Abstract
Introduction: Physical activity and body mass index (BMI) are independently associated with peripheral arterial disease (PAD). However, their relative significance and combined association with PAD remain unclear. Hypothesis: We hypothesize that physical activity is associated with a lower odds of PAD across the BMI spectrum and that physical activity attenuates the prevalence of PAD in obese patients. Methods: We studied 3,250,350 U.S. adults who self-referred for PAD screening from 2003-2008 (Life Line Screening Inc., Independence, Ohio). Subjects completed a medical/lifestyle questionnaire. They were categorized into physically active or physically inactive based on their response in the questionnaire to whether they engaged in any type of vigorous leisure time exercise on a regular basis. All subjects were evaluated for PAD by ankle brachial index, with <0.9 considered abnormal. We divided participants into standardized BMI categories: underweight (< 18.5), normal weight (18.5-24.9), overweight (25-29.9), obese class I (30-34.9), class II (35-39.9), and class III (> 40). Multivariable logistic regression was used to estimate the odds of PAD among the BMI categories, based on physical activity. Results: Overall, mean age was 63.1 ± 10.5 years, 65.5% were female, and mean BMI was 27.7 ± 5.8 kg/m 2 . 41.5% were physically inactive. Average BMI was higher in the physically inactive versus physically active group (28.9 ± 6.3 vs. 27.0 ± 5.3, P<0.0001). Prevalence of PAD initially decreased and then increased with BMI and was attenuated with physical activity. Following multivariable adjustment, physical activity was independently associated with lower odds of PAD across the BMI spectrum (Table). Conclusion: Physical activity is associated with lower odds of PAD in underweight, normal weight, overweight and obese individuals. The higher prevalence of PAD with increasing BMI is attenuated with physical activity.
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