Exercise Therapy for Claudication: Latest Advances

Abstract

Opinion statement Peripheral artery disease (PAD) creates a significant national and international healthcare burden. A first line treatment for PAD is supervised walking exercise in hospitals and clinics. Specifically, supervised walking exercise seeks to improve the classic symptom associated with PAD, intermittent claudication (IC), which is characterized by cramping, aching and pain of the muscles in the lower extremities during walking. While effective, supervised walking exercise is often not prescribed or utilized due to a number of treatment barriers such as lack of transportation to clinical centers and lack of insurance reimbursement. Walking exercise in community settings is an option that has gained attention due to the limitations of supervised walking exercise, as community walking is generally more convenient in terms of a patient’s schedule and may circumvent potential barriers such as treatment cost and transportation difficulties. However, more research is needed to improve the effectiveness of community-based walking programs since far less is known about the optimal structure of such programs. Other exercise therapy options are becoming available for PAD patients in addition to walking exercise. These modalities include but are not limited to leg and arm ergometry, polestriding and resistance training. These exercise therapy options have not to date been as well validated as supervised walking exercise. However, they may potentially be used in the event supervised walking exercise is not feasible or patient preference warrants an alternative exercise strategy.

Combined Aerobic and Resistance Exercise in Walking Performance of Patients With Intermittent Claudication: Systematic Review

“…The usual care approach, have a trend to deteriorate walking performance, considering that PAD is a progressive atherosclerotic disorder that deteriorates over time. These findings are in agreement with several randomized controlled trials and systematic reviews that compared supervised walking exercise to unsupervised exercise and usual care programs (McDermott et al, 2009;Hamburg and Balady, 2011;Vascular Disease Foundation, 2012;Mays and Regensteiner, 2013;McDermott, 2013;Lane et al, 2017).…”

“…Thereby, the promotion of exercise training in patients with PAD and IC is an important non-pharmacological strategy to treat and prevent this disease, which provides favorable systemic vascular effects that may reduce cardiovascular events and improve blood perfusion in PAD (McDermott et al, 2009). Supervised exercise programs have a higher efficacy in improving the physical fitness in particular the walking performance (i.e., claudication onset distance [COD], absolute claudication distance [ACD] or maximal walking distance [MWD]) and the symptomatology of this disease when compared to unsupervised exercise programs (McDermott et al, 2009;Mays and Regensteiner, 2013;McDermott, 2013). However, a recent meta-analysis found that structured home-based exercise programs are effective at improving walking performance in patients with PAD (Golledge et al, 2019).…”

The Impact of Walking Exercises and Resistance Training upon the Walking Distance in Patients with Chronic Lower Limb Ischaemia

“…It is recommended that a session includes three series of 8–12 repetitions of each exercise for each lower limb muscle group. A recess between the series of exercises should be 1-2 minutes [1, 7, 23, 26, 27]. …”

Consensus recommendations for essential vascular care in low- and middle-income countries

“…Given its low-cost and proven effectiveness, physiotherapy for cardiovascular health and/or claudication is essential at the first-level hospital. 46 …”