Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners

Abstract

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.

Partial home confinement during the COVID-19 pandemic, physical function, and physical activity in patients with symptomatic lower extremity peripheral artery disease

“…This has severely increased physical inactivity, generating a rapid unfavorable neuromuscular and cardio-metabolic condition leading to decreased physical function. 1 As exercise is first-line therapy in symptomatic patients with symptomatic lower extremity peripheral artery disease (PAD), [2][3][4][5] these individuals could be particularly affected during the COVID-19 pandemic.…”

“…Therefore, these results suggest a greater impact of partial confinement on aerobic capacity and walking endurance. Some limitations exist: (1) our sample size was small; (2) there was a variation in the post-partial confinement assessment in relation to the previous SET period; (3) it cannot be ruled out that our findings in the SG were merely due to natural deterioration in physical function over time; (4) physical activity data were not objectively measured and a non-validated questionnaire was used; and (5) data on self-reported physical activity and walking for exercise are lacking for the COMP group.…”

Intensity-dependent effects of exercise therapy on walking performance and aerobic fitness in symptomatic patients with lower-extremity peripheral artery disease: A systematic review and meta-analysis

“…1,2,4,16 The clinical benefits of SET for patients with PAD are well established, with improved walking capacity and an improved quality of life as the primary outcomes. 4,16,[22][23][24][25][26][27] Although without clear consistency, 16 the guidelines give recommendations in terms of claudication pain severity, SET volume, duration, and frequency. 1,4,[28][29][30][31] However, no or little guidance is offered as far as training intensity is concer ned.…”

Evidence-Based Recommendations for Medical Management of Peripheral Artery Disease

“…This review does not focus on the management of the leg symptoms of PAD, such as intermittent claudication. Readers are referred to previously published reviews on exercise therapy and revascularization used to treat the leg symptoms of PAD [31][32][33] .…”