supervised walking |
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rated class IA by the ACC/AHA PAD practice guidelines [9]
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effective strategy for improving PWT, COT and patient-reported outcomes [18]
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patient safety assured in hospital settings
|
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lack of insurance reimbursement [56]
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transportation to clinics may not be available for patients, additionally costly or inconvenient
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long term adherence problematic due to short duration of most supervised programs (3 months)
|
community walking |
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walking exercise in community settings more specific to activities of daily living than supervised walking and non-weight bearing modalities (e.g., leg ergometry)
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bypasses many of the barriers associated with supervised exercise
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lower cost [32]
|
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rated class IIB (as unsupervised exercise) by the ACC/AHA PAD practice guidelines [9]
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ineffective when clinicians provide only advice to exercise
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numerous social and built environment barriers to performing community-based walking such as crime and poor sidewalks [57]
|
leg ergometry |
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able to induce IC thus providing specific training to affected lower limbs in addition to central cardiovascular adaptations [38]
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potential alternative for patients with gait abnormalities limiting walking
|
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not assessed by ACC/AHA PAD practice guidelines
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many leg ergometers are uncomfortable for seating [58]
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no studies in community settings, thus similar barriers for implementation as supervised walking programs
|
arm ergometry |
|
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not assessed by ACC/AHA PAD practice guidelines
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lack of specificity for local level muscular adaptations due to inactive lower limbs
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studies needed examining implementation in community settings because supervision is required
|
polestriding |
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may be viable alternative for patients with balance issues
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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
|
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not rated by ACC/AHA PAD practice guidelines
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patients’ may be unfamiliar with the ski like motion required, thus adoption may be difficult
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differences in technique and/or fitness level may result in a wide range of walking improvement [46]
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patients may be uncomfortable walking with poles in community settings [45]
|
resistance training |
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plantar flexion resistance exercise can be performed while seated which may be more comfortable for patients
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resistance training improves other health outcomes such as increased bone mineral density and muscular strength [55]
|
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not rated by ACC/AHA PAD practice guidelines
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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
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unlikely to be as beneficial for the cardiovascular system as walking exercise
|