Exercise therapy in routine management of peripheral arterial disease and intermittent claudication: a scoping review

Background: Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We conducted a scoping review to examine the published literature on the availability and workings of exercise therapy in the routine management of patients with PAD and IC, and the attitude and practice of health professionals and patients. Methods: A systematic search was conducted in February 2018. The Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, Allied and Complementary Medicine Database, ScienceDirect, Web of Science and the Directory of Open Access Repositories were searched. Hand searching of reference lists of identified studies was also performed. Inclusion criteria were based on study aim, and included studies that reported on the perceptions, practices, and workings of routine exercise programs for patients with IC, their availability, access, and perceived barriers. Results: Eight studies met the eligibility criteria and were included in the review. Studies conducted within Europe were included. Findings indicated that vascular surgeons in parts of Europe generally recognize supervised exercise therapy as a best practice treatment for IC, but do not often refer their patients for supervised exercise therapy due to the unavailability of, or lack of access to supervised exercise therapy programs. Available supervised exercise therapy programs do not implement best practice recommendations, and in the majority, patients only undergo one session per week. Some challenges were cited as the cause of the suboptimal program implementation. These included issues related to patients’ engagement and adherence as well as resource constraints. Conclusion: There is a dearth of published research on exercise therapy in the routine management of PAD and IC. Available data from a few countries within Europe indicated that supervised exercise is underutilized despite health professionals recognizing the benefits. Research is needed to understand how to improve the availability, access, uptake, and adherence to the best exercise recommendations in the routine management of people with PAD and IC.

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Protocol for a prospective, longitudinal cohort study on the effect of arterial disease level on the outcomes of supervised exercise in intermittent claudication: the ELECT Registry

BMJ Open ◽

10.1136/bmjopen-2018-025419 ◽

2019 ◽

Vol 9 (2) ◽

pp. e025419 ◽

Cited By ~ 2

Author(s):

Marijn ML van den Houten ◽

Sandra CP Jansen ◽

Anneroos Sinnige ◽

Lijckle van der Laan ◽

Patrick WHE Vriens ◽

...

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Intermittent Claudication ◽

Exercise Therapy ◽

Imaging Modality ◽

Arterial Disease ◽

Invasive Treatment ◽

Supervised Exercise ◽

Peripheral Arterial ◽

Prospective Longitudinal

IntroductionDespite guideline recommendations advocating conservative management before invasive treatment in intermittent claudication, early revascularisation remains widespread in patients with favourable anatomy. The aim of the Effect of Disease Level on Outcomes of Supervised Exercise in Intermittent Claudication Registry is to determine the effect of the location of stenosis on the outcomes of supervised exercise in patients with intermittent claudication due to peripheral arterial disease.Methods and analysisThis multicentre prospective cohort study aims to enrol 320 patients in 10 vascular centres across the Netherlands. All patients diagnosed with intermittent claudication (peripheral arterial disease: Fontaine II/Rutherford 1–3), who are considered candidates for supervised exercise therapy by their own physicians are appropriate to participate. Participants will receive standard care, meaning supervised exercise therapy first, with endovascular or open revascularisation in case of insufficient effect (at the discretion of patient and vascular surgeon). For the primary objectives, patients are grouped according to anatomical characteristics of disease (aortoiliac, femoropopliteal or multilevel disease) as apparent on the preferred imaging modality in the participating centre (either duplex, CT angiography or magnetic resonance angiography). Changes in walking performance (treadmill tests, 6 min walk test) and quality of life (QoL; Vascular QoL Questionnaire-6, WHO QoL Questionnaire-Bref) will be compared between groups, after multivariate adjustment for possible confounders. Freedom from revascularisation and major adverse cardiovascular disease events, and attainment of the treatment goal between anatomical groups will be compared using Kaplan-Meier survival curves.Ethics and disseminationThis study has been exempted from formal medical ethical approval by the Medical Research Ethics Committees United ‘MEC-U’ (W17.071). Results are intended for publication in peer-reviewed journals and for presentation to stakeholders nationally and internationally.Trial registration numberNTR7332; Pre-results.

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Saving more lives and limbs: applying a cardiac rehabilitation model of structured exercise to symptomatic peripheral arterial disease

British Journal of Cardiac Nursing ◽

10.12968/bjca.2020.0086 ◽

2021 ◽

pp. 1-8

Author(s):

Susan Matthews ◽

Martin Fox ◽

Sarah Coy ◽

Jane Whittaker ◽

Gail Brough ◽

...

Keyword(s):

Quality Of Life ◽

Blood Pressure ◽

Peripheral Arterial Disease ◽

Cardiac Rehabilitation ◽

Intermittent Claudication ◽

Arterial Disease ◽

Morbidity And Mortality ◽

Supervised Exercise ◽

Peripheral Arterial

Background/Aims Peripheral arterial disease is common among those aged 60 years or above and can cause debilitating intermittent claudication. This impacts quality of life and is a marker for increased morbidity and mortality, mainly from cardiovascular disease. Access to recommended exercise programmes for people with symptomatic peripheral arterial disease is poor in most areas of the UK. This study aimed to evaluate the benefits of expanding an established cardiac rehabilitation service to accommodate supervised exercise for people with peripheral arterial disease Methods The study evaluated 11 participants peripheral arterial disease and intermittent claudication who were referred by the Manchester leg circulation service. Participants underwent the programme involving eight weekly 1.5 hour sessions of supervised exercise and cardiovascular education with support, reassurance and motivation. The participants' blood pressure, walking impairment, quality of life, anxiety and depression were monitored and reviewed. Results Overall, the participants' walking distance, intermittent claudication, quality of life and blood pressure had improved. The participants' overall satisfaction with the programme was excellent. The programme also demonstrated clinical and cost-effectiveness. Conclusions A structured, supervised exercise programme can have considerable benefits for people with peripheral arterial disease, improving their symptoms and quality of life. It may also help to reduce the morbidity and mortality risks associated with inactivity in this patient group.

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The effect of a 3-month supervised exercise programme on gait parameters of patients with peripheral arterial disease and intermittent claudication

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2012.05.002 ◽

2012 ◽

Vol 27 (8) ◽

pp. 845-851 ◽

Cited By ~ 12

Author(s):

Stephanie King ◽

Natalie Vanicek ◽

Katherine A. Mockford ◽

Patrick A. Coughlin

Keyword(s):

Peripheral Arterial Disease ◽

Intermittent Claudication ◽

Exercise Programme ◽

Arterial Disease ◽

Supervised Exercise ◽

Gait Parameters ◽

Peripheral Arterial

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Supervised exercise therapy in the management of peripheral arterial disease – an assessment of compliance

VASA ◽

10.1024/0301-1526/a000612 ◽

2017 ◽

Vol 46 (3) ◽

pp. 219-222 ◽

Cited By ~ 6

Author(s):

Thomas M. Aherne ◽

Elrasheid A. H. Kheirelseid ◽

Michael Boland ◽

Shane Carr ◽

Thekra Al-Zabi ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Exercise Therapy ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Symptomatic Improvement ◽

Smoking History ◽

Supervised Exercise ◽

Exercise Compliance ◽

The Mean ◽

Peripheral Arterial

Abstract. Background: Supervised exercise therapy (SET) is an effective option in the management of peripheral arterial disease (PAD). Unfortunately, poor compliance remains prevalent. This study aimed to assess patient exercise compliance and to identify factors influencing symptomatic improvement and SET participation. Patients and methods: Data regarding attendance at SET for this cohort study were extracted from a prospectively maintained database of patients with claudication attending SET at Dublin City University. All patients had ankle brachial index confirmed PAD with associated intermittent claudication. Exercise performance and symptomatic data were gathered retrospectively using patient charts and interviews. Results: Ninety-eight patients were referred for SET during the study period. The mean age was 69.2 (± 10.1) with 18 % being female. Median follow-up was 25.1 months (IQ range 17.0–31.6). Overall, the mean number of sessions attended per patient was 19.5. Exercise compliance was associated with a significant improvement in symptoms (p = 0.001). Other factors including anatomical level of claudication (P = 0.042) and educational level (p = 0.007) were found to affect the outcome of SET. Multivariate analysis revealed hypertension as a predictor of symptomatic outcome after SET (p = 0.045). Furthermore, ex-smokers (p = 0.021) and those previously diagnosed with hypercholesterolaemia (p = 0.020) or ischaemic heart disease (p = 0.029) had superior exercise compliance. Using linear regression, smoking history (p = 0.024) was identified as a predictor of compliance to SET. Conclusions: Establishing exercise compliance remains challenging in the PAD cohort. Pre-exercise patient education and personalised exercise prescriptions may result in improvements in function and compliance.

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