Walking exercise in patients with intermittent claudication not well implemented in Dutch primary care

Bartelink, Marie-Louise; Wullink, M. Verboom-Jansen A.J.; Stoffers, Jelle; Hoes, Arno W.

doi:10.3109/13814780509178014

Cited by 31 publications

(66 citation statements)

References 3 publications

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“…Nonostante questi risultati, i pazienti con claudicatio sottoposti a training fisico controllato continuano a rappresentare una percentuale irrisoria dei pazienti abitualmente riabilitati. Bartelink et al [53] hanno recentemente rilevato che solo il 52% dei pazienti che avevano risposto ad un questionario (58% del totale) praticavano esercizio fisico e solo il 32% di questi ultimi riceveva un qualsiasi tipo di trattamento supervisionato.…”

Section: Training Fisico (Tabella 1 E 2)unclassified

Why cardiovascular rehabilitation services should include patients with intermittent claudication?

Carlon

Zanchetta

2016

Monaldi Arch Chest Dis

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IntroduzioneLe linee guida ANMCO-SIC-GIVFRC del 1999 [1] sulla Riabilitazione Cardiologica riportano tra le indicazioni anche l'arteriopatia obliterante cronica degli arti inferiori (AOCP) e ne stabiliscono le modalità di valutazione e trattamento. Tuttavia, nei risultati del recente progetto ISYDE (Italian Survey on Cardiac Rehabilitation), finalizzato al censimento delle strutture di Cardiologia Riabilitativa (CR) operanti in Italia, la claudicatio intermittens non viene menzionata, essendo raggruppata all'interno della voce "altre indicazioni" e rappresentando pertanto una percentuale verosimilmente irrisoria dei pazienti trattati nelle strutture di CR [2]. È logico quindi chiedersi se la valutazione ed il trattamento di tale patologia ed in particolare della sua manifestazione clinica, rappresentata dalla claudicatio intermittens, debba far parte del patrimonio culturale del cardiologo riabilitatore o debba essere demandata ad altre figure professionali (chirurgo vascolare, radiologo, angiologo, emodinamista interventista).Lo scopo del presente articolo è quello di verificare, attraverso un'analisi delle problematiche presenti nel soggetto con claudicatio intermittens, se le competenze proprie del cardiologo riabilitatore possano essere trasferite sul distretto arterioso periferico, in modo da contribuire ad una migliore valutazione e trattamento di tale patologia. EpidemiologiaL'AOCP rappresenta una localizzazione molto frequente del processo aterosclerotico ( fig. 1). La sua reale incidenza e prevalenza varia a seconda della popolazione studiata e dello strumento diagnostico utilizzato [3]. Tale patologia, infatti, appare sottostimata sia perché solo una parte dei pazienti presenta sintomi [4][5][6][7] sia perché i soggetti anziani spesso considerano il dolore della claudicatio come un normale fenomeno dovuto all'invecchiamento, non riferendolo al proprio medico. A conferma di ciò, merita di essere citato il lavoro di Hirsch et al.[8], condotto su oltre 1000 soggetti con pregressa diagnosi di AOCP, dal quale emerge che ben l'83% dei pazienti e il 49% dei medici curanti, sono all'oscuro di tale diagnosi.Numerosi studi epidemiologici indicano una correlazione positiva tra prevalenza dell'AOCP, (determinata con tecniche non invasive) ed età, interessando il 2,5% dei soggetti tra i 40 e 59 anni, l'8,3% tra i 60 e 69 anni ed il 18,8% dei soggetti tra i 70 e 79 anni, risultando essere almeno 5 volte superiore rispetto alla prevalenza del sintomo clinico claudicatio [5]. Infatti, nel Rotterdam Study [6], condotto su 7715 soggetti di età >55 anni, la prevalenza di AOCP è risultata essere del 19,1% (20,5% nelle donne e 16,9% negli uomini), mentre la prevalenza del sintomo claudicatio solo del 1,6% (2,2% negli Chronic peripheral arterial disease represents a frequent and underestimated localization of atherosclerosis and its management often appears to be inadequate. The association with ischemic heart disease, the weighty prevalence of coronary disease risk factors, the high cardiovascular rate of morbidity and mor...

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Section: Training Fisico (Tabella 1 E 2)unclassified

Why cardiovascular rehabilitation services should include patients with intermittent claudication?

Carlon

Zanchetta

2016

Monaldi Arch Chest Dis

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“…However, there is no evidence to support the efficacy of this advice, and compliance is known to be low [14]. Several factors such as fear against pain, inadequate knowledge of the underlying disease, and poor general condition, contribute to the difficulty of starting, sustaining, and maintaining exercise therapy as indicated.…”

Section: Editorialmentioning

confidence: 99%

Exercise Therapy in Patients with Intermittent Claudication

2015

J Nov Physiother

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EditorialPeripheral artery disease (PAD) has been associated with specific risk factors such as smoking, diabetes mellitus (DM) as well as previous coronary and cerebrovascular disease [1]. Furthermore, PAD has been correlated to an increased risk for cardiovascular morbidity and mortality [2,3]. Although the most common symptom of PAD is intermittent claudication, recent data reveal that asymptomatic PAD is several times more common in the general population [1]. Therefore, modification of atherosclerosis risk factors as well as exercise therapy are strongly recommended as first-line treatment by recent guidelines [4].Patients with history of PAD experience significant limitation in everyday physical activities and walking, in particular [5,6]. In a recent study of more than 2,000 patients with suspected or known PAD, de Liefde et al have highlighted the prognostic value of impared walking distance on long-term major cardiovascular events [7]. In such patients, measurement of ankle brachial index (ABI) remains a valuable diagnostic and prognostic tool. ABI is an independent risk factor for cardiovascular diseases and mortality, even in asymptomatic patients [8,9]. Finally, there is recent evidence correlating abnormal measurements of ABI (< 0.9 or > 1.4) with silent cerebral small vessel disease [10] and a higher risk for presenting stroke in general population [11].Regarding the effect of physical activity on reducing symptoms and cardiovascular risk in PAD patients, several studies have shown that exercise has a known positive influence on vascular risk factors such as hypertension, hypercholesterolemia, and diabetes mellitus [12]. Furthermore, reports show that patients with PAD (or more specifically, intermittent claudication) who are physically active are less likely to die compared with a group of sedentary patients with PAD [13]. After adjustments for age, ABI, and body mass index, these results are similar in patients with intermittent claudication [13]. Research data clearly indicate that exercise treatment can improve walking distance and therefore, it is recommended in recent guidelines [4]. However, type and duration of exercise remains still under investigation.The most common exercise therapy prescription consists of onetime oral advice to walk more, usually without supervision or followup. However, there is no evidence to support the efficacy of this advice, and compliance is known to be low [14]. Several factors such as fear against pain, inadequate knowledge of the underlying disease, and poor general condition, contribute to the difficulty of starting, sustaining, and maintaining exercise therapy as indicated. Therefore, the importance of supervised exercise therapy (SET) is increasingly recognized. SET includes adequate coaching to increase the maximal walking distance as well as coaching in the necessary lifestyle changes, such as smoking cessation, weight control, and increase in overall exercise. A recent Cochrane Review has identified a significant improvement in walking distance in patie...

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“…The adherence of patients given an oral exercise advice appears to be low. Comorbidity, lack of (specific) advice, fear, and lack of discipline and supervision are barriers to actually perform regular walking exercise (31). For these reasons the importance of supervision was recognised.…”

Section: Exercise Therapymentioning

confidence: 99%

The Role of Supervised Exercise Therapy in Peripheral Arterial Obstructive Disease

Fokkenrood¹,

Lauret²,

Scheltinga³

et al. 2012

Vascular Surgery - Principles and Practice

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Walking exercise in patients with intermittent claudication not well implemented in Dutch primary care

Cited by 31 publications

References 3 publications

Why cardiovascular rehabilitation services should include patients with intermittent claudication?

Why cardiovascular rehabilitation services should include patients with intermittent claudication?

Exercise Therapy in Patients with Intermittent Claudication

The Role of Supervised Exercise Therapy in Peripheral Arterial Obstructive Disease

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