Peripheral Arterial Disease and Exercise

Peripheral artery disease (PAD) refers to build up of plaques and narrowing of the arteries of critical areas of the body such as the legs, head, and organs. It is most common for PAD to affect the arteries of the leg decreasing oxygen supply to the calf, thigh, and buttocks.

Patients with PAD often have no symptoms however as the disease progresses they being to present with intermittent claudication (IC). IC is characterised by reproducible pain in the muscles of legs, most commonly the calved, during periods of weight-bearing activity that is relieved with rest. Pain is often described as an ache, cramp, tightness or fatigue. In severe cases, PAD patients can experience chronic pain at rest and poor blood supply to the leg, which can lead to foot ulcers and gangrene complications that can arise include infections to soft tissue and bones, which can lead to limb loss if not treated appropriately.

Supervised exercise training is the first line of medical interventions for patients with PAD. Supervised exercise training is considered the gold standard of treatment for patients with PAD as it improves walking distance, health status and the ability to perform activities of daily living. Exercise is shown to provide improve walking distance and endurance, by increasing activity tolerance before the onset of symptoms, as well as reducing the risk of adverse cardiovascular events occurring. Both aerobic and resistance exercise have been shown to be beneficial in treating PAD. It is shown to improve blood flow, reduce the thickness of the blood, increase the number of capillaries to improve blood flow and improve the health of arteries and blood vessels.

Supervised exercise is associated with greater success in improving the health status of patients with PAD. Patients who participate in an unsupervised exercise session are often given very little guidance (often just “go home and exercise”) from medical practitioners, which leads to a lack of adherence. The pain and discomfort caused by PAD can also deter unsupervised patients, as they have reduced motivation to continue the activity after a period of rest (10-15min). Further, exercising unsupervised can increase the risk of adverse CV symptoms due to exposure to higher demands. Monitoring for CV symptoms, such as blood pressure response, and claudication can be used to reduce the severity of adverse events in a supervised environment, should they occur.

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