Rehabilitation Therapy in Peripheral Arterial Disease

Abstract

Peripheral arterial disease (PAD) is the result of atherosclerosis in the lower limb arteries, which can give rise to intermittent claudication (IC), limb ulceration, infections, and, in some circumstances, amputation. As a result of PAD, patients are frequently limited in both walking duration and speed. These ambulatory deficits impact both functional capacity and quality of life. The prevalence of PAD is increasing, and patients with this diagnosis have high cardiovascular morbidity and mortality. A comprehensive approach is required to improve outcomes in patients with PAD and include tobacco cessation, pharmacologic management of metabolic fitness, risk-factor modification, and exercise training. Supervised exercise programs significantly improve functional capacity and quality of life in addition to reducing IC. These programs reduce morbidity and mortality and are cost-effective; yet they are uncommonly prescribed. Supervised exercise training is an accepted intervention in the PAD population and has been included in both Canadian and American guidelines for PAD management. This review describes (1) key background information related to PAD, (2) the initial approach to PAD diagnosis, (3) pharmacologic management options, (4) risk-factor modification, and (5) the currently accepted approach to exercise training. Key recommendations for enhancing PAD care in a Canadian context are also discussed.