Introduction and objective:
Low physical activity in patients with claudication is associated with lower walking abilities as assessed by the treadmill test. The impact of physical activity on the ability to walk in a natural environment is unknown. The study aimed to assess the level of daily physical activity among patients with claudication, as well as the relationship between the level of daily physical activity and claudication distance measured during the outdoor walking and treadmill tests.

Material and methods:
The study included 37 patients (24 males), aged 70.03±5.9, with intermittent claudication. Daily step count was assessed using the Garmin Vivofit activity monitor, worn on the non-dominant wrist for 7 consecutive days. Pain-free walking distance (PFWDTT) and maximal walking distance (MWDTT) were measured via the treadmill test. During 60-minute outdoor walking, the maximal walking distance (MWDGPS), total walking distance (TWDGPS), walking speed (WSGPS), number of stops (NSGPS) and stop durations (SDGPS) were assessed.

Mean daily step count – 7,102±3,433. A significant correlation was observed between daily step count and MWDTT, TWDGPS (R=0.33, R=0.37, respectively (p<0.05). Furthermore, 51% of patients reached less than 7,500 steps/day and presented significantly shorter MWDTT, MWDGPS and TWDGPS, compared to the participants covering ≥7,500 steps (p<0.05).

The daily step count reflects claudication distance measured on a treadmill and only partially in a community outdoor setting. The minimal daily step count that should be recommended for patients with claudication, allowing achievement of significantly better results with regard to walking abilities, both on the treadmill and in outdoor settings, is at least 7,500 steps per day.

Sigvant B, Lundin F, Wahlberg E. The Risk of Disease Progression in Peripheral Arterial Disease is Higher than Expected: A Meta-Analysis of Mortality and Disease Progression in Peripheral Arterial Disease. Eur J Vasc Endovasc Surg. 2016;51(3):395–403.
Gardner AW, Addison O, Katzel LI, et al. Association between Physical Activity and Mortality in Patients with Claudication. Med Sci Sports Exerc. 2021;53(4):732–739.
Harwood AE, Pymer S, Ingle L, et al. Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners. BMJ Open Sport Exerc Med. 2020;6(1):e000897. Published 2020 Nov 5.
Spannbauer A, Chwała M, Ridan T, et al. Intermittent Claudication in Physiotherapists’ Practice. Biomed Res Int. 2019;2019:2470801. Published 2019 Sep 18.
Lauret GJ, Fokkenrood HJ, Bendermacher BL, et al. Physical activity monitoring in patients with intermittent claudication. Eur J Vasc Endovasc Surg. 2014;47(6):656–663.
Abaraogu UO, Dall PM, Seenan CA. The Effect of Structured Patient Education on Physical Activity in Patients with Peripheral Arterial Disease and Intermittent Claudication: A Systematic Review. Eur J Vasc Endovasc Surg. 2017;54(1):58–68.
Heikkilä K, Coughlin PA, Pentti J, et al. Physical activity and peripheral artery disease: Two prospective cohort studies and a systematic review. Atherosclerosis. 2019;286:114–120.
Payvandi L, Dyer A, McPherson D, et al. Physical activity during daily life and brachial artery flow-mediated dilation in peripheral arterial disease. Vasc Med. 2009;14(3):193–201.
Lee JM, Kim Y, Welk GJ. Validity of consumer-based physical activity monitors. Med Sci Sports Exerc. 2014;46(9):1840–1848.
Gommans LN, Hageman D, Jansen I, et al. Minimal correlation between physical exercise capacity and daily activity in patients with intermittent claudication. J Vasc Surg. 2016;63(4):983–989.
Tew G, Copeland R, Le Faucheur A, et al. Feasibility and validity of self-reported walking capacity in patients with intermittent claudication. J Vasc Surg. 2013;57(5):1227–34.
Le Faucheur A, Abraham P, Jaquinandi V, et al. Measurement of walking distance and speed in patients with peripheral arterial disease: a novel method using a global positioning system. Circulation. 2008;117(7):897–904.
Noury-Desvaux B, Abraham P, Mahé G, et al. The accuracy of a simple, low-cost GPS data logger/receiver to study outdoor human walking in view of health and clinical studies. PLoS One 2011;6(9):e23027.
Gernigon M, Fouasson-Chailloux A, Colas-Ribas C, et al. Test-retest Reliability of GPS derived Measurements in Patients with Claudication. Eur J Vasc Endovasc Surg. 2015;50(5):623–9.
Kulik A, Rosłoniec E, Madejski P, et al. Outdoor Walking Test With a Global Positioning System Device as an Additional Tool for Functional Assessment of Older Women. J Aging Phys Act. 2020;17:1–6.
McDermott MM, Guralnik JM, Tian L, et al. Comparing 6-minute walk versus treadmill walking distance as outcomes in randomized trials of peripheral artery disease. J Vasc Surg. 2020;71(3):988–1001.
O’Connell S, ÓLaighin G, Kelly L, et al. These Shoes Are Made for Walking: Sensitivity Performance Evaluation of Commercial Activity Monitors under the Expected Conditions and Circumstances Required to Achieve the International Daily Step Goal of 10,000 Steps. PLoS One. 2016;11(5):e0154956. Published 2016 May 11.
El-Amrawy F, Nounou MI. Are Currently Available Wearable Devices for Activity Tracking and Heart Rate Monitoring Accurate, Precise, and Medically Beneficial?. Healthc Inform Res. 2015;21(4):315–320.
Schmidt SAJ, Lo S, Hollestein LM. Research Techniques Made Simple: Sample Size Estimation and Power Calculation. J Invest Dermatol. 2018;138(8):1678–1682.
Abaraogu UO, Dall PM, Brittenden J, et al. Efficacy and Feasibility of Pain management and Patient Education for Physical Activity in Intermittent claudication (PrEPAID): protocol for a randomised controlled trial. Trials. 2019;20(1):222.
Paluch AE, Bajpai S, Bassett DR, et al. Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet Public Health. 2022;7(3):e219-e228.
Pelclová J, Frömel K, Řepka E, et al. Is Pedometer-Determined Physical Activity Decreasing in Czech Adults? Findings from 2008 to 2013. Int J Environ Res Public Health. 2016;13(10):1040. Published 2016 Oct 24.
Spartano NL, Lyass A, Larson MG, et al. Objective physical activity and physical performance in middle-aged and older adults. Exp Gerontol. 2019;119:203–211.
Hall G, Laddu DR, Phillips SA, et al. A tale of two pandemics: How will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another? Prog Cardiovasc Dis. 2021;64:108–110.
Wattanapisit A, Thanamee S. Evidence behind 10,000 steps walking. J Health Res. 2017;31(3):241–248.
Gardner AW, Montgomery PS, Wang M, et al. Daily Step Counts in Participants With and Without Peripheral Artery Disease. J Cardiopulm Rehabil Prev. 2021;41(3):182–187.
Nasr MK, McCarthy RJ, Walker RA, et al. The role of pedometers in the assessment of intermittent claudication. Eur J Vasc Endovasc Surg. 2002;23(4):317–320.
Galea Holmes MN, Weinman JA, Bearne LM. A randomized controlled feasibility trial of a home-based walking behavior-change intervention for people with intermittent claudication. J Vasc Nurs. 2019;37(2):135–143.
Gardner AW, Montgomery PS, Wang M, et al. Association between meeting daily step count goals with ambulatory function and quality of life in patients with claudication. J Vasc Surg. 2021;73(6):2105–2113.
Tudor-Locke C, Craig CL, Thyfault JP, et al. A step-defined sedentary lifestyle index: <5000 steps/day. Appl Physiol Nutr Metab. 2013;38(2):100–114.
Gardner AW, Montgomery PS, Scott KJ, et al. Association between daily ambulatory activity patterns and exercise performance in patients with intermittent claudication. J Vasc Surg. 2008;48(5):1238–1244.
Tudor-Locke C, Han H, Aguiar EJ, et al. How fast is fast enough? Walking cadence (steps/min) as a practical estimate of intensity in adults: a narrative review. Br J Sports Med. 2018;52(12):776–788.
van den Houten MML, Hageman D, Gommans LNM, et al. The Effect of Supervised Exercise, Home Based Exercise and Endovascular Revascularisation on Physical Activity in Patients With Intermittent Claudication: A Network Meta-analysis. Eur J Vasc Endovasc Surg. 2019;58(3):383–392.
Jansen SCP, van Nistelrooij LPJ, Scheltinga MRM, et al. Successful Implementation of the Exercise First Approach for Intermittent Claudication in the Netherlands is Associated with Few Lower Limb Revascularisations. Eur J Vasc Endovasc Surg. 2020;60(6):881–887.
Barbosa JP, Farah BQ, Chehuen M, et al. Barriers to physical activity in patients with intermittent claudication. Int J Behav Med. 2015;22(1):70–76.
Abaraogu U, Ezenwankwo E, Dall P, et al. Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program. PLoS One. 2018;13(7):e0201095. Published 2018 Jul 26.
Dörenkamp S, Mesters I, de Bie R, et al. Patient Characteristics and Comorbidities Influence Walking Distances in Symptomatic Peripheral Arterial Disease: A Large One-Year Physiotherapy Cohort Study. PLoS One. 2016;11(1):e0146828. Published 2016 Jan 11.
Gardner AW, Sieminski DJ, Killewich LA. The effect of cigarette smoking on free-living daily physical activity in older claudication patients. Angiology. 1997;48(11):947–955.
Quintella Farah B, Silva Rigoni VL, de Almeida Correia M, et al. Influence of smoking on physical function, physical activity, and cardiovascular health parameters in patients with symptomatic peripheral arterial disease: A cross-sectional study. J Vasc Nurs. 2019;37(2):106–112.
Gardner AW, Killewich LA, Montgomery PS, et al. Response to exercise rehabilitation in smoking and nonsmoking patients with intermittent claudication. J Vasc Surg. 2004;39(3):531–538.
Gal R, May AM, van Overmeeren EJ, et al. The Effect of Physical Activity Interventions Comprising Wearables and Smartphone Applications on Physical Activity: a Systematic Review and Meta-analysis. Sports Med Open. 2018;4(1):42. Published 2018 Sep 3.
Chan C, Sounderajah V, Normahani P, et al. Wearable Activity Monitors in Home Based Exercise Therapy for Patients with Intermittent Claudication: A Systematic Review. Eur J Vasc Endovasc Surg. 2021;61(4):676–687.
Jelani QU, Petrov M, Martinez SC, et al. Peripheral Arterial Disease in Women: an Overview of Risk Factor Profile, Clinical Features, and Outcomes. Curr Atheroscler Rep. 2018;20(8):40.
Porras CP, Bots ML, Teraa M, et al. Differences in Symptom Presentation in Women and Men with Confirmed Lower Limb Peripheral Artery Disease: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2022;63(4):602–612.
Farah BQ, Ritti-Dias RM, Cucato GG, et al. Factors Associated with Sedentary Behavior in Patients with Intermittent Claudication. Eur J Vasc Endovasc Surg. 2016;52(6):809–814.
Hernandez H, Myers SA, Schieber M, et al. Quantification of Daily Physical Activity and Sedentary Behavior of Claudicating Patients. Ann Vasc Surg. 2019;55:112–121.