Exercise as a Treatment Option in Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a chronic, progressive atherosclerotic process limiting the blood flow to the lower limbs which causes an imbalance between oxygen supply and metabolic needs during physical activity with typical claudication symptoms. One important aspect of treatment besides optimal reduction of underlying risk factors is exercise training. Exerciseinduced increase of blood flow in arteries leading to the working and inactive musculature causes an increase of shear stress as the main physiological mechanism for the improvement in pain-free and maximal walking distances. The dominant and best examined training mode with respect to walking ability in daily life is walking exercise with an increase of maximal walking distance by around 150%. Strength training has a marginal or no effect on walking distance, however it facilitates strength dependent daily tasks like stair climbing. Arm cranking seems to be an alternative to walking, gaining a similar increase in walking distance as walking, and patients with orthopaedic problems might especially benefit from upper limb exercise. Basically, exercise training in PAD is determined by frequency, duration and intensity. A baseline walking test on a treadmill or in the field is very much recommended in order to monitor training advances and to establish a training plan. Exercise training has to be structured systematically with individual adaptation of training load. A total of 2–3 sessions per week with a duration of 30–45 min walking time per session seems to be enough to peak the increase in absolute walking distance. Supervised training has a clinical relevant advantage compared to non-supervised training with respect to an increase in walking distance. Drug treatment has to be combined with exercise training and is not a substitute for exercise. Interventional treatment is best accompanied by exercise training and is only associated with a higher increase in walking distance in a short time after treatment compared with exercise.