The Effect of Exercise Modalities on Walking Capacity in Patients With Intermittent Claudication

Abstract

U sually caused by progressive atherosclerosis and associated thrombosis, peripheral arterial disease (PAD) is characterized by a reduced blood flow to the lower limbs, leading to ischemia during physical exertion and intermittent claudication as clinical presentation. 1 Intermittent claudication, classically defined by pain and muscle cramps when walking, results in a greatly reduced walking capacity and functional status. 2,3 This functional decline lowers patient quality of life and willingness to engage in physical activity, which further worsens the risk of cardiovascular disease 4 and premature mortality. 5 For these reasons, improving walking capacity is now considered a priority for the treatment of PAD. 6 Aerobic exercise, typically in the form of walking, is considered a first-line treatment in this population. 7 Scientific evidence supports the existing guidelines that recommend ≥3/wk of supervised exercise sessions of intermittent walking, according to the pain threshold (3-4/5), for 30-45 min/ session, for ≥3 mo. [7][8][9] Recent meta-analyses and clinical trials have shown an increase in maximum walking distance (MWD) on treadmill tests after supervised exercise therapy (SET) in patients with symptomatic PAD. [10][11][12][13] Although home-based exercise has shown encouraging results, the magnitude of these results was inferior to SET. 14 According to the American Heart Association, the optimal SET modality still needs to be determined for patients with PAD. 15 Accumulating data indicate that other types of SET, such as Nordic walking, underwater exercise, and resistance training, could also be effective in improving walking capacity in patients with PAD. [16][17][18][19] Recently, a meta-analysis 8 suggested that other modes of exercise (without any distinction between them) could improve walking ability similar to supervised intermittent walking. Although this

Determining the Optimal Type of Exercise for People With Symptomatic Lower Extremity Peripheral Artery Disease: Is There a One-Size-Fits-All Approach?

“…Altogether, Tremblay et al 6 present a thorough NMA comparing exercise modalities and clearly report and acknowledge the limitations. In the future, comorbid conditions and ability to exercise to target intensity and more can be applied to an algorithm that will move us closer to developing targeted exercise prescriptions for improving walking capacity and other health-related outcomes.…”

“…Tremblay et al 6 reported two major limitations of these studies. First, there were only three AT+RT studies that measured the MWD and second was that the exercise prescriptions were highly variable.…”

“…In this issue of the Journal of Cardiopulmonary Rehabilitation and Prevention, Tremblay et al 6 present the results of a network meta-analysis (NMA) designed to compare the effect of different modalities of supervised exercise therapy on walking capacity among people with symptomatic PAD. The authors are to be commended for this thorough analysis of the existing literature.…”

Walking Intensity Preference of Patients With Peripheral Arterial Disease

“…1 The American Heart Association/American College of Cardiology and European Society of Cardiology position statements 2,3 recommend walking exercises, in sets of three, for 5 min at an intensity that elicits moderate or maximum pain. Despite the proven effectiveness of this prescription in improving walking capacity, [4][5][6] pain during exercise has been considered one of the main barriers to the practice of physical activity (PA). 7 Exercise with a self-selected intensity has emerged as an alternative strategy for exercise prescription that can potentially increase adherence to the practice of PA. 7 Interestingly, the preferred walking exercise intensity has not yet been described in patients with PAD and claudication symptoms.…”

“…The American Heart Association/American College of Cardiology and European Society of Cardiology position statements2,3 recommend walking exercises, in sets of three, for 5 min at an intensity that elicits moderate or maximum pain. Despite the proven effectiveness of this prescription in improving walking capacity,4–6 pain during exercise has been considered one of the main barriers to the practice of physical activity (PA) 7…”