Ankle to brachial pressure index in normal subjects and trained cyclists with exercise-induced leg pain

Purpose: This study compared ankle to brachial pressure indices (ABPI) before and after maximal exercise in three groups in order to investigate maximal exercise testing and ABPI as a useful procedure for the differential diagnosis of exercise-induced leg pain (EILP) in athletes. Methods: ABPI measurements were taken before and after cycle ergometer exercise to volitional exhaustion or reproduction of symptoms in three groups: 1) untrained individuals (N=10, 3 female, 7 male; age 35 +/-5 yr (mean +/- SD)); 2) trained cyclists (N=10, 3 female, 7 male; age, 30 +/-5 yr); and 3) symptomatic group of trained cyclists, complaining of EILP (N=12, 2 female, 10 male; age, 35 +/-9 yr). Results: Resting blood pressure indices were similar in all groups. ABPI were reduced (P<0.05) in all groups after exercise, No differences between left and right legs were noted in the elite and untrained groups; however, a significant difference (P<0.05) was noted between the nonsymptomatic (0.79 +/-0.10) and symptomatic (0.61 +/-0.20) legs in the subjects with EILP. Despite these group results, only three subjects in the symptomatic group met the published criteria (index of <0.5) for endofibrosis of the external iliac artery. All positive ABPI tests were subsequently confirmed via arteriogram. Conclusion: Maximal exercise testing combined with ABPI measurement is a simple noninvasive procedure that may be useful for the examination of EILP. The results of this study suggest that, in cases with unilateral symptoms, a between-leg ABPI difference of 0.18 (at the first minute of recovery) may be considered as a useful additional diagnostic criterion.