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. Author manuscript; available in PMC: 2014 Apr 1.
Published in final edited form as: Curr Treat Options Cardiovasc Med. 2013 Apr;15(2):188–199. doi: 10.1007/s11936-013-0231-z

Table 1.

Summary of advantages and disadvantages of various exercise therapy options for peripheral artery disease patients with intermittent claudication

Exercise Modality Advantages Disadvantages
supervised walking
  • -

    rated class IA by the ACC/AHA PAD practice guidelines [9]

  • -

    effective strategy for improving PWT, COT and patient-reported outcomes [18]

  • -

    patient safety assured in hospital settings

  • -

    lack of insurance reimbursement [56]

  • -

    transportation to clinics may not be available for patients, additionally costly or inconvenient

  • -

    long term adherence problematic due to short duration of most supervised programs (3 months)

community walking
  • -

    walking exercise in community settings more specific to activities of daily living than supervised walking and non-weight bearing modalities (e.g., leg ergometry)

  • -

    bypasses many of the barriers associated with supervised exercise

  • -

    lower cost [32]

  • -

    rated class IIB (as unsupervised exercise) by the ACC/AHA PAD practice guidelines [9]

  • -

    ineffective when clinicians provide only advice to exercise

  • -

    numerous social and built environment barriers to performing community-based walking such as crime and poor sidewalks [57]

leg ergometry
  • -

    able to induce IC thus providing specific training to affected lower limbs in addition to central cardiovascular adaptations [38]

  • -

    potential alternative for patients with gait abnormalities limiting walking

  • -

    not assessed by ACC/AHA PAD practice guidelines

  • -

    many leg ergometers are uncomfortable for seating [58]

  • -

    no studies in community settings, thus similar barriers for implementation as supervised walking programs

arm ergometry
  • -

    alternative for patients who are high risk for wounds such as those with CLI

  • -

    effective for improving central cardiorespiratory adaptations of patients otherwise limited in ability to exercise [40]

  • -

    not assessed by ACC/AHA PAD practice guidelines

  • -

    lack of specificity for local level muscular adaptations due to inactive lower limbs

  • -

    studies needed examining implementation in community settings because supervision is required

polestriding
  • -

    may be viable alternative for patients with balance issues

  • -

    maintains upright weight-bearing nature of walking exercise however poles decrease lower limb loading [59] thus attenuating IC and increasing central cardiorespiratory demand and improvement

  • -

    not rated by ACC/AHA PAD practice guidelines

  • -

    patients’ may be unfamiliar with the ski like motion required, thus adoption may be difficult

  • -

    differences in technique and/or fitness level may result in a wide range of walking improvement [46]

  • -

    patients may be uncomfortable walking with poles in community settings [45]

resistance training
  • -

    plantar flexion resistance exercise can be performed while seated which may be more comfortable for patients

  • -

    resistance training improves other health outcomes such as increased bone mineral density and muscular strength [55]

  • -

    not rated by ACC/AHA PAD practice guidelines

  • -

    plantar flexion exercise focuses on the muscles of the calf thus patients with IC in the thighs or buttocks will not derive benefit from this modality

  • -

    unlikely to be as beneficial for the cardiovascular system as walking exercise

ACC American College of Cardiology; AHA American Heart Association; CLI critical limb ischemia; COT claudication onset time; IC intermittent claudication; PAD peripheral artery disease; PWT peak walking time