In peripheral artery disease, diabetes is associated with reduced physical activity level and physical function and impaired cardiac autonomic control: A cross-sectional study

Background: Diabetes has been considered one of major risk factor for peripheral artery disease (PAD). Interestingly, the influence of diabetes in daily physical activity levels and cardiovascular function in PAD patients is poorly known.Objective: To analyze the influence of diabetes in physical activity levels, physical function and cardiovascular health parameters in patients with PAD and claudication symptoms. Methods: Cross-sectional study including a sample of 267 PAD patients, being 146 non-diabetic and 121 diabetics. Physical activity levels were objectively measured by accelerometer, and the time spent in sedentary (0-100 counts/min), light (101-1040counts/min) and moderate-vigorous (≥ 1041 counts/min) physical activities were obtained. Physical function assessment included six-minute walk test, handgrip strength test and short physical performance battery. Cardiovascular health parameters were brachial blood pressure, heart rate variability, and arterial stiffness. Results: Diabetic PAD patients spent more time in sedentary behavior [p=0.001, effect size (ES)=0.234], and less time in light (p=0.003, ES=0.206), and moderate to vigorous physical activities (p<0.001, 0.258) than non-diabetic PAD patients. Diabetic PAD patients presented lower six-minute walking distance (p=0.005, ES=0.194) and impaired cardiac autonomic modulation [Standard deviation of all NN intervals (SDNN) p<0.001, ES=0.357; Square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) p<0.001, ES=0.280; and NN50 count divided by the total number of all NN intervals (pNN50) p<0.001, ES=0.291] in comparison with non-diabetic PAD patients. After adjustment for confounders, diabetes remained associated with sedentary behavior (p=0.011), light physical activity (p=0.020), moderate to vigorous physical activity (p=0.008), six-minute walking distance (p=0.030), SDNN (p<0.001), RMSSD (p=0.004), and PNN50 (p=0.004). Conclusion: In conclusion, diabetic PAD patients presented lower physical activity levels, reduced physical function and impaired autonomic modulation compared to non-diabetic PAD patients.