Exercise and peripheral arterial disease (PAD)

• a review shows that exercise programmes clearly improve walking time and distance for people considered fit for exercise regimens. This benefit appears to be sustained over two years (1)
  • the review authors concluded that:
  • exercise therapy should play an important part in the care of selected patients with intermittent claudication, to improve walking times and distances
  • angioplasty may be more beneficial than exercise in improving walking capacity in the short term but it is uncertain whether this effect is sustained over 12 months.
  • antiplatelet agents were less effective than exercise in improving walking distance but should continue to be used because of benefits in reducing cardiovascular events and death
    • in contrast, pentoxifylline was more effective than exercise but may have fewer beneficial effects on the cardiovascular system in general
    • Iloprost gave less improvement in walking time than exercise
    • pneumatic foot and calf compression showed non-significant increases in walking distances over exercise
• a randomised trial involving the use of treadmill exercise and resistance training in patients with peripheral arterial disease revealed (2)
  • demonstrated that supervised treadmill exercise intervention increases walking endurance, measured by the 6-minute walk and treadmill walking performance, in patients with PAD both with and without classic intermittent claudication symptoms
  • lower extremity resistance training intervention did not improve 6-minute walk distance in PAD participants
    • however, resistance training improved maximal treadmill walking time and quality-of-life measures, particularly stair climbing ability
  • study authors concluded that "..physicians should recommend supervised treadmill exercise programs for PAD patients, regardless of whether they have classic symptoms of intermittent claudication.."

NICE state (3):

• offer a supervised exercise programme to all people with intermittent claudication
  • involves:
    • 2 hours of supervised exercise a week for a 3-month period
    • encouraging people to exercise to the point of maximal pain

Reference:

1. Watson L, Ellis B, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD000990
2. McDermott MM et al. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA. 2009 Jan 14;301(2):165-74.
3. NICE (March 2018). Lower limb peripheral arterial disease: diagnosis and management