Post-exercise ankle blood pressure and ankle to brachial index after heavy load bicycle exercise

The American Heart Association (AHA) recommendations for diagnosing peripheral artery disease (PAD) after exercise are a decrease >20% of ankle brachial index (ABI) or >30 mm Hg of ankle systolic blood pressure (ASBP) from resting values. We evaluated ABI and ASBP values during incremental maximal exercise in physically active and asymptomatic patients. Patients (n=726) underwent incremental bicycle tests with pre- and post-exercise recording of all four limbs arterial pressures simultaneously. Univariate and multivariate analyses were performed to define the correlation between post-exercise ABI with various clinical factors, including age. Thereafter, the population was divided into groups of age: less than 40 (G<40), from 40 to 44 (G40/44) from 45 to 49 (G45/49), from 50 to 54 (G50/54), from 55 to 59 (G55/59), from 60 to 64 (G60/64), and 65 and above (G >= 65) years. Results are mean +/- SD. * is two-tailed P<.05 for ANOVA with Dunnett's post-hoc test from G40. Changes from rest in ASBP were -3 +/- 22 (G<40), -2 +/- 20 (G40/44), 4 +/- 22* (G45/49), 10 +/- 25* (G50/54), 18 +/- 21* (G55/59), 23 +/- 27* (G60/64), and 16 +/- 22* (G >= 65) mm Hg. Decreases from rest in ABI were 32 +/- 9 (G<40), 33 +/- 9 (G40/44), 29 +/- 8 (G45/49), 27 +/- 10* (G50/54), 24 +/- 7* (G55/59), 22 +/- 12* (G60/64), and 21 +/- 12* (G >= 65) % of resting ABI. Maximal incremental exercise results in ABI and ASBP changes are mostly dependent on age. The AHA limits for post-exercise ABI are inadequate following maximal incremental bicycle testing. Future studies detecting PAD in active patients should account for the effect of age.