ExRx for Individuals with Peripheral Artery Disease
By Jennifer Green, MS
|Jennifer Green, NCHPAD Visiting Information Specialist|
With the onset of physical activity our muscles have a higher metabolic demand. With an inadequate amount of blood supply to the muscles, it only makes sense that the primary effect of PAD during a single exercise session is the progression of claudication pain. However, it has been well-documented that exercise training is successful in the prevention and treatment of this disease. Studies have shown that clients with PAD have one-third the risk of mortality when compared to their inactive counterparts. The majority of individuals with peripheral artery disease report that the level of severity of claudication at any given level of work following a period of supervised exercise training tends to be less than at pre-training.
The aim of any physical activity program for an individual with PAD should be to improve pain responses, improve walking time, and reduce cardiovascular risk factors which often contribute to the development of this condition. In regards to progression, duration should be increased before intensity. For the greatest benefits, exertion to the point of leg pain is required. Therefore, modes of activity could include interval walking, pole striding, stair climbing or other activities that require effort from the major muscles of the lower extremities. These activities should be performed 3-5 days per week at an intensity that causes pain with a score of 3 on the 4-point claudication scale (See figure 5.4 in ACSM's Guidelines for Exercise Testing and Prescription Eighth Edition). When interval walking, a full recovery is allowed between intervals. Sessions may start out at 20 minutes at 40% heart rate reserve (HRR), eventually progressing to 40 minutes per session at 70% HRR over a period of 6 months. Non-weight bearing activities such as stationary biking and swimming should only be used for warm-up and cool-down. It is also suggested that clients participate in a home-based walking program and accumulate at least 30 minutes of walking daily. Resistance training is also suggested as an important part to a comprehensive exercise program and should be done at least 2 days per week, performing 1-2 sets of 10-12 repetitions focusing on both the upper and lower body.
It is important to remember that there are some circumstances in which it is inappropriate for clients with peripheral artery disease to exercise. Medical clearance based on a physical exam, blood screening, and graded exercise test should be completed preceding participation; and exercise should not be performed when there are simultaneous comorbidities that may limit exercise tolerance. Additionally, monitor for changes in risk factors, especially ischemia. Cold weather may worsen the symptoms of PAD and therefore a longer warm-up is suggested.
Due to the necessity of continuing to exercise until the point of pain, encouragement, education and behavior modification are all going to be extremely important when working with these clients. It will be important to educate them on why they are being pushed to this point and the benefits they will gain from participating in a physical activity program. Understanding where your client is at in terms of the stages of change will also be crucial. Successfully moving through these stages may be more difficult due to the level of pain some individuals may experience. Adherence to an exercise program for individuals with peripheral artery disease is important and drop-out rates tend to be high; making a connection with your client will be just as important as making the program interesting. Exercise programming is both a science and an art. Being creative, as well as following guidelines will pay off in the end because your client will receive the most benefit.
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Thompson, W. R., PhD, FACSM, Gordon, N. F., MD, PhD, MPH, FACSM, & Pescatello, L. S., PhD, FACSM (Eds.). (2010). ACSM's guidelines for exercise testing and prescription (8th ed.). Baltimore: Lippincott Williams & Wilkins.
Please send any questions or comments to Jennifer Green at firstname.lastname@example.org.