Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or ‘self-facilitated’ exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.

Background In the United Kingdom (UK), exercise intensity is prescribed from a fixed percentage range (% heart rate reserve (%HRR)) in cardiac rehabilitation programmes. We aimed to determine the accuracy of this approach by comparing it with an objective, threshold-based approach incorporating the accurate determination of ventilatory anaerobic threshold (VAT). We also aimed to investigate the role of baseline cardiorespiratory fitness status and exercise testing mode dependency (cycle vs. treadmill ergometer) on these relationships. Design and methods A maximal cardiopulmonary exercise test was conducted on a cycle ergometer or a treadmill before and following usual-care circuit training from two separate cardiac rehabilitation programmes from a single region in the UK. The heart rate corresponding to VAT was compared with current heart rate-based exercise prescription guidelines. Results We included 112 referred patients (61 years (59–63); body mass index 29 kg·m–2 (29–30); 88% male). There was a significant but relatively weak correlation ( r = 0.32; p = 0.001) between measured and predicted %HRR, and values were significantly different from each other ( p = 0.005). Within this cohort, we found that 55% of patients had their VAT identified outside of the 40–70% predicted HRR exercise training zone. In the majority of participants (45%), the VAT occurred at an exercise intensity <40% HRR. Moreover, 57% of patients with low levels of cardiorespiratory fitness achieved VAT at <40% HRR, whereas 30% of patients with higher fitness achieved their VAT at >70% HRR. VAT was significantly higher on the treadmill than the cycle ergometer ( p < 0.001). Conclusion In the UK, current guidelines for prescribing exercise intensity are based on a fixed percentage range. Our findings indicate that this approach may be inaccurate in a large proportion of patients undertaking cardiac rehabilitation.

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Background and Objectives: Intermittent claudication (IC) is the most common symptom of peripheral arterial disease, which significantly affects walking ability, functional capacity and quality of life. Supervised exercise programmes (SEP) are recommended as first line treatment, but recruitment and adherence rates are poor. The time required to complete a SEP is the most common barrier to participation cited by patients who decline. High-intensity interval training (HIIT) is more time efficient than current SEP's and therefore has the potential to overcome this barrier.We conducted a systematic review to appraise the evidence for HIIT programmes for IC.Data Sources and Review Methods: MEDLINE, Embase and CENTRAL databases were searched for terms related to HIIT and IC. Randomised and non-randomised trials that investigated HIIT for the treatment of IC were included, with no exclusions based on exercise modality, protocol or use of a comparator arm. Outcome measures were walking distances, peak oxygen uptake, recruitment and adherence rates and quality of life. Risk of bias was assessed using the Cochrane tool and study quality using a modified PEDro scale.Results: 9 articles reporting 8 studies were included in the review. HIIT appears to improve walking distances and oxygen uptake in relation to controls, with improvements attainable in just 6 weeks. When HIIT was compared to low-intensity exercise, it appeared that longer low-intensity programmes were required to obtain similar benefits to those from short-term HIIT. Conclusion:Initial evidence suggests that HIIT may provide benefits for IC patients.initially, pilot studies of low-volume, short-term HIIT versus usual SEP's are required. This will allow for larger randomised controlled trials to be appropriately designed and adequately powered to further explore the potential benefits of HIIT in IC.