9. Joseph Schneider, MD, PhD;
  10. William H. Pearce, MD;
  11. Lloyd M. Taylor, MD; and
  12. Elizabeth Clark, MD
  1. From the Feinberg School of Medicine at Northwestern University and Catholic Health Partners, Chicago, Illinois; National Institute on Aging, Bethesda, Maryland; University of California at San Diego School of Medicine, San Diego, California; Evanston Hospital, Skokie, Illinois; and Oregon Health Sciences Medical Center, Portland, Oregon.

    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.

    Design: Cross-sectional study.

    Setting: 3 academic medical centers in the Chicago area.

    Participants: 740 men and women (460 with peripheral arterial disease).

    Measurements: 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 (β-regression coefficient = −523 ft [95% CI, −592 to −454 ft]; P < 0.001), less physical activity (β = −514.8 activity units [CI, −657 to −373 activity units]; P < 0.001), slower 4-m walking velocity (β = −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.

    Article and Author Information

    • Acknowledgments: The authors thank the study participants and their physicians for their time and effort.

    • Grant Support: By the National Heart, Lung, and Blood Institute (R01-HL58099), the Robert Wood Johnson Foundation, and the National Center for Research Resources, National Institutes of Health (RR-00048). Dr. McDermott is a recipient of an Established Investigator Award from the American Heart Association.

    • Requests for Single Reprints: Mary McGrae McDermott, MD, 675 North Saint Clair, Suite 18-200, Chicago, IL 60611.

    • Current Author Addresses: Drs. McDermott and Martin: 675 North Saint Clair, Suite 18-200, Chicago, IL 60611.

    • Drs. Greenland and Liu and Ms. Chan: 680 North Lake Shore Drive, Suite 1102, Chicago, IL 60611.

    • Dr. Guralnik: Gateway Building, Room 3-C309, 729 Wisconsin Avenue, Bethesda MD, 20892.

    • Dr. Criqui: 9500 Gilman Drive, La Jolla, CA 92093-0607.

    • Ms. Celic: 676 North Saint Clair, Suite 200, Chicago, IL 60611.

    • Dr. Schneider: 9977 Woods Drive, Skokie, IL 60077.

    • Dr. Pearce: 675 North Saint Clair, Galter 10–105, Chicago, IL 60611.

    • Dr. Taylor: Department of Vascular Surgery, Oregon Health & Science University, Vascular Surgery—OP11, 3181 Southwest Sam Jackson Park Road, Portland, OR 97201-3098.

    • Dr. Clark: 2520 North Lakeview, Chicago, IL 60614.

    • Author Contributions: Conception and design: M.M. McDermott, P. Greenland, K. Liu, J.M. Guralnik, M.H. Criqui, G.J. Martin, J. Schneider, L.M. Taylor.

    • Analysis and interpretation of the data: M.M. McDermott, P. Greenland, K. Liu, J.M. Guralnik, M.H. Criqui, C. Chan, L.M. Taylor.

    • Drafting of the article: M.M. McDermott, J.M. Guralnik, M.H. Criqui, G.J. Martin, J. Schneider.

    • Critical revision of the article for important intellectual content: M.M. McDermott, P. Greenland, J.M. Guralnik, L. Celic, M.H. Criqui, C. Chan, G.J. Martin, J. Schneider, W.H. Pearce, L.M. Taylor, E. Clark.

    • Final approval of the article: M.M. McDermott, P. Greenland, K. Liu, J.M. Guralnik, M.H. Criqui, J. Schneider, L.M. Taylor.

    • Provision of study materials or patients: L. Celic, G.J. Martin, J. Schneider, W.H. Pearce, E. Clark.

    • Statistical expertise: K. Liu, J.M. Guralnik, M.H. Criqui, C. Chan.

    • Obtaining of funding: M.M. McDermott, P. Greenland, M.H. Criqui, L.M. Taylor.

    • Administrative, technical, or logistic support: P. Greenland, L. Celic, C. Chan, G.J. Martin.

    • Collection and assembly of data: M.M. McDermott, L. Celic, C. Chan.

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    1. Ann Intern Med June 18, 2002 vol. 136 no. 12 873-883
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