Peripheral vascular disease is found in older adults with history of tobacco consumption. It may present with skin discoloration, pain with exertion or at rest, and may at times need surgeries for improved blood flow or even may lead to amputations. Physicians assess it using ankle/brachial index (ABI) utilizing the ultrasound machine in the office or via more invasive studies.
There is now evidence that peripheral vascular disease is associated with falls. In a study with 367 peripheral vascular disease subjects aged 68 ± 1 years compared with 458 controls aged 67 ± 1 years balance and gait parameters were measured including single leg stance time, history of ambulatory stumbling and unsteadiness, and history of falling. Single leg stance time was 28% shorter ( p < .001) in the peripheral vascular disease group compared with controls (15.9 ± 0.9 vs 22.1 ± 1.0). History of ambulatory stumbling and unsteadiness was 86% more prevalent ( p < .001) in the peripheral vascular disease group (150/367 = 41%) than in the controls (101/458 = 22%), and history of falling was 73% more prevalent ( p < .001) in the peripheral vascular disease subjects (95/367 = 26%) than in the controls (69/458 = 15%). Within the peripheral vascular disease group several measures were related to balance and falling measures: 6-minute walk distance, self-reported ambulatory function, and daily physical activity were significantly ( p < .05), surprisingly ABI was not related ( p > .05) [Andrew W. Gardner, Polly S. Montgomery, Impaired Balance and Higher Prevalence of Falls in Subjects With Intermittent Claudication, The Journals of Gerontology: Series A, Volume 56, Issue 7, 1 July 2001, Pages M454–M458, https://doi.org/10.1093/gerona/56.7.M454]
Supervised exercise therapy, cilostazol, lipid-lowering therapy, and antiplatelet therapy increase pain-free walking distance in patients with peripheral vascular disease. The best treatment is supervised treadmill endurance training therapy, which increases maximal pain-free walking distance by up to 180 m. (Strength of Recommendation: A, based on systematic reviews of randomized controlled trials [RCTs] Am Fam Physician. 2017 Feb 1;95(3):182.). Supervised vs non-supervised three sessions per week of walking on a treadmill exercise until moderate or intense pain occurred improved the maximal walking distance, moderate effect size of 0.51 (95% confidence interval [CI], 0.24 to 0.81) and 0.69 (95% CI, 0.51 to 0.86) at six weeks and three months, respectively. A meta-analysis review article of 14 RCTs with 1,002 patients 57 to 70 years of age with PVD compared supervised exercise therapy with non-supervised exercise therapy (Fokkenrood HJ, et al. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev. 2013;(8):CD005263).
Practically, we recommend treating patients with peripheral vascular disease as those with impaired somatosensation, that is training static and dynamic balance. Of course, quit smoking, supervised-treadmill based endurance training 3 times a week with intensity of till moderate or intense pain occurs, cilostazol 50mg by mouth twice a day in addition to say simvastatin 40 mg by mouth daily and aspirin or Plavix. Multimodal assessment of course is crucial for other co-morbid conditions that may be affecting fall risk.
Please discuss this with your doctor. Information here is for educational purpose only and medical decisions may be made differently for different patients depending on their medical history.
Dr. Atanelov, MD Fall Prevention and Stroke Rehabilitation Medical Institute