2. Peripheral Arterial Disease (PAD) Occlusion or blockage of the arteries by plaque of the lower extremities resulting in insufficient blood flow to the limbs 12% of adults over 50 being diagnosed with PAD Links between PAD and hypercholesterolemia, hypertension, type 2 diabetes and Coronary artery disease. In 2006-2007, 2,163 deaths and 25,813 hospitalisations around Australia1
3.
4. How Exercise improves Claudication Muscle carnitine metabolism in the leg will facilitate extraction of oxygen and substrates in the blood Increased levels of circulating endothelial progenitor cells and macrophage-derived angiogeniccells Nitric oxide increases vasodilation Improved biomechanics of walkingdecreases oxygen cost of walking2
5. Results- Treadmill Walking vs Strength training A treadmill walking program (Hiatt et al, 1994) has shown to be the most effective type of exercise in people with claudication for increasing peak walking time, improvements in peak oxygen consumption and the onset of claudication pain3
6. ACC/AHA guidelines for management of patients with PAD A meta-analysis of 21 trials of supervised treadmill training revealed that pain-free walking time improved an average of 180% and maximal walking time increased by 120%4
7. Conclusions Supervised exercise training for PAD patients with claudication has been consistently effective in improving the symptoms of claudication, maximal walking distance and pain-free walking distance. Treadmill walking programs show the greatest improvements in claudication in comparison to Strength training which also improves symptoms but not as significantly as treadmill training5.
8. References 1Bhatt DL,StegPG,Ohman EM. International prevalence, recognition,and treatment of cardiovascular risk factors in out-patients with atherothrombosis. JAMA2006; 295:180–89 2Hiatt WR, Regensteiner JG, Wolfel EE, Carry MR, Brass EP. Effect of exercise training on skeletal muscle histology and metabolism in peripheral arterial disease. J Appl Physiol1996; 81:780–88 3Hiatt WR,WolfelEE,MeierRH,Regensteiner JG. Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response. Circulation1994; 90: 1866–74 4 Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. JAMA 1995; 274:975–801145–51 5Hirsch AT, Haskal ZJ, Hertzer NR et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial diseaseJ Am Coll Cardiol2006; 47:1239–312.
9. Limitations Studies looked at supervised exercise training programs-at home the patients may not be as strict or compliant to the protocol- may affect results
10. Data Collection The two types of walking assessments used used were motorized treadmills programs including the Gardner–Skinner, Hiatt, or Naughton Protocols and a 6-minute walk test used in elderly patients. Health related quality of life issues were also assessed by validated questionnaires such as the Medical outcomes study SF-36 and Walking Impairment questionnaires, both which asses the functional status of the PAD community
