The most common symptom of peripheral artery disease in the lower extremities is intermittent claudication. Exercise therapy benefits patients with intermittent claudication by reducing limb symptoms and improving both physical activity and quality of life. However, a number of constraining factors limit patient participation in supervised exercise programs.
Supervised exercise programs have been recommended as first-line therapies for the treatment of claudication in patients with PAD. The treatment goals are: (1) to reduce limb symptoms, (2) to improve exercise capacity and prevent or lessen physical disability, and (3) to reduce the occurrence of cardiovascular events.
Guidelines and indications for exercise therapy:
The ESC , AHA/ACC , and Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC II) have all declared that the evidence supporting exercise therapy in the treatment of claudication is sufficiently robust to merit a Level I recommendation.
The fundamental component of training is a supervised program of treadmill exercise . The exercise session begins with treadmill exercise at a speed and grade that induce claudication within 3 to 5 minutes. The patient is instructed to stop walking and rest when his or her claudication pain reaches a moderate level. When the claudication has abated, the patient resumes walking until moderate claudication discomfort recurs. This cycle of exercise and rest is repeated for at least 30 minutes in the first few sessions of the program. In subsequent visits, the speed or grade of the treadmill is increased if the patient is able to walk for 10 minutes or longer at a lower workload without reaching moderate claudication pain.
The duration and frequency of the exercise training sessions and duration of the exercise training program are important to achieve maximal benefit with training sessions: >30 minutes per session provides greater benefit than <30 minutes per session; >3 sessions per week is more effective than <3 sessions per week, and program lengths of >26 weeks are more effective than program lengths of <26 weeks. Alternatives to treadmill exercise potentially consist of various forms of lower extremity exercise alone or in combination (brisk walking, bicycle ergometer, and strength training). However, the outcomes of treadmill exercise have so far been found to be superior to the outcomes of several other lower extremity exercises, namely cycling, stair climbing, and static and dynamic leg exercises.
While home exercise (unsupervised) programs can be modified or supplemented to improve their effectiveness, structured, supervised exercise programs generally have superior outcomes compared to unsupervised programs. A few studies have demonstrated that patients completing home- based exercise programs were able to improve both their initial claudication distance and absolute claudication distance.
Type 2 diabetes is the most common form of diabetes and can lead tomany complications. Reduction of HgA1c is shown to decrease complications. Bothaerobic exercise and resistance exercise have been shown to reduce HgA1c, but it is unclear if one method is better than the otherat reducing HbA1c.
Exercising at least 150 minutes a week has been recommended for those with impaired glucose tolerance and can result in a reduction in HbA1c. advice on physical activity, when combined with dietary counsel, can lead patients toward a decrease in HbA1c. Aerobic exercise was believed to be the best way to reduce HbA1c. However, a systematic review suggests that resistance training is also a reasonable option for reduction in HbA1c in type 2 diabetic patients. Studies have shown that a combination of aerobic and resistance training may be more beneficial than either alone. It has been proven that both aerobic exercise and resistance exercise can be used to reduce HbA1c in type 2 diabetics, but is one type of exercise better than the other? No distinction need be made on which type of exercise should be done by type 2 diabetics to reduce HbA1c. Combined exercise might be a better option than either alone. More studies need to be done on exercise intensity to determine if there is a link between intensity and reduction of HbA1c.For now the recommendation should remain to exercise at least 150 minutes a week regardless of the type of exercise.