Physical Activity and Subsequent Risk of Hospitalization With Peripheral Artery Disease and Critical Limb Ischemia in the ARIC Study

Yifei Lu, Shoshana H. Ballew, Lucia Kwak, Elizabeth Selvin, Corey A. Kalbaugh, Jennifer A. Schrack, Kunihiro Matsushita, Moyses Szklo

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1 Scopus citations


Background: Whether physical activity is a determinant of peripheral artery disease (PAD) remains unclear. We therefore assessed the association of physical activity (amount and intensity) with subsequent risk of hospitalization with PAD and its severe form, critical limb ischemia, in the ARIC (Atherosclerosis Risk in Communities) study. Methods and Results: We included 12 513 participants free of cardiovascular disease at baseline (1987–1989), with a mean age of 53.9 years, 55.3% women, and 25.0% black. Physical activity was assessed using a modified Baecke questionnaire and categorized into poor (no moderate [3 to <6 metabolic equivalents] or vigorous [≥6 metabolic equivalents] exercise), intermediate (1–74 min/wk vigorous or 1–149 min/wk moderate plus vigorous exercise), and recommended (≥75 min/wk vigorous or ≥150 min/wk moderate plus vigorous exercise). We also modeled moderate and vigorous exercise individually. All analyses applied Cox regression models. Intermediate and recommended exercise were seen in 24.7% and 38.1%, respectively. During a median follow-up of 25.4 years, 434 incident hospitalizations with PAD (166 critical limb ischemia) were documented. Recommended versus poor activity was associated with a lower demographically adjusted PAD risk (hazard ratio, 0.68; 95% CI, 0.54–0.85) but attenuated after accounting for lifestyle factors (hazard ratio, 0.84; 95% CI, 0.66–1.05). When analyzing moderate and vigorous exercise separately, vigorous exercise was robustly related to lower risk of hospitalization with PAD, and critical limb ischemia in particular (hazard ratio, 0.72; 95% CI, 0.54–0.97 per 200 metabolic equivalents*min/wk increment in the most extended model). Conclusions: Higher amount and intensity of physical activity were related to lower risks of hospitalization with PAD and critical limb ischemia, further highlighting the importance of engaging in physical activity for vascular health.

Original languageEnglish (US)
Article numbere013534
JournalJournal of the American Heart Association
Issue number21
StatePublished - Nov 5 2019


  • critical limb ischemia
  • peripheral artery disease
  • physical activity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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