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

Abstract

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.

Medical Management of Peripheral Arterial Disease: Deciphering the Intricacies of Therapeutic Options

“…An additional meta-analysis found that SHE programs were associated with decreased LDL-C, total cholesterol, SBP, and DBP 78 . However, European countries found that the implementation and utilization of SHE programs was still sub-optimal 79 . Given the overwhelming body of evidence to support exercise programs for PAD over the past 30 81 .…”

“… 78 However, European countries found that the implementation and utilization of structured home-based exercise programs was still suboptimal. 79 Given the overwhelming body of evidence supporting the benefits of exercise programs for PAD over the past 30 years, the American Heart Association (AHA) has endorsed supervised exercise programs (ie, supervised treadmill exercise therapy) for patients with claudication with a Class of Recommendation (COR) I - Level of Evidence (LOE) A recommendation. 80 Alternative strategies for exercise therapy (upper body ergometry, cycling, pain-free/low-intensity walking) are listed as COR IIa - LOE A.…”

Supervised physical exercise therapy of peripheral artery disease patients: M-health challenges and opportunities

“…The disease can cause intermittent claudication, limb ulceration, infections and amputation. Patients usually have limited walking abilities, both regarding duration and speed, with impact to their life quality [1]. This scenario is particularly important due to its relationship with ageing and its well-known cardiovascular risk factor and cardiovascular diseases [18].…”

“…However, frequently, the patients overestimate the claudication severity including on the Walking Impairment Questionnaire (WIQ), with many reporting distances falling below the walking treadmill test results. In contrast, distances reported through Information and Communication Technologies (ICT) tools (as Google Maps 1 or Open Street Maps 2 ) have no such discernible trend, suggesting that landmarks-based method is efficient and allows remote control of patient compliance [1].…”

Satisfaction and Acceptability of Telemonitored Home-Based Exercise in Patients With Intermittent Claudication: Pragmatic Observational Pilot Study

“…Furthermore, even when SET is available, patients’ participation is low, mainly because of a lack of transportation and time [ 11 , 12 ]. In addition, reimbursement issues and lack of uptake in health policy plans further hamper the widespread use of SET [ 13 ]. As a result, next to optimal pharmacological treatment, first-line IC management is often limited to a less-effective Go-Home-And-Walk advice.…”