Bassem Zarif^1,2*, Akram Samir^1,2, Safwat Al-Nahrawi^1,2 and Eman Gamal²

¹National Heart Institute, Egypt ²Ministry of Health and Population, Egypt

*Corresponding Author: Bassem Zarif, Department of Cardiology, National Heart Institute, Ministry of Health and Population, Cairo, Egypt.

Received: October 18, 2021; Published: November 18, 2021

Abstract

Intermittent claudication (IC) is the most common symptom of peripheral artery disease (PAD). IC can worsen the quality of life and results in marked exercise intolerance and limitation to daily activities with increased risk of cardiovascular complications. Exercise training is the first line of conservative management in PAD. However, patients with IC may not tolerate weight-bearing exercises because of leg discomfort induced by physical effort. This review will address alternative rehabilitation strategies to reduce exercise limitations and improve exercise tolerance in patients with IC.

Keywords: Peripheral Artery Disease; Exercise Intolerance; Exercise Limitations; Intermittent Claudication; Exercise Training

References

1. Abaraogu U., et al. “Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program”. PLoS One 13 (2018): e0201095.
2. Ambrosetti M., et al. “Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology”. European Journal of Preventive Cardiology (2020): 2047487320913379.
3. Askew C D., et al. “Physiological and symptomatic responses to cycling and walking in intermittent claudication”. Clinical Physiology and Functional Imaging 22 (2002): 348-355.
4. Blomqvist C G and B Saltin. “Cardiovascular adaptations to physical training”. Annual Review of Physiology 45 (1983): 169-189.
5. Bronas U G., et al. “Comparison of the effect of upper body-ergometry aerobic training vs treadmill training on central cardiorespiratory improvement and walking distance in patients with claudication”. Journal of Vascular Surgery 53 (2011): 1557-1564.
6. Cheng J., et al. “Treadmill exercise promotes neurogenesis and myelin repair via upregulating Wnt/betacatenin signaling pathways in the juvenile brain following focal cerebral ischemia/reperfusion”. International Journal of Molecular Medicine 45 (2020): 1447-1163.
7. Dobson JL., et al. “Benefits of exercise intervention in reducing neuropathic pain”. Frontiers in Cell Neuroscience 8 (2014): 102.
8. Dörenkamp Sarah., et al. “Patient Characteristics and Comorbidities Influence Walking Distances in Symptomatic Peripheral Arterial Disease: A Large One-Year Physiotherapy Cohort Study”. PLoS One 11 (2016): e0146828-e28.
9. Fowkes F G., et al. “Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis”. Lancet 382 (20213): 1329-1340.
10. Haas T L., et al. “Exercise training and peripheral arterial disease”. Comprehensive Physiology 2 (2012): 2933-3017.
11. Hamburg N M and GJ Balady. “Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits”. Circulation 123 (2011): 87-97.
12. Hardman R L., et al. “Overview of classification systems in peripheral artery disease”. Seminars in Interventional Radiology 31 (2014): 378-388.
13. Harwood A E., et al. “A systematic review of muscle morphology and function in intermittent claudication”. Journal of Vascular Surgery 66 (2017): 1241-1257.
14. Hiatt W R., et al. “Benefit of exercise conditioning for patients with peripheral arterial disease”. Circulation 81 (1999): 602-609.
15. Hiatt W R., et al. “Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response”. Circulation 90 (1994): 1866-1874.
16. Larsen O A and N A Lassen. “Effect of daily muscular exercise in patients with intermittent claudication”. Lancet 2 (1996): 1093-1096.
17. Machado I., et al. “Combined Aerobic and Resistance Exercise in Walking Performance of Patients With Intermittent Claudication: Systematic Review”. Frontiers in Physiology 10 (2019): 1538.
18. McDermott M M., et al. “Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial”. JAMA 301 (2009): 165-174.
19. McDermott Mary McGrae., et al. “Leg strength in peripheral arterial disease: associations with disease severity and lower-extremity performance”. Journal of Vascular Surgery 39 (2004): 523-530.
20. McGuigan M R., et al. “Resistance training in patients with peripheral arterial disease: effects on myosin isoforms, fiber type distribution, and capillary supply to skeletal muscle”. Journals of Gerontology Series A Biological Sciences and Medical Science 56 (2001): B302-310.
21. Nadeau M., et al. “The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation”. Canadian journal of surgery. Journal Canadien De Chirurgie 56 (2013): 372-377.
22. Olesen K K W., et al. “Peripheral artery disease, lower limb revascularization, and amputation in diabetes patients with and without coronary artery disease: a cohort study from the Western Denmark Heart Registry”. BMJ Open Diabetes Research Care 9 (2021): e001803.
23. Parmenter B J., et al. “Resistance training as a treatment for older persons with peripheral artery disease: a systematic review and meta-analysis”. British Journal of Sports Medicine 54 (2020): 452-461.
24. Parmenter BJ., et al. “High-intensity progressive resistance training improves flat-ground walking in older adults with symptomatic peripheral arterial disease”. Journal of the American Geriatrics Society 61 (2013): 1964-1970.
25. Pescatello Linda S. ACSM's guidelines for exercise testing and prescription (Wolters Kluwer/Lippincott Williams and Wilkins Health: Philadelphia) (2014).
26. Peters C M L., et al. “Two-year Outcome of Quality of Life and Health Status for the Elderly with Chronic Limb-threatening Ischemia”. Clinical Interventions in Aging 15 (2020): 2383-2395.
27. Ritti-Dias R M., et al. “Strength training increases walking tolerance in intermittent claudication patients: randomized trial”. Journal of Vascular Surgery 51 (2010): 89-95.
28. Salhiyyah K., et al. “Pentoxifylline for intermittent claudication”. Cochrane Database of Systematic Reviews 9 (2015): CD005262.
29. Samra S S., et al. “Efficacy and safety of cilostazol, a novel phosphodiesterase inhibitor in patients with intermittent claudication”. Journal of Indian Medical Association 101 (2003): 561-562, 64.
30. Sanderson B., et al. “Short-term effects of cycle and treadmill training on exercise tolerance in peripheral arterial disease”. Journal of Vascular Surgery 44 (2006): 119-127.
31. Stewart K J., et al. “Exercise training for claudication”. The New England Journal of Medicine 347 (2002): 1941-1951.
32. Swedish Council on Health Technology, Assessment. SBU Systematic Review Summaries.' in, Peripheral Arterial Disease - Diagnosis and Treatment: A Systematic Review (Swedish Council on Health Technology Assessment (SBU) (2008).
33. Copyright © 2007 by the Swedish Council on Health Technology Assessment.: Stockholm) (2007).
34. Treat-Jacobson D., et al. “Efficacy of arm-ergometry versus treadmill exercise training to improve walking distance in patients with claudication”. Vascualr Medicine 14 (2009): 203-213.
35. Treat-Jacobson D., et al. “Optimal Exercise Programs for Patients With Peripheral Artery Disease: A Scientific Statement From the American Heart Association”. Circulation 139 (2019): e10-e33.
36. Ugwu E., et al. “Ankle brachial index as a surrogate to vascular imaging in evaluation of peripheral artery disease in patients with type 2 diabetes”. BMC Cardiovasc Disord 21 (2021): 10.
37. van Schaardenburgh M., et al. “Exercise in claudicants increase or decrease walking ability and the response relates to mitochondrial function”. Journal of Translational Medicine 15 (2017): 130.
38. Walker R D., et al. “Influence of upper- and lower-limb exercise training on cardiovascular function and walking distances in patients with intermittent claudication”. Journal of Vascular Surgery 31 (2000): 662-669.

Citation

Citation: Bassem Zarif., et al. “Breaking the Tie: How to Start Rehabilitation in Patients with Severe Limiting Intermittent Claudication". Acta Scientific Medical Sciences 5.12 (2021): 130-135.

Copyright

Copyright: © 2021 Bassem Zarif., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.