The association between chronic venous disease and ...

CVD was categorized using the clinical CEAP classification [24]: C0 No visible or palpable signs of venous disease, C1 telangiectasias or ... Skiptomaincontent Advertisement SearchallBMCarticles Search DownloadPDF Research OpenAccess Published:14October2021 Theassociationbetweenchronicvenousdiseaseandmeasuresofphysicalperformanceinolderpeople:apopulation-basedstudy Suvi-PäivikkiSinikumpu1,Maija-HelenaKeränen2,JariJokelainen3,SirkkaKeinänen-Kiukaanniemi4,5&LauraHuilaja1  BMCGeriatrics volume 21,Article number: 556(2021) Citethisarticle 699Accesses 6Altmetric Metricsdetails AbstractBackgroundMusclepumpdysfunctionisanessentialcomponentofchronicvenousdisease(CVD)pathology.Agingreducesmusclestrengthwhichfurtherweakensthevenousreturn.However,theepidemiologyofCVDanditsrelationshipwiththephysicalperformanceinolderpersonsispoorlystudied.WestudiedtheprevalenceofCVDinsubjectsagedover70yearsanditsassociationprimarilywiththeShortPhysicalPerformanceBattery(SPPB)and10mwalktest.MethodsAnaccurateclinicallegexaminationwasperformedandtheClinical-Etiological-Anatomical-Pathophysiological-classification(CEAP,clinicalclassificationofchronicvenousdisorders,C1-C6)determinedbydermatologistsin552subjectsagedbetween70and93yearsbelongingtotheNorthernFinlandBirthCohort1966–Parents’Study(NFBC-PS).LinearregressionanalyseswereusedtoexaminetheassociationbetweenCVDandfunctionaltestsandanthropometricmeasurements.ResultsTheprevalenceofCVD(C1-C6)was54.3%.C1wasdiagnosedin22.1%(n=84),C2in15.2%(n=45),C3in8.2%(n=45),C4in7.8%(43),C5in0.4%(n=2)andC6in0.5%(n=3).TheprevalenceandseverityofCVDincreasedwithincreasingage(p<0.05).MalespresentedmorewithseverestagesofCVD(C4-C6)(p<0.001).SubjectswithCVDhadsignificantlylowertotalSPPBscoresandlongertimesinthe10mwalktest(p<0.001).TheassociationbetweenCVDseverityandSPPBremainedstatisticallysignificantinfemalesafteradjustingforage,bodymassindex(BMI)andnumberofchildren.The10mwalktesttimeswereassociatedwithCVDwhenadjustedforsexandagebutnotafteradjustingforBMI.ConclusionsItisrecommendedthatdetailedskinexaminationoflegsshouldbeperformedbyphysicianstreatingoldersubjectsinordertoimproveearlydiagnosisofCVD.Wehighlighttheimportanceofphysicalactivityinolderpersons-lowerlimbactivationofolderpersonswithCVDmayimprovevenousreturnandthereforepreventprogressionofCVD.WefoundanassociationbetweenCVDandgaitspeed,however,theremayexistbidirectionalrelationship. PeerReviewreports BackgroundChronicvenousdisease(CVD),includingvaricoseveinsandchronicvenousinsufficiency(CVI),isacommonmedicalconditioninadults[1,2,3].CVDaffectspeopleglobally,butismostprevalentindevelopedcountries[2,4,5].ThemostseverestageofCVDisvenouslegulcer[1].CVDhasvariousconsequencesbothfortheindividualandsociety.Venousdiseasesimpactaperson’squalityoflife(QoL)causingsymptomslikepain,weightsensation,itchinganddiminishedmobility[6].Moreover,investigationsofCVD,woundcareandhospitalizationimposeasubstantialfinancialburdenonsociety[7,8].ThemainetiologyofCVDischronicvenoushypertensionandvenousrefluxthatdevelopafterthecalf-musclepumpdysfunction[9].Inolderpersons,musclestrengthisreducedwhichthenweakensthevenousreturninvalves[10].Inaddition,physicalactivityhasotherundisputedhealthbenefitsinolderpeople:itimprovesaqualityoflife,reducesdisability,mortalityandpreventsforchronicdiseases[11,12].Inturn,lowerwalkingspeed,legstrengthandbalanceareassociatedwithhigherriskofmortalityinpersonsover70[13].However,regardlessofmultiplebenefitsofphysicalactivityolderadultsaresedentaryandhavelowlevelofphysicalactivity,especiallywomenandolderagegroups[11].ApproximationsofCVDoccurrencediffergreatlyinstudymethods,diagnosticcriteria,geographicregions,selectionofstudysubjectsandethnicity[1,2,3,4,5,7,14,15,16,17,18,19].However,subjectsinpreviousstudiesweremoderatelyyoungandepidemiologicalstudiesamongolderpersonsarelacking[4,8,20,21].Arecentinternationalsurvey(TheVeinConsultProgram),withover90000subjectsin23countries,foundclinicallysignificantCVDinapproximately70%oftheparticipants(meanage51.8years)[4]andreportedanincreaseinpredictedprobabilityofCVDwithage,beinghighestinsubjectsagedover65years.Datainthatstudywascollectedfromthepopulationvisitinggeneralpractitionersforvariousreasons.Asimilarfindingwasseeninthepopulation-basedBonnVeinStudy(n=3072,aged18to79years)inwhichtheprevalenceofCVDwashighestinsubjectsaged60to80years[15].Inthepioneeringpopulation-basedEdinburghVeinStudy(n=1566,ages18to64years)theprevalenceofvaricoseveinswas55.7%inthoseaged55to64yearsbeingsignificantlylowerinthoseagedfrom35to44years(28.8%)[20].DuetoagingoftheWesternpopulation,theprevalenceofCVDisprojectedtoincreaseinthecomingyears[2].Thus,itisalarmingthat,despiteinternationalguidelines,CVDispoorlyrecognizedbyphysicians[22,23,24].ThereisanurgentneedforimprovedawarenessofCVDanditsriskfactors.Moreover,itisimportanttohighlighttheimportanceofphysicalactivityinolderpersonsinmeanstoimprovemusclestrengthandfurtherpreventmorbidity.TheprimaryaimofthisstudywastodeterminetheprevalenceofCVDinsubjectsagedover70fromtheNorthernFinlandBirthCohort1966-Parents’Study(NFBC-PS)byusingtheClinical-Etiological-Anatomical-Pathophysiologicalclassification(CEAP,C0-C6)[24].Secondly,wewantedtostudytheassociationbetweenCVDandShortPhysicalPerformanceBattery(SPPB)and10mwalktestperformancesincepowerinlowerextremitymusclesisknowntoreducewithagingandthusweakeningofthevenousreturn.Inaddition,therelationshipbetweenCVDandbodymassindex(BMI),bodycomposition,bloodpressure,thenumberofchildren(females),socioeconomicstatus(SES),sexandlivingstatusintheolderpopulationwasexamined.MethodsStudycohort,dermatologicalexaminationandCEAPclassificationTheNorthernFinlandBirthCohort1966(NFBC1966)isanepidemiologicalandlongitudinalresearchprograminthetwonorthernmostprovincesinFinland(OuluandLapland).TheNFBC1966comprisedtheoffspringofthemothers,wholivedineitherprovinceandwhoseexpecteddeliverydatefellbetween1stJanuaryand31stDecember1966[25].ThesurvivingparentsofthesubjectsintheNFBC1966haveparticipatedinacomprehensivehealthstudycalledNFBC-PSandinvitedtotakepartinadiversehealthquestionnaire(Keränenetal.,unpublishedobservations)[26].AllparticipantslivingintheOuluarea(n=1239)werealsoinvitedtoparticipateintheclinicalexamination,includingtotalbodyskinexamination.Askinexaminationwasperformed on in552participants(346femalesand206males)andthissubpopulationwasincludedinthefinalskinstudyanalysis.TheskindatawascollectedbetweenMay2018andMarch2019onthepremisesoftheFacultyofMedicineoftheUniversityofOulu[26].Thecomprehensiveclinicalsurveyincludedathorough20-minutewhole-skinexaminationperformedbyexperienceddermatologist.Allareasoftheskinwereobservedincludingthenails,hairandscalp,withadetailedinspectionofthelegs.CVDwascategorizedusingtheclinicalCEAPclassification[24]:C0Novisibleorpalpablesignsofvenousdisease,C1telangiectasiasorreticularveins,C2varicoseveins(distinguishedfromreticularveinsbyadiameterof3mmormore),C3edema,C4changesinskinandsubcutaneoustissuesecondarytoCVD,pigmentationoreczema,lipodermatosclerosisoratrophieblanche,C5healedvenousulcerandC6activevenousulcer(Fig1).StagesC1-C3werecategorizedasmildormoderatediseaseandstagesC4-C6asseveredisease(CVIreferstoanadvancedformofCVDwithskinchangesandulceration[CEAP,severediseasesC4-C6]).Duringinspectionofthelegs,subjectswerestandingonaplatformwiththeirfeetinthreestandardpositions:facingtheexaminerwithheelstogetherandfeetspreadwideapart,facingawayfromtheexaminerinasimilarposition,andfacingawayfromtheexaminerwithfeetparallelasintheEdinburghVeinStudy[20].Subjectsremainedinastandingpositionforatleasttwominutesbeforeexaminationoftheirveins,toallowbloodtopoolinthelegs.Allsignsofvaricoseveinsandskinfindingswererecorded.Fig1Skinfindingsinchronicvenousdisease(clinicalCEAPclassificationinparenthesis).A edemaandvaricoseveins(C3)B stasisdermatitis(C4)C healedvenousulcer,post-inflammatorypigmentationandlipodermatosclerosis(C5)D activevenousulcer(C6).FullsizeimageTheShortPhysicalPerformanceBattery(SPPB),10mwalktestandanthropometricmeasurementsTheShortPhysicalPerformanceBattery(SPPB)includedthechairstand,gaitspeedandbalancetests[27].TheSPPBwascalculatedaccordingtoliteraturestandards[27].ThetotalscoreofSPPBrangedfrom0to12whileeverysub-testrangedfrom0(worstperformance)to4(bestperformance).Thestudynursefirstdemonstratedeachtestforparticipants.Totesttheabilitytostandupfromthechair,studymemberswereaskedtoholdtheirarmsontheirchest,risefromthechairandsitdownagainfivetimesasquicklyaspossible.Thebalanceteststartedwithasemitandemposition,inwhichtheheelofonefootwasplacedtothesideofthefirsttoeoftheotherfootwiththeparticipantchoosingwhichfoottoplaceforward.Thetimingwasstoppedwhenthestudymembermovedtheirfeetorwhen10secondswaselapsed,whicheverwassooner.Thosewhowereabletoholdasemitandempositionwerefurtherevaluatedbyabalancetestintandemposition.Thoseunabletoholdasemitandempositionwereaskedtodoatestwiththefeetinasidebysideposition.Inthegaitspeedtest,participantswereinstructedtowalk4minaspaciouscorridor.Distanceswereprovidedatthebeginningandendofthetimedwalkwaytoallowparticipantsspacetoaccelerate/decelerateoutsidethedatacollectionarea.Participantswereinstructedto“walkatyourcomfortable,usualpace”untiltheyreachedtheendofthemarkedpath.Thetimetaken,inseconds,forthe4mwalktestwasrecorded.The10mwalktestfollowedthesameprocedure.Theclinicalexaminationincludedbodyweightinlightclothing,measuredwithadigitalscale.Heightwasrecordedasthemeanoftwomeasurementsusingastandardcalibratedstadiometer.Bodymassindex(BMI)wascalculatedastheratioofweighttoheightsquared(kg/m2).Bodycompositionwasanalyzedbymultifrequencybioelectricimpedanceanalysis(BIA;InBody960,Biospace,Seoul,Korea).Studyparticipantswereclassifiedintofivegroups,basedontheirBMI,accordingtoWHOcriteria:underweight(<18.5),normal(18.5–25),overweight(25–30),obese(30–35)andseverelyobese(>35).Systolicanddiastolicbloodpressurewasmeasuredthreetimesaminuteapartafter15minutesofrestontherightarmofseatedparticipantsusinganautomatedoscillometricbloodpressuredeviceandappropriatelysizedcuff(OmronDigitalAutomaticBloodPressureMonitorModelM10-IT,Japan).Themeanofthethreesystolicanddiastolicvalueswasusedintheanalyses.Testresultswererecordedbyauthorizedstudynurses.Self-reportedquestionnairesandmedicalhistoryTheSESofthestudysubjectswasdefinedaseducationallevel[28].Thestudycaseswereclassifiedintothreesubgroupsaccordingtotheirhighestlevelofeducation:1)primaryschool,2)secondaryschooland3)post-secondaryleveleducation/vocationalcollege/university.Informationoneducation,livingstatus(aloneorwithaspouse/otherfamilymember),andpossibleriskfactorsforCVD(thenumberofchildrenandcomorbidities;historyofcongestiveheartfailure,atherosclerosisofnativearteriesoftheextremities,diseasesofthemusculoskeletalsystemandconnectivetissue)wereself-reportedinhealthquestionnaires.Patientrecords(historyofpreviousdeepvenousthrombosis,previousinterventionalmanagementofCVDandhipfraction)wereobtainedfromtheFinnishCareRegisterforHealthCare,maintainedbytheNationalInstituteofHealthandWelfare,andselectedbydiagnosesbasedontheInternationalClassificationofDiseases(ICD-10codesI80.0,I80.1,I80.20,I80.29,I80.3,I80.8,I80.9,S72.0andinterventioncodesPHB76-78,PHD78,PHM76-79,PHN75,PHS78,PHT99,PHW96,TPH10,PH2AC,PH2AE,PH2BC)(Supplementarydata).StatisticalmethodsChi-squaredtest,T-testorANOVAwereusedtodescribethecategoricalandcontinuouscharacteristicsofthestudysample,respectively.Linearregressionanalysesadjustedforage,genderandBMIwereperformedtostudyassociationsofCVDseverity(mildC1-C3orsevereC4-C6)withtheSPPBscoreandtimespentonthe10mspeedtestasdependentvariable.Inaddition,forfemalestheanalyseswereadjustedforthenumberofchildren.Regardingtohistoryofself-reporteddiseases(thehistoryofcongestiveheartfailure,atherosclerosisofnativearteriesoftheextremitiesanddiseasesofthemusculoskeletalsystemandconnectivetissue)therewasnotstatisticaldifference(p-value>0.05)betweenthosewithoutCVD(C0)andwithCVD(C1-C6)whichisthereasonthesewerenotincludedtotheadjustedmodel.ThelinearityassumptionwascheckedbyinspectingtheResidualsvsFittedplot,andtheQ-Qplotofresidualswasusedtovisuallycheckthenormalityassumption.TheinteractionbetweenSPPBCVDandsexwasassessed,andmodelsweremadeseparatelyformalesandfemales.P-values<0.05wereconsideredstatisticallysignificant.AnalyseswereperformedusingR,version4.0.2(https://www.R-project.org/).EthicalapprovalTheEthicalCommitteeoftheNorthernOstrobothniaHospitalDistrictapprovedthestudy(115/2012)whichwasperformedaccordingtotheprinciplesoftheHelsinkiDeclarationof1983.ResultsThemean(SD)ageatthetimeoftheskinstudywas78.4(4.18),witharangeof70–93years.SubjectdemographicsarepresentedinTable1.Table1Demographicsofstudyparticipants(n/%,unlessotherstated)FullsizetableAccordingtotheclinicalexaminationtheprevalenceofCVD(CEAPC1-C6)was54.3%inthesample.Table2summarizesthesex-andage-specificpercentagedistributionsofCVD.BoththeprevalenceofCVDandthediseaseseverityincreasedwithage(p<0.01).CVDaffectedmorefemalesthanmalesbutmaleshadahigherrateofseveredisease(p<0.01).ThedemographiccharacteristicsandphysicalperformancetestresultsbetweenthreegroupsdividedbyCEAPseverityclassificationareshowninTable2.SPPBscoresshowedasignificantassociationwithCEAPclassification.ThetotalscoreinSPPB(from0to12)wassignificantlylowerinthosewithCVDwhencomparedwiththosewithaC0classification(p<0.001)andthetotalscoredecreasedwithincreasedCVDseverity.TherewasnosignificantdifferenceinthegradeofCVDbetweengroupsbasedonthe4mspeedtestwhereasadifferencewasdemonstratedinthe10mspeedtest(p<0.05).ThosewithCVDhadalsomorevenousinterventionsandvenousthrombosisintheirhistorythanthosewithoutCVD(C0)(p<0.05).SubjectswithCVDpresentedwithhigherweight,heightandBMI.CVDseverityincreasedbytheincreasingbodyfatmass(p<0.01,Table2).Ingenderspecifiedanalyses,thiswasseenonlyinmales(p<0.01,Table3).HigherskeletalmusclemassassociatedwiththeCVDseverityinmales(C0vsC1-C6,p<0.01)(Table3).Table2ClinicalCEAPclassificationbysubjectdemographicsandfunctionaltestsFullsizetableTable3ClinicalCEAPclassificationbybodycompositionmeasurementsinbothsexaFullsizetableAsshowninTable4,theassociationbetweenSPPBandsevere(C4-6)CVDremainedstatisticallysignificantinfemalesafteradjustingforBMI,ageandnumberofchildren(whencomparedwiththegroupC0).Inmalesthecorrespondingassociationdisappearedafteradjusting.Inthe10mspeedtesttherewassignificantassociationbetweenCVDafteradjustingforsexandage(datanotshown).However,theassociationdisappearedafteradjustingforBMI.Table4AssociationbetweenclinicalCVDandSPPBor10mwalktestFullsizetableDiscussionOurclinicalandcross-sectionalstudyisthefirsttodeterminetheprevalenceofCVDinapureagedpopulationbyusingtheclinicalCEAPclassification.ResultsfromthisstudyconfirmthatCVDiscommoninolderindividuals,affectingeveryotherpersonagedover70years.Inaddition,wefoundthatseveretypesofCVDbecamemorecommonwithincreasingage.CVDwasmoreprevalentinfemaleswhencomparedwithmaleswhereasthemostseverestagesofCVDwerepredominantlyseeninmales.Tobestofourknowledge,thisisthefirststudyinwhichtheassociationbetweenphysicalperformancetests(SPPBand10walktest)andCVDwasresearched.IntheseanalyseswefoundthatfunctionallimitationsinolderpersonswereclearlyassociatedwithCVDanditsseverity.OtherstudiesshowingthattheprevalenceofCVDincreaseswithageareinlinewithourstudy[1,2,3,4,15,16,17,18,19,21,29].Nevertheless,previousstudieshavehadsomelimitations:subjectshavebeenratheryoung,ordataontheage-specificprevalenceofCVDhavebeenincompleteandthustherealprevalenceofCVDintheolderpopulationhasstayedlargelyunknown.Inaddition,diagnosticcriteriahavevariedbetweenstudieswhichmakescomparisonwiththepresentstudydifficult.TheEdinburghVeinStudyusedamodifiedCEAPindiagnosingCVDandreporteda25%and12%prevalenceofCVIinmaleandfemalesubjects,respectively,inpatientsaged55to64years[18].TheVeinConsultProgramusedsolelytheC-classificationwithoutultrasoundindiagnosis,correspondingwithourstudymethod.ThislargestudyreportedtheprevalenceofCVItobe26%(themeanageofthestudypopulationwas51.8years)[4].Bycomparison,theprevalenceofCVI(CVDstages4-6)was45%inthecurrentstudy,anobservationmostlikelyexplainedbythehighermeanage(71.8years)inourstudy.ElderlysubjectshavemanyriskfactorsforCVD:multimorbidity,immobility,poornutritionandweakenedhealingprocessesallincreasetheriskofvaricoseveins,skinchangesandothervenousalterationswhichfurtherpredisposesindividualsforchroniclegulcers[30].ThusitisunderstandablethatnotonlytheprevalencebutalsotheseverityofCVDincreaseswithage,asalsoseeninthepresentstudy[1,4].ThesocioeconomicimpactofCVDinoldersubjectsissubstantialbecauseofreducedqualityoflife.Heavinessoflegs,itching,afeelingofswellingandcrampsarecommonsymptomsinCVDpatientsandcomplicatedailyactivities.VenousulcersarethemostunwantedendpointofCVD.Ulcersareoftenpainfulandkeepsufferersfromengaginginsocialactivities,leading,intheworstcases,todepression[2].Qualityoflifeinpatientswithvenousulcerationhasbeenreportedtobepoorandcomparabletothatofpatientswithcongestiveheartfailureorchroniclungdisease[2].CVDalsoimposesasignificantburdenonhealthcaresystems.CurrentlyCVDconsumes2%ofhealthcarebudgetsintheUS[2].Withanageingpopulation,itisunavoidablethatthenumberofseriousCVDeventsisgoingtoincrease.Inthisstudy,theassociationbetweenphysicalperformanceandCVDwassurveyedbyusingtheSPPBandthe10mwalktest.SPPBisacomprehensiveandobjectivetooltoevaluatelowerextremityphysicalperformancestatusandfunctionalcapability[27].TheSPPBhasbeenselectedfromseveralobservationalstudiesandithassuggestedtobeahighlysensitiveindicatorofhealthstatusandanindicatorofvulnerabilitythuspredictingalsoall-causemortality[27,31].Inaddition,theSPPBiseasytoperform[31].Similarly,walkingspeed(the10mwalktestusedinthisstudy)isawidelyusedobjectivemeasureoffunctionalmobility;ithasbeenusedtomeasuretheassociationbetweenhealth-relatedoutcomes,disability,falls,hospitalizationandmortality[32].InterestinglywefoundthatthetotalscoreofSPPBwassignificantlylowerinthosewithCVDwhencomparedwiththosewithC0.Moreover,thetotalSPPBscoredecreasedwithincreasingseverityofCVD.Similarly,thetimetakenforthe10mwalktestincreasedwithCVDseverity.Anessentialcomponentofvenouspathology–besideshypertensionandvalvularincompetence–ismusclepumpdysfunction,asdemonstratedinseveralstudiesofpatientswithCVI[10,33,34,35].DuringtheagingprocessmusclemassdeclinesbecauseofatrophyintypeIImusclefibers[36].Weakenedcalfandthighmusclemassworsensvenousreturn[10,37].Previously,therelationshipbetweenlower-extremitymusclestrengthandCVDhasonlybeenresearchedinafewstudieswithrathersmallsamplesizes[10,38,39,40].AllthesestudiesdemonstratedthatcalfmuscleenduranceisweakenedinthosewithCVI.However,morefutureresearchwithlargersamplesizesandrelevantclinicaloutcomemeasureshasbeencalledfor[38].Asfarasweknow,thisisthefirststudywheretheassociationbetweenSPPBandCVDoritsseverityhasbeenstudied.Varicoseveins(C1-C2)affectmorefemaleswhencomparedwithmales[41,42,43].Ahighernumberoffulltermpregnanciesisasignificantriskfactorforvaricoseveins[44],partlyexplainingthedifference.Ithasalsobeenspeculatedthatsexsteroidhormoneconcentrationscouldplayaroleinthedevelopmentofvaricoseveins[45]butinturn,theuseoforalcontraceptivesorhormonereplacementtherapyhavenotshowedundisputedriskforvaricoseveins[46].WestudiedalsotheassociationbetweenbodycompositionandCVDseparatelyinbothsex.WefoundthatinmalesthosewithoutCVD(C0)hadhigherskeletalmusclemassthanthosewithCVD(C1-C6).InmalestheincreasingseverityofCVDwasassociatedwiththeincreasingbodyfatmasstoo.Correspondenly,femaleswithoutCVDpresentedwithhigherpercentageskeletalmusclemasswhencomparedwiththosewithCVDbutthedifferencedidnotreachstatisticalsignificance.However,thereisnoconsistentunderstandingastowhetherthemoreseverestageofCVDaremorecommoninfemalesormales[15,19,47].Inthepresentstudywefoundthat,overall,femalesubjectspresentedmorefrequentlywithCVDbutthattheseverestagesweremoreprevalentinmales.WhenotherriskfactorsofCVDweretakenintoaccountwedemonstratedthatCVDwasassociatedwithahistoryofvenousinterventionsandvenousthrombosis.SimilarlytheincreasingnumberofchildrenhadrelationshipwiththeCVDseverity,althoughtheresultwasnotstatisticallysignificant.Themajorstrengthsofthisstudyaretwofold:apuregeneralpopulationofolderpeopleandamoderatelygoodsamplesize.OurstudyaddssignificantlytotheknowledgeofCVDinagedindividuals,whichhasbeenmuch-needed.TheclinicalCEAPclassificationwasusedinthisstudyasrecommendedbyclinicalpracticeguidelines[3].TheclinicalexaminationoflegswasperformedbyexperienceddermatologistswhoarebestqualifiedtodifferentiatethedermatologicalfindingsofCVDfromotherdermatologicaldiseases.Inaddition,interobserverreliabilitywastestedbetweenthetwomainresearchers(SPS,LH)anditsdegreewashigh[48].TheSPPBand10mwalktestwerechosenasanindicatorofmusclestrengthastheymeasurefunctionallimitationsinolderpersonsandhavebeenusedtoidentifypeopleatgreaterriskformortalityanddisability.Thesefunctionaltestswereperformedbytrainednursesinsteadofself-reportinginformation.TheuseofobjectivemeasuresliketheSPPBarepreferredinolderpeoplebecauseself-reportingisvulnerabletoinherentbiasandinaccuracy[49].AsalimitationofthestudyweacknowledgethatnoduplexultrasoundwasperformedtoverifyclinicaldiagnosesofCVD.However,theclinicalCEAPisaninexpensivemethod,easytodoandavailabletoallphysicians.Inaddition,notallofthestudycasesinvitedchosetoparticipatewhichmayhaveledtoselectionbias.ConclusionsAsaconclusion,wehighlighttheimportanceofdermatologicalevaluationofthelowerextremitiesforolderpeople.SkinexaminationenablestheearlyidentificationofCVDandenhancestheprospectsofoptimaltreatment.OldersubjectswithclinicalsignsofCVDshouldbeevaluatedtoassesstheirneedforfurtherinvestigations[50,51].Theyshouldbeinstructedabouttheuseofcompressionbandswheneverpossibleandproperfootcareasmeanstodiminishsymptomsandpreventtheprogressionofchroniculcers.Inaddition,whilephysicalactivityhasitsevidentbenefitsforhealthwerecommendlowerlimbactivationforolderpersonswithCVDbecauseitmightimprovethevenousreturnandthereforepreventtheprogressionofCVD. Availabilityofdataandmaterials ThedatathatsupportthefindingsofthisstudyareavailablefromNorthernFinlandBirthCohort1966Study.Restrictionsapplytotheavailabilityofthesedata,whichwereusedunderlicenseforthisstudy.Dataareavailableathttp://www.oulu.fi/nfbc/node/44315withthepermissionofNorthernFinlandBirthCohort. 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ReprintsandPermissionsAboutthisarticleCitethisarticleSinikumpu,SP.,Keränen,MH.,Jokelainen,J.etal.Theassociationbetweenchronicvenousdiseaseandmeasuresofphysicalperformanceinolderpeople:apopulation-basedstudy. BMCGeriatr21,556(2021).https://doi.org/10.1186/s12877-021-02528-9DownloadcitationReceived:17March2021Accepted:29September2021Published:14October2021DOI:https://doi.org/10.1186/s12877-021-02528-9SharethisarticleAnyoneyousharethefollowinglinkwithwillbeabletoreadthiscontent:GetshareablelinkSorry,ashareablelinkisnotcurrentlyavailableforthisarticle.Copytoclipboard ProvidedbytheSpringerNatureSharedItcontent-sharinginitiative KeywordsOlderpeopleChronicvenousdiseaseShortPhysicalPerformanceBattery(SPPB)10mwalktestLegulcer DownloadPDF Advertisement BMCGeriatrics ISSN:1471-2318 Contactus Submissionenquiries:[email protected] Generalenquiries:[email protected]