A Systematic Review of Exercise Prescription in Patients with Intermittent Claudication: Does Pain Matter?

Seed, Sally A; Harwood, Amy; Sinclair, Jonathan Kenneth; Pymer, Sean; Caldow, Edward; Ingle, Lee; Egun, Anselm; Birkett, Stefan T

doi:10.1016/j.avsg.2021.06.025

Cited by 9 publications

(5 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, others have reported that improvements in walking performance may be obtained with less severe claudication pain during exertion 101 . According with recent findings, walking training with pain is not clearly 20 superior to walking training without pain regarding changes in walking distances [109][110][111][112] .…”

Section: Supervised Exercise Trainingmentioning

confidence: 93%

“…It may be assumed that walking training with moderate, low, or no pain is associated with higher compliance and possibly long-term maintenance of training or change in activity behaviour 112 . This indicates that a more flexible approach to exercise prescription may therefore be required, considering the patient's needs and preferences, and what might achieve a high level of (long term) adherence.…”

Section: Supervised Exercise Trainingmentioning

confidence: 99%

See 1 more Smart Citation

Exercise therapy for chronic symptomatic peripheral artery disease

Mazzolai,

Belch,

Venermo

et al. 2024

Vasa

View full text Add to dashboard Cite

Summary: All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.

show abstract

Section: Supervised Exercise Trainingmentioning

confidence: 93%

Section: Supervised Exercise Trainingmentioning

confidence: 99%

Exercise therapy for chronic symptomatic peripheral artery disease

Mazzolai,

Belch,

Venermo

et al. 2024

Vasa

View full text Add to dashboard Cite

show abstract

“…13 A recent systematic review also suggests pain-free SEPs elicit similar improvements in walking performance and functional outcomes compared to moderate pain. 14 The missed consideration of pain-free SEPs and high claudication pain prescription may lead to poor uptake, as high claudication pain has been commonly cited as a barrier to exercise adherence and uptake of SEPs. 15,16 Indeed patients taking part in a low pain SEP where 1.52 times more likely to complete the SEP than those in the high pain SEP. 16 As SEPs are the first line of treatment for patients with PAD, guidelines must ensure greater participation occurs; consequently, patient ability and preference should be considered, so it is tolerable and beneficial for all patients.…”

Section: Introductionmentioning

confidence: 99%

“… 13 A recent systematic review also suggests pain-free SEPs elicit similar improvements in walking performance and functional outcomes compared to moderate pain. 14 …”

Section: Introductionmentioning

confidence: 99%

What is the correct level of claudication pain to prescribe? Universal inconsistency within guidelines, a painful issue

et al. 2023

Self Cite

View full text Add to dashboard Cite

“… 16 As such, it remains unclear which level of claudication is optimal for improving walking performance in patients with IC. 21 The aim of this trial is to directly compare the effects of exercise prescribed at different levels of claudication [pain-free (PF), moderate pain (MOD-P) and maximal pain (MAX-P)] on (1) maximal and pain-free walking distance; (2) adherence; (3) acceptability, tolerability and enjoyment of the exercise intervention; (4) walking behaviour and physical activity; and (5) barriers and quality of life. It is cautiously expected that maximal pain will lead to greatest improvements in walking performance.…”

Section: Introductionmentioning

confidence: 99%

Effects of exercise prescribed at different levels of claudication pain on walking performance in patients with intermittent claudication: a protocol for a randomised controlled trial

Birkett

Sinclair

Seed

et al. 2022

Therapeutic Advances in Cardiovascular Disease

Self Cite

View full text Add to dashboard Cite

Background: Peripheral artery disease affects over 236 million people globally and the classic symptom is intermittent claudication (IC) which is associated with reduction in physical activity. The evidence that supervised exercise programmes (SEPs) improve pain-free and maximal walking distance is irrefutable. However, adherence rates are low with exercise-related pain cited as a contributing factor. National and international guidelines recommend exercising at a moderate to maximal level of claudication pain to improve walking ability; however, exercising pain-free or at mild claudication pain has been shown to achieve this outcome. There is limited evidence that compares the relative effects of exercise prescribed at different levels of claudication pain. Objective: The objective of this study is to directly compare the effects of exercise prescribed at three different levels of claudication pain on walking performance. Design: This study will be a single-centre randomised controlled trial. Methods: Based on an a priori power calculation, 51 patients with IC will be allocated to 24 weeks of twice-weekly pain-free (PF), moderate pain (MOD-P) or maximal pain (MAX-P) exercise. The PF group will cease exercise at the onset of claudication (1 on the 0–4 IC rating scale), the MOD-P group will stop once moderate pain is reached (2 on the rating scale) and the MAX-P group will stop once maximal pain is reached (4 on the rating scale). Analysis: Outcome measures will be assessed at baseline, 12 and 24 weeks adopting an analysis of covariance (ANCOVA) to compare MWD across three time points. The primary outcome for the trial will be change in maximal treadmill walking distance at 12 and 24 weeks. Registration: Trial registration number: NCT04370327.

show abstract

A Systematic Review of Exercise Prescription in Patients with Intermittent Claudication: Does Pain Matter?

Cited by 9 publications

References 41 publications

Exercise therapy for chronic symptomatic peripheral artery disease

Exercise therapy for chronic symptomatic peripheral artery disease

What is the correct level of claudication pain to prescribe? Universal inconsistency within guidelines, a painful issue

Effects of exercise prescribed at different levels of claudication pain on walking performance in patients with intermittent claudication: a protocol for a randomised controlled trial

Contact Info

Product

Resources

About