Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease: A Science Advisory From the American Heart Association

Abstract

Patients with lower-extremity peripheral artery disease (PAD) have greater functional impairment, faster functional decline, increased rates of mobility loss, and poorer quality of life than people without PAD. Supervised exercise therapy (SET) improves walking ability, overall functional status, and health-related quality of life in patients with symptomatic PAD. In 2017, the Centers for Medicare & Medicaid Services released a National Coverage Determination (CAG-00449N) for SET programs for patients with symptomatic PAD. This advisory provides a practical guide for delivering SET programs to patients with PAD according to Centers for Medicare & Medicaid Services criteria. It summarizes the Centers for Medicare & Medicaid Services process and requirements for referral and coverage of SET and provides guidance on how to implement SET for patients with PAD, including the SET protocol, options for outcome measurement, and transition to home-based exercise. This advisory is based on the guidelines established by the Centers for Medicare & Medicaid Services for Medicare beneficiaries in the United States and is intended to assist clinicians and administrators who are implementing SET programs for patients with PAD.

Multimodal Supervised Exercise Training Is Effective in Improving Long Term Walking Performance in Patients with Symptomatic Lower Extremity Peripheral Artery Disease

“…Exercise is also beneficial for other manifestation of atherosclerotic disease, such as coronaropathy or cerebrovascular disease, as well as for many other health conditions [ 38 , 39 , 40 ], and should therefore be encouraged in all patients with PAD. Guidelines from the European Society for Vascular Medicine and the American Heart Association recommend SET whenever available with a class of recommendation of either I B and I A, respectively [ 2 , 6 , 19 , 41 , 42 ]. The main obstacle for implementing SET as routine first line management is the lack of regional availability and patient’s motivation [ 43 , 44 ].…”

“…The other two thirds of the exercise training time were performed outdoors (if the weather allowed) with Nordic walking. The patients were taught the proper way of walking with the poles and were asked to walk until reaching a level of moderate-to-severe claudication, and then paused until complete resolution of the pain, before resuming walking [ 19 ]. During Nordic walking sessions, training intensity was mainly set at 12–14 on the 6–20 Borg scale (moderate intensity).…”

“…A constant-load treadmill test was also performed at each endpoint to determine the pain-free and maximal walking distance (PFWD and MWD, respectively). PFWD was defined as the distance in meters until the onset of pain in the lower limbs, and MWD was defined as the distance until patients reached maximum claudication and stopped walking [ 19 ]. The treadmill test was performed at 3.2 km/h speed with a 12% slope.…”

Assessing health-related quality of life among patients with peripheral artery disease: A review of the literature and focus on patient-reported outcome measures

“…The initial treatment strategy is modification of cardiovascular risk factors, including smoking cessation, blood pressure and lipid control, optimizing blood sugar control, and exercise. 6 For symptomatic PAD, societal guidelines recommend a trial of medical treatment and supervised exercise therapy (SET) as first-line therapy, 7,8 with revascularization reserved for residual symptoms. 9 The Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) study, which enrolled patients with claudication, found that SET with optimal medical therapy provided comparable durable improvement in functional status and HRQoL as compared with a combination of optimal medical therapy and revascularization.…”

Importância do destreinamento físico sobre a capacidade funcional em indivíduos com doença arterial obstrutiva crônica periférica: estudo transversal piloto

“…3,5 Several different studies have compared the effects of physical training on the 6MWTD and PFWD, whether aerobic exercises, strength training, or a combination of the two, and with durations ranging from 8 to 16 weeks. [6][7][8][9][10] However, after the intervention period, patients tend to give up on physical training.…”