Exercise Rehabilitation in Peripheral Artery Disease

Abstract

In the United States, 8 million adults have peripheral artery disease (PAD), a number that is likely to escalate as the population ages.1,–,3 Lower-extremity PAD is a component of systemic atherosclerosis and confers a markedly heightened risk of cardiovascular morbidity and mortality.4,–,7 It is now established that PAD accelerates functional decline leading to physical disability.8,9 Exercise therapy combined with comprehensive secondary prevention has the potential to benefit patients with PAD by preserving or improving functional capacity and reducing cardiovascular events. Accordingly, this review will address the relation between exercise intolerance and outcomes in patients with PAD; the effects of exercise training in PAD and the many possible mechanisms of benefit; and the potential role of comprehensive secondary prevention programs in these patients. Traditionally, PAD has been viewed as a disease of the lower extremities typified by intermittent claudication. Studies now have demonstrated the malignant cardiovascular course of PAD even in the absence of claudication. The presence of PAD can be readily identified by the ankle-brachial index (ABI), a simple test comparing systolic blood pressure measured in the arm and in the ankle by Doppler.10,–,12 Among patients with a low ABI (defined as ≤0.90) detected in both population-based and high-risk primary care cohorts, only 10% to 15% have intermittent claudication.13,–,15 The international ABI Collaboration patient-level meta-analysis of >48 000 individuals found that a low ABI predicted a doubling of 10-year risk of mortality, cardiovascular mortality, and major coronary events at all levels of Framingham Risk Score.4 Importantly, the German Epidemiological Study on Ankle Brachial Index recently reported that asymptomatic individuals with PAD identified in a primary care screening program had similarly elevated 5-year risk of morbidity and …