Physical activity (PA) and exercise are part of the best medical therapy for PAD and diabetes.(1-3) PA has been shown to improve glycemic control, leg symptoms, quality of life, physical function (PF), and amputation free survival period.(1-4) However, people with PAD and T2DM, often experience pain when exercising, and can be advised to offload as a result of ulceration; load bearing exercise may even precipitate symptoms, such as foot lesions in the presence of severe distal neuropathy, and symptoms of intermittent claudication, which results in reduced activity. (2,5) The aim of this study was to quantify differences in PA, inactivity, and PF, in people with T2DM and PAD.

This analysis included data from 672 participants who took part in the Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Control (CODEC) cross-sectional study, 48 of which had PAD. Eligible participants were recruited from both primary and secondary care settings in the Midlands area, UK. Participants were asked to wear an accelerometer (GENEActive, ActivInsights, Kimbolton, UK) on their non-dominant wrist for 7 days to quantify different physical behaviours: daily acceleration, intensity, inactivity, time in light PA, moderate-to-vigorous PA in at least 1 minute bouts, and the average acceleration achieved during the most active continuous 2, 5, 10, 30 and 60 minute periods of the 24-h day. PF was assessed using the short physical performance battery (SPPB), the Duke Activity Status Index (DASI), sit to stand repetitions in 60 seconds (STS-60) and hand-grip strength. Differences between subjects with and without PAD were estimated using regressions adjusted for possible confounders.

People with T2DM and PAD undertake less PA, have higher levels of inactivity, and have poorer PF compared to people without PAD. Some of the differences in PA and inactivity between groups are possibly related to sociodemographic and clinical differences between subjects with and without PAD. Yet, differences in acceleration during the most active continuous 10, 5 and 2 minute periods of the 24-h day, and in the following measures of PF: STS-60, DASI score and SPPB, persisted after accounting for sociodemographic and clinical characteristics.

The presence of PAD in T2DM has detrimental effects on PA, inactivity, and PF. In subjects with T2DM, the presence of PAD was independently associated with lower average acceleration during the most active 10, 5 and 2 minute periods of the day, as well as worse PF on the SPPB, DASI, and STS-60.

1. Lane R, Harwood A, Watson L, Leng GC. Exercise for intermittent claudication. The Cochrane database of systematic reviews. 2017;12:CD000990. 2. Norgren L, Hiatt, W., Dormandy, J., Nehler, M., Harris, K. and Fowkes, F. Inter-society consensus for the management of peripheral artery disease (TASC II). The Society for Vascular Surgery. 2007;45:S5-67. 3. Kirwan JP, Sacks J, Nieuwoudt S. The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic journal of medicine. 2017;84(7 Suppl 1):S15. 4. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes care. 2003;26(12):3333-3341. 5. Gerage AM, Correia MdA, Oliveira PMLd, et al. Physical activity levels in peripheral artery disease patients. Arquivos brasileiros de cardiologia. 2019;113:410-416.