The BASES Expert Statement on Exercise Training for People with Intermittent Claudication due to Peripheral Arterial Disease

Tew, Garry, Harwood, Amy, Ingle, Lee, Chetter, Ian and Doherty, Patrick (2018) The BASES Expert Statement on Exercise Training for People with Intermittent Claudication due to Peripheral Arterial Disease. The Sport and Exercise Scientist, 57. ISSN 1754-3444

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Abstract

Lower-limb peripheral arterial disease (PAD) is a type of cardiovascular disease in which the blood vessels (arteries) that carry blood to the legs and feet are hardened and narrowed or blocked by the build-up of fatty plaques (called atheroma). It affects around 13% of adults over 50 years old, and major risk factors for its development include smoking, diabetes mellitus, and dyslipidaemia (Morley, Sharma, Horsch & Hinchliffe, 2018). The presence of PAD itself is also a risk factor for other cardiovascular problems, such as angina, heart attack and stroke. This is because the underlying disease process, atherosclerosis, is a systemic process, meaning that blood vessels elsewhere in the body may also be affected.The most common symptom of PAD is intermittent claudication (IC), which is muscle pain or discomfort in the legs and/or buttocks brought on by walking and relieved within minutes on rest (Figure 1). It occurs due to an inability to increase blood flow (and oxygen delivery) sufficiently to match the metabolic demands of the lower-limb muscles during exercise. The walking distance or speed at which symptoms occur depends on multiple factors including the severity and site of the arterial disease, walking pace, terrain, incline and footwear. Nevertheless, IC can cause marked reductions in functional capacity and quality of life (Morley et al., 2018).Treatments for IC, aimed at relieving symptoms and reducing the risk of further cardiovascular disease, include lifestyle changes (e.g., stopping smoking, exercising more), vasoactive drugs (e.g. naftidrofuryl oxalate), and revascularisation (i.e. angioplasty or bypass surgery). In 2012, the United Kingdom’s National Institute of Health and Care Excellence (NICE) published a clinical guideline on the management of PAD, which stated that a supervised exercise programme should be offered as a first-line therapy for IC (NICE, 2012). This statement provides an overview of the evidence on exercise training and recommendations for people delivering exercise programmes to this population.

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