The relationship between history of falling and physical function in subjects with peripheral arterial disease

Abstract

The purpose of this study was to determine whether peripheral arterial disease (PAD) subjects with a history of falling had more impaired physical function than their non-falling counterparts. A total of 120 PAD subjects (26%) who had fallen over the past year and 346 PAD subjects (74%) who had not fallen were evaluated. Additionally, subjects were characterized on physical function, consisting of balance, strength, ambulatory function, and monitored physical activity, as well as PAD-specific measures of ankle/brachial pressure index (ABPI) and treadmill claudication distances.

Full-tandem stance time was 19% shorter (p ≤ 0.001) in the fallers than in the non-fallers (7.2 ± 0.3 vs 8.9 ± 0.1 s; mean ± SEM), and the self-reported ability to climb stairs was 36% lower (27 ± 4 vs 42 ± 2%). Furthermore, the fallers were 126% more likely (p ≤ 0.001) to report ambulatory stumbling and unsteadiness, took 14% longer (p = 0.022) to perform five sequential sit-to-stand transfers using an armless chair, covered 16% shorter distance (p ≤ 0.001) during a 6-min walk test, and were 25% less physically active than the non-fallers. The groups had similar ABPI and treadmill claudication distances (p ≤ 0.05). A history of falling was independently related to the self-reported ability to climb stairs, the full-tandem stance time, self-reported ambulatory stumbling and unsteadiness, and daily physical activity (multiple R = 0.47, p ≤ 0.001). In conclusion, impairments in multiple domains of physical function were associated with a history of falling in PAD subjects with intermittent claudication. Furthermore, the link between poor physical function and falling was independent of PAD severity.

Keywords

ambulation balance falls intermittent claudication leg strength physical activity

References

Vogt MT , Wolfson SK , Kuller LH. Lower extremity arterial disease and the aging process: a review. J Clin Epidemiol 1992; 45: 529-542.

Scott-Okafor HR , Silver K , Parker J , Gardner AW. Lower extremity strength deficits in peripheral arterial occlusive disease patients with intermittent claudication. Angiology 2001; 52:7-14.

Sieminski DJ , Gardner AW. The relationship between daily physical activity and the severity of peripheral arterial occlusive disease. Vasc Med 1997; 2: 286-291.

Regensteiner JG , Steiner JF , Panzer RJ , Hiatt WR. Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease. J Vasc Med Biol 1990; 2: 142-152.

Feinglass J , McCarthy WJ , Slavensky R , Manheim LM , Martin GJ , and the Chicago Claudication Outcomes Research Group . Effect of lower extremity blood pressure on physical functioning in patients who have intermittent claudication. J Vasc Surg 1996; 24: 503-512.

Gardner AW , Montgomery PS. Impaired balance and higher prevalence of falls in subjects with intermittent claudication. J Gerontol 2001; 56A: M454-M458.

Gryfe CI , Amies A , Ashley MJ. A longitudinal study of falls in an elderly population: I. Incidence and morbidity. Age Ageing 1977; 6: 201-210.

Baker SP , Harvey AH. Fall injuries in the elderly. Clin Geriatr Med 1985; 1: 501-512.

Tinetti ME. Factors associated with serious injury during falls by ambulatory nursing home residents. J Am Geriatr Soc 1987; 35: 644-648.

10.

Alexander BH , Rivara FP , Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health 1992; 82: 1020-1023.

11.

Smallegan M. How families decide on nursing home admission. Geriatr Consult 1983; 1:21-24.

12.

Howell MA , Colgan MP , Seeger RW , Ramsey DE , Sumner DS. Relationship of severity of lower limb peripheral vascular disease to mortality and morbidity: a six-year follow-up study. J Vasc Surg 1989; 9: 691-697.

13.

Pentecost MJ , Criqui MH , Dorros G et al. Guidelines for peripheral percutaneous transluminal angioplasty of the abdominal aorta and lower extremity vessels. Circulation 1994; 89: 511-531.

14.

Rose G , McCartner P , Reid DD. Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prevent Soc Med 1977; 31:42-48.

15.

Hiatt WR , Marshall JA , Baxter J et al. Diagnostic methods for peripheral arterial disease in the San Luis Valley diabetes study. J Clin Epidemiol 1990; 43: 597-606.

16.

Gardner AW , Skinner JS , Cantwell BW , Smith LK. Progressive vs single-stage treadmill tests for evaluation of claudication. Med Sci Sports Exerc 1991; 23: 402-408.

17.

Tinetti ME , Speechley M , Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701-1707.

18.

Brown M , Sinacore DR , Binder EF , Kohrt WM. Physical and performance measures for the identification of mild to moderate frailty. J Gerontol 2000; 55A: M350-M355.

19.

Richardson JK , Hurvitz EA. Peripheral neuropathy: a true risk factor for falls. J Gerontol 1995; 50A: M211-M215.

20.

Gardner AW , Killewich LA , Katzel LI et al. Relationship between free-living daily physical activity and peripheral circulation in patients with intermittent claudication. Angiology 1999; 50: 289-297.

21.

Montgomery PS , Gardner AW. The clinical utility of a 6-minute walk test in peripheral arterial occlusive disease patients. J Am Geriatr Soc 1998; 46: 706-711.

22.

Gardner AW , Poehlman ET. Assessment of free-living daily physical activity in older claudicants: validation against the doubly labeled water technique. J Gerontol 1998; 53A: M275-M280.

23.

Pasini FL , Pastorelli M , Beerman U , deCandia S , Gallo S. Peripheral neuropathy associated with ischemic vascular disease of the lower limb. Angiology 1996; 47: 568-577.