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BMJ Open Access logoLink to BMJ Open Access
. 2020 Feb 12;54(23):1443–1444. doi: 10.1136/bjsports-2019-101930

Infographic. Exercise for intermittent claudication

Garry A Tew 1,2,, Louise Allen 3, Christopher D Askew 4,5, Ian Chetter 6, Gabriel Cucato 1, Patrick Doherty 2, Andrew Garnham 7, Amy Harwood 8,9, Lee Ingle 9, Michael Jenkins 3, Jonathan Michaels 10, Sara Pittack 11, Chris Seenan 12, Hazel Trender 13
PMCID: PMC7677460  PMID: 32051119

graphic file with name bjsports-2019-101930f01.jpg

Intermittent claudication (IC) is pain or discomfort in the muscles of the calf, thigh or buttock that occurs during walking and is relieved by rest. It affects 4% of people over 60 years of age and is the most common symptom of peripheral arterial disease (PAD). For people with IC, the goals of treatment are twofold: (1) secondary prevention of cardiovascular disease through management of risk factors (eg, tobacco use, dyslipidaemia, diabetes, hypertension and physical inactivity); (2) improving functional status, with treatment options including exercise training, revascularisation and vasodilator therapy.1

In 2012, the UK’s National Institute for Health and Care Excellence published a clinical guideline on the diagnosis and management of PAD.1 This guideline recommended that a 3-month supervised exercise programme (SEP) should be offered as a first-line therapy for IC, and that revascularisation and vasodilator therapy should only be considered if exercise provides insufficient symptom relief. Although research studies have shown unsupervised exercise to be generally less effective at improving functional status than an SEP, it can still be effective, and should be recommended if an SEP is not available.1 2

The evidence supporting the efficacy of exercise for people with IC dates back to 1966 when a study reported that 6 months of interval walking exercise improved patients’ pain-free and maximum walking distances.3 Over the following 50+ years, numerous randomised trials and meta-analyses have been published supporting the efficacy of exercise in improving functional status in this population.4 Despite this evidence and the clinical guideline recommendations, the provision of SEPs is variable, with one study reporting that only 38.5% of vascular units in the UK had access to an SEP.5 Potential barriers include a lack of funding, facilities and patient motivation.

The benefits of exercise for people with IC are too great to be ignored. Therefore, to support the provision and uptake of exercise, we have developed two new resources. First, a statement for healthcare professionals that summarises the evidence and provides exercise prescription guidelines.2 Second, an infographic of key messages aimed primarily at patients. This infographic, which may be shared digitally or used as a poster or handout in clinics, aims to encourage patients to make exercising a regular habit by highlighting potential benefits and providing clear guidelines and safety messages. We hope that readers will share this infographic widely to enhance awareness of this debilitating condition and the important role that exercise can play in its management.

Footnotes

Twitter: @garry_tew, @chrisseenan

Correction notice: This article has been corrected since it published Online First. The title has been corrected.

Contributors: GT led the design of the infographic and drafted the accompanying text. All coauthors contributed to the design of the infographic and reviewing and revising the text. All authors approved the final version to be published and are accountable for all aspects of the work.

Funding: The infographic was funded by The Circulation Foundation and Northumbria University.

Competing interests: None declared.

Patient consent for publication: Not required.

Provenance and peer review: Not commissioned; externally peer reviewed.

References

  • 1. National Institute for Health and Care Excellence Peripheral arterial disease: diagnosis and management (clinical guideline CG147), 2012. Available: www.nice.org.uk/guidance/cg147 [PubMed]
  • 2. Tew GA, Harwood A, Ingle L, et al. The BASES Expert Statement on exercise training for people with intermittent claudication due to peripheral arterial disease. The Sport and Exercise Scientist, 2018. Available: https://www.bases.org.uk/imgs/autumn_2018_7601_bas_expert_statement__v2_569.pdf
  • 3. Larsen OA, Lassen NA. Effect of daily muscular exercise in patients with intermittent claudication. Lancet 1966;2:1093–5. 10.1016/S0140-6736(66)92191-X [DOI] [PubMed] [Google Scholar]
  • 4. Lane R, Harwood A, Watson L, et al. Exercise for intermittent claudication. Cochrane Database Syst Rev 2017;12:CD000990 10.1002/14651858.CD000990.pub4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5. Harwood AE, Smith GE, Broadbent E, et al. Access to supervised exercise services for peripheral vascular disease patients. The Bulletin of the Royal College of Surgeons of England 2017;99:207–11. 10.1308/rcsbull.2017.207 [DOI] [Google Scholar]

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