Exercise for intermittent claudication. Physical Therapy. (2011)

My Comments

This was short review paper but I liked it because it gave consensus recommendations from both the TASC II (Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease) as well as the program from the American Heart Association.

 The TASC II program is as follows:

• Begin treadmill walking at a speed that causes calf pain within 3-5 minutes
• Walking should be stopped when claudication pain is moderate (2 on 4 point scale)
• Rest until pain has resolved, walk, rest, walk… (progressing from 30-60 minutes)
• If the patient can walk 10 minutes without a break (increase either the speed or incline on treadmill)
• Train 3 times per week for 3 months

 The American Heart Association guidelines are as follows:

• Begin walking on treadmill or track with an intensity starts pain (1 on claudication pain scale) in 3-5 minutes
• Walk until pain reaches 2 on scale then rest by sitting or standing
• Repeat cycle for 35 minutes
• Increase the exercise program by 5 minutes to 50 minutes total
• Train 3-5 times per week for a minimum of 12 weeks

 Pain Scale (used in paper):

1. Minimal discomfort
2. Moderate pain (patient can be distracted)
3. Intense pain
4. Unbearable pain

Looking at the two programs I see more similarities than differences, so I would expect them to work about the same. They are very similar to the protocol I’m starting my patients with. The paper mentions that supervised exercise still works substantially better than independent exercise, and looking at the program I’m not sure why that is. Possibly it could be that walking with claudication is painful and maybe it helps to have someone tell you when to get up and start walking again. However neither of these programs encouraged the patients to work up to higher levels of pain. It might also be that people who end up with intermittent claudication generally aren’t the kind of people who enjoy cardiovascular exercise for it’s own right (I know I sure don’t), so maybe they need that extra push to get going. I’ll try to learn more about differences found as I read through some of the individual studies, because eventually virtually everyone with PAD is going to need to transition to an independent exercise program.