Skip to main content
SpringerLink
Log in

Exercise Therapy for Peripheral Artery Disease

  • Peripheral Vascular Disease (S Kinlay, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To summarize evidence regarding exercise treatments for lower extremity peripheral artery disease (PAD).

Recent Findings

Supervised walking exercise is recommended by practice guidelines for PAD. Supervised treadmill exercise improves treadmill walking distance by approximately 180 m and 6-min walk distance by 30–35 m, compared to control. The Centers for Medicaid and Medicare Services covers 12 weeks of supervised exercise, but most people with PAD do not participate. Home-based walking exercise may be more convenient and accessible than supervised exercise. In randomized clinical trials, home-based walking exercise interventions incorporating behavioral methods, such as accountability to a coach, goal-setting, and self-monitoring, improved 6-min walk distance by 40–54 m, compared to control. Arm and leg ergometry also improved walking endurance for people with PAD, but efficacy compared to walking exercise remains unclear.

Summary

Walking exercise is first-line therapy for PAD-related walking impairment and can be effective in either a supervised or a structured home-based setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127(1):143–52.

    Article  PubMed  Google Scholar 

  2. Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–40.

    Article  PubMed  Google Scholar 

  3. Polonsky TS, McDermott MM. Lower extremity peripheral artery disease without chronic limb-threatening ischemia: a review. JAMA. 2021;325(21):2188–98.

    Article  PubMed  Google Scholar 

  4. McDermott MM. Lower extremity manifestations of peripheral artery disease: the pathophysiologic and functional implications of leg ischemia. Circ Res. 2015;116(9):1540–50.

    Article  PubMed  PubMed Central  Google Scholar 

  5. McDermott MM, Greenland P, Liu K, Guralnik JM, Criqui MH, Dolan NC, et al. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA. 2001;286(13):1599–606.

    Article  CAS  PubMed  Google Scholar 

  6. McDermott MM, Liu K, Greenland P, Guralnik JM, Criqui MH, Chan C, et al. Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA. 2004;292(4):453–61.

    Article  CAS  PubMed  Google Scholar 

  7. McDermott MM, Greenland P, Tian L, Kibbe MR, Green D, Zhao L, et al. Association of 6-minute walk performance and physical activity with incident ischemic heart disease events and stroke in peripheral artery disease. J Am Heart Assoc. 2015;4(7):e001846. https://doi.org/10.1161/JAHA.115.001846. PMID: 26219563; PMCID: PMC4608069.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12):e686–725.

    PubMed  Google Scholar 

  9. Lane R, Harwood A, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2017;12(12):CD000990.

    PubMed  Google Scholar 

  10. McDermott MM, Ades P, Guralnik JM, Dyer A, Ferrucci L, Liu K, et al. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA. 2009;301(2):165–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. McDermott MM, Ferrucci L, Tian L, Guralnik JM, Lloyd-Jones D, Kibbe MR, et al. Effect of granulocyte-macrophage colony-stimulating factor with or without supervised exercise on walking performance in patients with peripheral artery disease: the PROPEL randomized clinical trial. JAMA. 2017;318(21):2089–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. McDermott MM, Bazzano L, Peterson CA, Sufit R, Ferrucci L, Domanchuk K, et al. Effect of telmisartan on walking performance in patients with lower extremity peripheral artery disease: The TELEX randomized clinical trial. JAMA. 2022;328(13):1315–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Conte MS, Pomposelli FB, Clair DG, Geraghty PJ, McKinsey JF, Mills JL, et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015;61(3 Suppl):2S-41S.

    Article  PubMed  Google Scholar 

  14. McDermott MM. Home-based walking exercise for peripheral artery disease. JAMA. 2022;327(14):1339–40.

    Article  PubMed  Google Scholar 

  15. Gardner AW, Parker DE, Montgomery PS, Scott KJ, Blevins SM. Efficacy of quantified home-based exercise and supervised exercise in patients with intermittent claudication: a randomized controlled trial. Circulation. 2011;123(5):491–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gardner AW, Parker DE, Montgomery PS, Blevins SM. Step-monitored home exercise improves ambulation, vascular function, and inflammation in symptomatic patients with peripheral artery disease: a randomized controlled trial. J Am Heart Assoc. 2014;3(5): e001107.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fakhry F, van de Luijtgaarden KM, Bax L, den Hoed PT, Hunink MG, Rouwet EV, et al. Supervised walking therapy in patients with intermittent claudication. J Vasc Surg. 2012;56(4):1132–42.

    Article  PubMed  Google Scholar 

  18. Gommans LN, Saarloos R, Scheltinga MR, Houterman S, de Bie RA, Fokkenrood HJ, et al. Editor’s choice–the effect of supervision on walking distance in patients with intermittent claudication: a meta-analysis. Eur J Vasc Endovasc Surg. 2014;48(2):169–84.

    Article  CAS  PubMed  Google Scholar 

  19. McDermott MM, Ades PA, Dyer A, Guralnik JM, Kibbe M, Criqui MH. Corridor-based functional performance measures correlate better with physical activity during daily life than treadmill measures in persons with peripheral arterial disease. J Vasc Surg. 2008;48(5):1231–7, 7.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  20. McDermott MM, Guralnik JM, Tian L, Zhao L, Polonsky TS, Kibbe MR, et al. Comparing 6-minute walk versus treadmill walking distance as outcomes in randomized trials of peripheral artery disease. J Vasc Surg. 2020;71(3):988–1001.

    Article  PubMed  Google Scholar 

  21. Jensen TS, Chin J, Ashby L, Schafer J, Dolan D. Proposed national coverage determination for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD). Available from: https://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=287.

  22. Harwood AE, Smith GE, Cayton T, Broadbent E, Chetter IC. A systematic review of the uptake and adherence rates to supervised exercise programs in patients with intermittent claudication. Ann Vasc Surg. 2016;34:280–9.

    Article  PubMed  Google Scholar 

  23. Dua A, Gologorsky R, Savage D, Rens N, Gandhi N, Brooke B, et al. National assessment of availability, awareness, and utilization of supervised exercise therapy for peripheral artery disease patients with intermittent claudication. J Vasc Surg. 2020;71(5):1702–7.

    Article  PubMed  Google Scholar 

  24. Divakaran S, Carroll BJ, Chen S, Shen C, Bonaca MP, Secemsky EA. Supervised exercise therapy for symptomatic peripheral artery disease among medicare beneficiaries between 2017 and 2018: participation rates and outcomes. Circ Cardiovasc Qual Outcomes. 2021;14(8): e007953.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cetlin MD, Polonsky T, Ho K, Zhang D, Tian L, Zhao L, et al. Barriers To participation in supervised exercise therapy reported by people with peripheral artery disease. J Vasc Surg. 2022;77(2):506–14. https://doi.org/10.1016/j.jvs.2022.09.014. Epub 2022 Sep 20. PMID: 36150636.

    Article  PubMed  Google Scholar 

  26. Hammond MM, Tian L, Zhao L, Zhang D, McDermott MM. Attendance at supervised exercise sessions and walking outcomes in peripheral artery disease: results from 2 randomized clinical trials. J Am Heart Assoc. 2022;11(24): e026136.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Regensteiner JG, Meyer TJ, Krupski WC, Cranford LS, Hiatt WR. Hospital vs home-based exercise rehabilitation for patients with peripheral arterial occlusive disease. Angiology. 1997;48(4):291–300.

    Article  CAS  PubMed  Google Scholar 

  28. Savage P, Ricci MA, Lynn M, Gardner A, Knight S, Brochu M, et al. Effects of home versus supervised exercise for patients with intermittent claudication. J Cardiopulm Rehabil. 2001;21(3):152–7.

    Article  CAS  PubMed  Google Scholar 

  29. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006;113(11):e463-654.

    PubMed  Google Scholar 

  30. McDermott MM, Liu K, Guralnik JM, Criqui MH, Spring B, Tian L, et al. Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial. JAMA. 2013;310(1):57–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Bearne LM, Volkmer B, Peacock J, Sekhon M, Fisher G, Galea Holmes MN, et al. Effect of a home-based, walking exercise behavior change intervention vs usual care on walking in adults with peripheral artery disease: the MOSAIC randomized clinical trial. JAMA. 2022;327(14):1344–55.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Golledge J, Singh TP, Alahakoon C, Pinchbeck J, Yip L, Moxon JV, et al. Meta-analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease. Br J Surg. 2019;106(4):319–31.

    Article  CAS  PubMed  Google Scholar 

  33. •• Thangada ND, Zhang D, Tian L, Zhao L, Rejeski WJ, Ho KJ, et al. Home-based walking exercise and supervised treadmill exercise in patients with peripheral artery disease: an individual participant data meta-analysis. JAMA Netw Open. 2023;6(9):e2334590. This randomized clinical trial of 305 participants with PAD demonstrated for the first time that walking for exercise at a pace inducing ischemic leg symptoms was significantly more effective than walking for exercise at a comfortable pace, for the outcomes of 6-min walk distance and treadmill walking time, despite the fact that those randomized to walking exercise at a pace inducing ischemic leg symptoms walked about half as many minutes per week as those randomized to walking exercise at a comfortable pace.

    Article  PubMed  PubMed Central  Google Scholar 

  34. McDermott MM, Spring B, Berger JS, Treat-Jacobson D, Conte MS, Creager MA, et al. Effect of a home-based exercise intervention of wearable technology and telephone coaching on walking performance in peripheral artery disease: the HONOR randomized clinical trial. JAMA. 2018;319(16):1665–76.

    Article  PubMed  PubMed Central  Google Scholar 

  35. •• McDermott MM, Spring B, Tian L, Treat-Jacobson D, Ferrucci L, Lloyd-Jones D, et al. Effect of low-intensity vs high-intensity home-based walking exercise on walk distance in patients with peripheral artery disease: The LITE Randomized Clinical Trial. JAMA. 2021;325(13):1266–76. This randomized clinical trial of 305 participants with PAD demonstrated for the first time that walking for exercise at a pace inducing ischemic leg symptoms was significantly more effective than walking for exercise at a comfortable pace, for the outcomes of 6-min walk distance and treadmill walking time, despite the fact that those randomized to walking exercise at a pace inducing ischemic leg symptoms walked about half as many minutes per week as those randomized to walking exercise at a comfortable pace.

    Article  PubMed  PubMed Central  Google Scholar 

  36. McDermott MM. Walking exercise for peripheral artery disease. JAMA Cardiol. 2023;8(4):310–1.

    Article  PubMed  Google Scholar 

  37. Ulfsdottir H, Bäck M, Cider Å, Jivegård L, Sandberg A, Nordanstig J, et al. Cost-Effectiveness of exercise therapy in patients with intermittent claudication-a comparison of supervised exercise, home-based structured exercise, and walk advice from the SUNFIT trial. J Clin Med. 2023;12(16):5277. https://doi.org/10.3390/jcm12165277. PMID: 37629318; PMCID: PMC10455939.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Gommans LN, Fokkenrood HJ, van Dalen HC, Scheltinga MR, Teijink JA, Peters RJ. Safety of supervised exercise therapy in patients with intermittent claudication. J Vasc Surg. 2015;61(2):512-8.e2.

    Article  PubMed  Google Scholar 

  39. Waddell A, Seed S, Broom DR, McGregor G, Birkett ST, Harwood AE. Safety of home-based exercise for people with intermittent claudication: a systematic review. Vasc Med. 2022;27(2):186–92.

    Article  PubMed  Google Scholar 

  40. • Treat-Jacobson D, McDermott MM, Beckman JA, Burt MA, Creager MA, Ehrman JK, et al. Implementation of supervised exercise therapy for patients with symptomatic peripheral artery disease: a science advisory from the American Heart Association. Circulation. 2019;140(13):e700–10. This scientific advisory from the American Heart Association provides an overview and practical guide to implementing supervised exercise therapy for patients with symptomatic peripheral artery disease that is covered by Medicare.

    Article  PubMed  Google Scholar 

  41. Thangada ND, Xu S, Tian L, Zhao L, Criqui MH, Ferrucci L, et al. Hospitalizations during home-based walking exercise interventions in peripheral artery disease: results from two randomized clinical trials. Vasc Med. 2023;28(6):583–5. https://doi.org/10.1177/1358863X231191909. Epub 2023 Aug 25. PMID:37622748.

    Article  PubMed  Google Scholar 

  42. Zwierska I, Walker RD, Choksy SA, Male JS, Pockley AG, Saxton JM. Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: a randomized controlled trial. J Vasc Surg. 2005;42(6):1122–30.

    Article  PubMed  Google Scholar 

  43. Tew G, Nawaz S, Zwierska I, Saxton JM. Limb-specific and cross-transfer effects of arm-crank exercise training in patients with symptomatic peripheral arterial disease. Clin Sci (Lond). 2009;117(12):405–13.

    Article  PubMed  Google Scholar 

  44. Bronas UG, Treat-Jacobson D, Leon AS. Comparison of the effect of upper body-ergometry aerobic training vs treadmill training on central cardiorespiratory improvement and walking distance in patients with claudication. J Vasc Surg. 2011;53(6):1557–64.

    Article  PubMed  Google Scholar 

  45. Regensteiner JG, Steiner JF, Hiatt WR. Exercise training improves functional status in patients with peripheral arterial disease. J Vasc Surg. 1996;23(1):104–15.

    Article  CAS  PubMed  Google Scholar 

  46. McGuigan MR, Bronks R, Newton RU, Sharman MJ, Graham JC, Cody DV, et al. Resistance training in patients with peripheral arterial disease: effects on myosin isoforms, fiber type distribution, and capillary supply to skeletal muscle. J Gerontol A Biol Sci Med Sci. 2001;56(7):B302–10.

    Article  CAS  PubMed  Google Scholar 

  47. Parmenter BJ, Mavros Y, Ritti Dias R, King S, Fiatarone SM. Resistance training as a treatment for older persons with peripheral artery disease: a systematic review and meta-analysis. Br J Sports Med. 2020;54(8):452–61.

    PubMed  Google Scholar 

Download references

Funding

Neela D. Thangada reports grant support from the NIH (5T32HL069771-19). Mary M. McDermott reports grants from NHLBI, NIA, and the American Heart Association.

Author information

Authors and Affiliations

  1. Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, 10th floor, Chicago, IL, 60611, USA

    Neela D. Thangada & Mary M. McDermott

Authors
  1. Neela D. Thangada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary M. McDermott
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NDT and MMM both wrote the main manuscript and prepared the tables. All authors reviewed the manuscript.

Corresponding author

Correspondence to Mary M. McDermott.

Ethics declarations

Conflict of Interest

The authors declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thangada, N.D., McDermott, M.M. Exercise Therapy for Peripheral Artery Disease. Curr Cardiol Rep (2024). https://doi.org/10.1007/s11886-024-02043-4

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11886-024-02043-4

Keywords

Search

Navigation