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A Toolkit on Supervised Exercise for PAD

Clinical practice guidelines for treatment of lower extremity peripheral artery disease (PAD) include a Class I recommendation for supervised exercise training for patients with intermittent claudication (IC). Prospective studies and meta-analyses have consistently shown that supervised exercise for patients with IC can increase their walking distances, quality of life, and function. Unfortunately, these programs are not available in all communities, and instructions from physicians to “get out and walk” are clearly not as effective as a supervised exercise program. To help correct this treatment gap, the Vascular Disease Foundation and the American Association of Cardiovascular and Pulmonary Rehabilitation partnered to develop a PAD Exercise Training Toolkit. This toolkit is available in a free, downloadable format at www.vdf.org or www.aacvpr.org. It includes evidence-based and practical information for healthcare professionals to use to develop exercise programs specifically designed for patients with PAD. Differences in Exercise for PAD Patients Patients with lower extremity PAD often develop IC due to inadequate oxygenation of exercising muscles. These patients often self-regulate their activity level to avoid discomfort, which can lead to a downward spiral of worsened disability. Multiple studies have shown that supervised treadmill walking to the point of moderate claudication pain, interspersed with brief rest periods, with exercise sessions lasting 30 minutes or longer and occurring at least three times per week can double maximum walking distance and significantly reduce symptoms. “Instructions from physicians to ‘get out and walk’ are clearly not as effective as a supervised exercise program.” The mechanisms leading to improved symptoms and function have not been fully elucidated but include changes in the exercising muscle. This includes improved oxygen extraction...
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