Implementing a community-based structured exercise programme for patients with peripheral arterial disease in conjunction with an existing cardiac rehabilitation service results in better outcomes

Abstract

Structured exercise has been shown to improve intermittent claudication symptoms in patients with peripheral arterial disease, and the National Institute for Health and Care Excellence recommend it as a first-line treatment. A community-based podiatry-led lower limb arterial assessment service implemented a structured exercise programme for claudicants by liaising with a cardiac rehabilitation team to incorporate claudicants into an existing exercise programme for cardiac patients, thus using the skills, manpower and facilities already in place. Key findings of an audit of the first 12 months were: (1) higher than average uptake by claudicants compared with other supervised exercise programmes; (2) 72% reported an improvement in claudication symptoms; (3) 24% reported no deterioration in walking distance; (4) only 17% of patients were referred on for a surgical opinion on completion of the programme: prior to the community-based exercise programme all claudicants were seen in secondary care for assessment before being offered hospital-based structured exercise; (5) high level of patient satisfaction. Patients were supported to address modifiable cardiovascular risk factors such as smoking cessation, weight management, increasing physical activity and commencing best medical therapy. The audit indicates a high level of patient satisfaction, improvement in claudication symptoms and prevention of unnecessary surgical referrals. Patients were empowered to take ownership of their cardiovascular health. This has implications for financial savings and better use of resources and may contribute to a long-term reduction in cardiovascular-related morbidity and mortality, although further research into long-term outcomes should be considered. Br J Diabetes 2016;16:193-197

Lower limb vascular assessment techniques of podiatrists in the United Kingdom: a national survey

“…There are current examples of the effectiveness of such changes in improving lower limb vascular assessment and management. These relate to Podiatry-led PAD services emerging in the UK, in which vascular trained podiatrists and vascular nurses are working together to provide local population PAD assessment, diagnosis, triage and management, in partnership with GPs and Vascular teams [20, 21]. These services, whilst small in number, are both clinically and cost effective, having been endorsed as best practice models nationally by NICE and are a successful strategy for improving lower limb vascular management in podiatry practice.…”

Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care

“…The new MPPG-based PAD device uses an automated portable diagnostic technology developed by a North East England device development team (NIHR i4i funded project: II-C1–0412-20,003) which aims to improve on current diagnostic accuracy, reduce test speed and is simple to use by a range of health care practitioners in primary care. It is aimed to be used at the first patient contact and to identify patients that need either reassurance, primary prevention of cardiovascular risk factors or onward referral for specialist intervention [15] and ultimately to reduce unnecessary referrals [17]. This is particularly important when current guidance is a default referral strategy to a vascular surgeon if there is doubt about the diagnosis [18, 19].…”

Exercise training in heart failure

“…Improved achieved metabolic equivalents (METS) also offers prognostic benefit, with an increase of one MET achieved during a 12-week rehabilitation programme associated with a 13% reduction in overall mortality 48. VO 2Max and METS are the two main parameters, used in prescribing training intensity during endurance exercise, with the heart rate recovery and Borg Rating of Perceived Exertion scale other good objective alternatives 13. Less vigorous activities should be formulated for more deconditioned patients.…”