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Peripheral Artery Disease Boosting Activity, Health, and Quality of Life

As many as one out of ten patients in Australia’s primary care settings deal with peripheral artery disease (PAD).1 The Australian Institute of Health and Welfare associates PAD with nearly 60,000 hospitalisations annually, as well as 1,900 deaths

Of course, in its mild presentation, PAD causes no symptoms. As severity increases, claudication occurs. That’s pain in the lower extremity caused by walking. Unfortunately, claudication commonly leads to sedentary lifestyle and the host of subsequent negative health consequences.2

On the other hand, guideline-recommended, supervised exercise therapy is shown to improve pain-free walking ability, overall functional status, health-related quality of life, and allcause mortality risk.3,4 A referral to supervised exercise therapy should be considered for any patient who is not at risk of acute limb ischemia but who is lowering activity levels due to claudication.5

Additionally, supervised exercise therapy should be offered to patients following revascularisation. Research shows that supervised exercise therapy adds to the benefits of revascularisation.6,7

The following information may help healthcare practitioners when consulting with clients about the possibility of supervised exercise therapy. • Research suggests that 36 to 72 sessions of therapeutic exercise are needed to achieve continued lifetime ambulatory and health benefits, as well as to lower all-cause mortality risk.3,4

As many as three sessions of supervised exercise therapy per week may be needed initially, with the goal of two additional home exercise sessions. As patient training progresses and successful exercise adherence is verified, the ratio of supervised to independent exercise sessions can be modulated.

• A common starting place is treadmill exercise, with the goal of continuously increasing intensity to cause claudication in five to ten minutes.4

The exercise physiologist will consider alternative exercise modes for patients who are not able to safely walk with intensity on the treadmill or who need other modes for optimal outcomes. As training progresses, the exercise physiologist may add multimodal therapeutic exercises to maximise functional benefits.

• Training a patient to understand the needed intensity level is of paramount importance. Patients often develop misinterpretations over time, thinking of the therapy as interval training rather than choosing the right intensity to induce claudication and then taking a break.

• Similarly, patient discouragement is common. When the progress occurs as increasing intensity, patients commonly misinterpret the same-length/same-number intervals as a lack of progress. It is the role of the exercise physiologist to keep the patient motivated and adherent to the therapeutic exercise plan.

• The combination of exercise physiology and physiotherapy, state-of-the-art equipment such as next-generation unweighted rehab, and the availability of a patient-only gym make Advanced Physiotherapy a qualified destination for your PAD rehab referrals.

 Exercise Sessions with tailored programs Group Exercise Classes Falls Prevention and much more Refer to Advanced for: Musculoskeletal Disorders Chronic Pain Pre and Post Surgery Exercise Weight Management Obesity Diabetes Metabolic Syndrome CVA (Stroke) Parkinson’s Disease Multiple Sclerosis Depression, Anxiety,


1. Australian Institute of Health and Welfare. Heart, stroke and vascular disease: Australian facts [Internet]. Canberra: Australian Institute of Health and Welfare, 2023 [cited 2023 Aug. 23]. Available from:

2. Gardner AW, Montgomery PS, Wang M, Shen B, Casanegra AI, Silva-Palacios F, Zhang S, Pomilla WA, Esponda OL, Kuroki M. Daily step counts in participants with and without peripheral artery disease. Journal of Cardiopulmonary Rehabilitation and Prevention. 2021 May 1;41(3):182-7.

3. Treat-Jacobson D, McDermott MM, Bronas UG, Campia U, Collins TC, Criqui MH, Gardner AW, Hiatt WR, Regensteiner JG, Rich K, American Heart Association Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Council on Cardiovascular and Stroke Nursing. Optimal exercise programs for patients with peripheral artery disease: a scientific statement from the American Heart Association. Circulation. 2019 Jan 22;139(4):e10-33.

4. Gardner AW, Addison O, Katzel LI, Montgomery PS, Prior SJ, Serra MC, Sorkin JD. Association between physical activity and mortality in patients with claudication. Medicine and Science in Sports and Exercise. 2021 Apr 4;53(4):732.

5. Ehrman JK, Gardner AW, Salisbury D, Lui K, Treat-Jacobson D. Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease: A review of current experience and practice-based recommendations. Journal of Cardiopulmonary Rehabilitation and Prevention. 2023 Jan 1;43(1):15-21.

6. Saratzis A, Paraskevopoulos I, Patel S, Donati T, Biasi L, Diamantopoulos A, Zayed H, Katsanos K. Supervised exercise therapy and revascularization for intermittent claudication: network meta-analysis of randomized controlled trials. JACC: Cardiovascular Interventions. 2019 Jun 24;12(12):1125-36.

7. Biswas MP, Capell WH, McDermott MM, et al. Exercise training and revascularization in the management of symptomatic peripheral artery disease. JACC Basic Transl Sci. 2021;6(2):174-188.

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