Impact of LLL and Aerobic Exercise on Peripheral Arterial Outcomes in Patients With Type 2 Diabetes

Body mass index (Kg/M^2): by dividing the weight by kilogram over Height by meter square.

Duplex ultrasonography of the lower extremity arteries, from common femoral to pedal arteries is used to measure PSV

• Peak systolic velocities (PSV) were recorded in meters per second (Ugwu et al., 2021).
• The normal peak systolic velocity (PSV) in peripheral lower limb arteries varies from 45-180 cm/s (Abdelrahman, 2010).

Severe arterial disease manifests as a PSV over 200 cm/s, monophasic waveform, and spectral broadening of the Doppler waveform.

• Ankle-Brachial Index (ABI) is a ratio of the highest ankle systolic blood pressure obtained in the anterior tibial/ dorsalis pedis or posterior tibial artery to that of the highest brachial systolic pressure.

An ABI < 0.9 was diagnostic of PAD and values were stratified according to severity as:

• 0.7-0.89 = mild arterial obstruction.
• 0.5-0.69 = moderate arterial obstruction.
• ≤ 0.5 = severe arterial obstruction.

The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain." Delgado etal., 2018).

• no pain (0-4 mm)
• mild pain(5-44 mm)
• moderate pain (45-74 mm)
• severe pain (75-100 mm). (Weigl K et al., 2021)

The Edinburgh Claudication Questionnaire (ECQ) Definition of positive classification requires all of the following responses: \\Yes" to (1), \\No" to (2), \\Yes" to (3), Grade 1 \\No" to (4), and Grade 2 \\Yes" to (4). If these criteria are met, a typical claudicant is one who indicates the pain is in the calf, regardless of whether the pain is also marked at other sites; a diagnosis of atypical claudication is made when the pain is marked in the thigh or buttock, in the absence of any calf pain. Subjects should not be diagnosed with claudication if the pain is indicated in the hamstrings, feet, shins, and joints, or radiates in the absence of any calf pain

The initial claudication distance (ICD), or pain-free walking distance; is the distance walked at the onset of claudication pain The absolute claudication distance (ACD), or maximal walking distance at which claudication pain becomes so severe that the patient is forced to stop (Jongert et al., 2003)

depend on Modified Bruce protocol with the treadmill. Modified Bruce protocol, the first stage at 1.7mph and 0% grade second stage at 1.7 mph 5% grade, and the third stage at 1.7 mph and 10% grade.

The test score is the time taken on the test, in minutes. This can also be converted to an estimated VO2 max score using the calculator below and the following formulas, where the value "T" is the total time completed (expressed in minutes and fractions of a minute e.g. 9 minutes 25 seconds = 9.25 minutes).

Men : VO2max (ml/kg/min) = 14.76 -(1.379 × T) + (0.451 × T²)-(0.012 × T³) Women: VO2max (ml/kg/min) = 4.38x T -3.9 (ACSM, 2023)