Provision of exercise services in patients with peripheral artery disease in the United Kingdom

Abstract

Objectives Supervised exercise programmes (SEPs) are a vital treatment for people with intermittent claudication, leading improvements in walking distance and quality of life and are recommended in multiple national and international guidelines. We aimed to evaluate the use and structure of SEPs in the United Kingdom (UK). Design We conducted an anonymous online survey using the Jisc platform comprising of 40 questions. The survey was designed to address key areas such as access, provision, uptake and delivery of SEPs in the United Kingdom. Ethical approval was obtained from Coventry University (P108729). Methods The list of trusts providing vascular services was obtained from the National Vascular Registry (NVR) report. The survey was disseminated via social media, The Vascular Society of Great Britain and Ireland and the Society for Vascular Technology. Data were exported to a Microsoft Excel document and analysed using simple descriptive statistics. Results Of 93 vascular units identified, we received response from 48. Of these, 23 had access to an exercise programme (48%). The majority of SEPs were exclusively for PAD patients (77%), with 21% using integrated services. 67% of respondents were providing a circuit-based programme, and 5 out of 23 were meeting the dose recommendations in the UK National Institute for Health and Care Excellence (NICE) guidelines. Respondents felt that programmes were moderately to extremely important to patients, slightly to very important to clinicians and not at all important to slightly important to commissioning/funding bodies. Conclusion SEPs are a well-established first-line treatment for patients with IC and they are recommended by NICE guidelines. Despite this, many patients still do not have access to an exercise programme, and clinicians do not feel that they have support from commissioning/funding bodies to develop them. There is an urgent need for funding, development and delivery of SEPs in the United Kingdom.

Evaluating the feasibility and acceptability of an exercise and behaviour change intervention in socioeconomically deprived patients with peripheral arterial disease: The textpad study protocol

“…Supervised exercise training and secondary cardiovascular prevention are considered a cornerstone for clinical treatment in patients with PAD due to the benefits in different health parameters, such as functional capacity, cardiovascular function, and quality of life [5,7,48,49]. Despite these benefits, in the UK patients has limited access to supervised exercise training in the clinical setting and, patients are not systematically offered evidence-based interventions that support behavioural modification for their risk factors [10]. In addition, a recent study found that financial limitations and travel distances were cited as barriers to participation in supervised exercise training in PAD patients in the UK.…”

“…In addition, a recent study found that financial limitations and travel distances were cited as barriers to participation in supervised exercise training in PAD patients in the UK. [10]. To tackle these barriers, we will test the feasibility, acceptability and effectiveness of a home-based exercise and behavioural intervention in patients with PAD.…”

“…Despite these recommendations, supervised exercise is rarely delivered in the clinical setting [10] and, patients are not systematically offered evidence-based interventions that support behavioural modification. Ineffectual provision of and, referral to, behaviour change programmes may contribute to further deterioration of health, leading many patients to undergo surgical procedures for PAD management (e.g., stent or bypass).…”

Credibility, Accuracy, and Comprehensiveness of Readily Available Internet-Based Information on Treatment and Management of Peripheral Artery Disease and Intermittent Claudication: Review

“…However, SEPs have been much less frequently and appropriately endorsed by websites (21/62, 34%). Even though SEPs are endorsed by the NICE and AHA guidelines [ 3 , 16 ], lack of resources and funding often prevent their widespread use in practice [ 31 ]. Therefore, recommendations on websites alone are not enough to improve the management of PAD.…”

Safety of home-based exercise for people with intermittent claudication: A systematic review

“… 7 , 8 Structured SET has shown improvements in peak oxygen consumption, pain-free and maximal walking distances, and quality of life. 9 , 10 Despite strong evidence demonstrating the benefits of SET, its availability, adherence, and uptake remain low, 11 – 13 especially in the US, when compared to antiplatelet therapy, statins, and smoking cessation. 14 Commonly cited barriers include time constraints, travel difficulties, and other personal commitments.…”