Relative Tolerance to Upper- and Lower-Limb Aerobic Exercise in Patients with Peripheral Arterial Disease

ObjectivesTo investigate the effects of peripheral arterial disease (PAD) on relative tolerance to upper- and lower-limb aerobic exercise.MethodsPeak cardiorespiratory responses evoked by an incremental arm-cranking test (ACT) and an incremental leg-cranking test (LCT) were compared in patients with PAD (N=101; median age 69 year, range 50–85 years). Claudication distance (CD) and total distance before intolerable claudication pain (maximum walking distance: MWD) were also assessed during walking.ResultsPeak oxygen consumption (V˙O2) for the ACT was 94% of that measured for the LCT (1.01±0.03 versus 1.10±0.03 l min−1, respectively; P<0.001), but in a significant proportion of patients (35%; P  <0.001), exceeded that recorded for the LCT. The ratio of upper- to lower-limb peak V˙O2 was higher (0.98±0.04 compared to 0.98±0.05 l min−1 and 1.00±0.06 compared to 1.21±0.06 l min−1; P<0.01), whereas walking performance (CD: 94±14 versus 187±25 m, P<0.01; MWD: 227±20 versus 394±33 m, P<0.01) was lower for patients in the lowest ankle to brachial pressure index quartile compared to patients in the highest quartile, respectively.ConclusionUpper-limb aerobic conditioning could be a useful exercise stimulus for maintaining or improving cardiorespiratory function in patients with severe PAD as they have a greater relative upper-limb aerobic power.