18
Treatment
Table 23. Structured Exercise Programs for PAD: Definitions
Supervised exercise program COR: I LOE: A
Program takes place in a hospital or outpatient facility.
Program uses intermittent walking exercise as the treatment modality.
Program can be standalone or within a cardiac rehabilitation program.
Program is directly supervised by qualified healthcare provider(s).
Training is performed for a minimum of 30–45 min/session; sessions are performed
at least 3 times/wk for a minimum of 12 wk.
Training involves intermittent bouts of walking to moderate-to-maximum
claudication, alternating with periods of rest.
Warm-up and cool-down periods precede and follow each session of walking.
Structured community- or home-based exercise program COR: IIa LOE: A
Program takes place in the personal setting of the patient rather than in a clinical
setting.
Program is self-directed with guidance of healthcare providers.
Healthcare providers prescribe an exercise regimen similar to that of a supervised
program.
Patient counseling ensures understanding of how to begin and maintain the program
and how to progress the difficulty of the walking (by increasing distance or speed).
Program may incorporate behavioral change techniques, such as health coaching or
use of activity monitors.
Table 24. Minimizing Tissue Loss in Patients With PAD
COR LOE
Recommendations
I C-LD Patients with PAD and diabetes mellitus should be counseled
about self-foot examination and healthy foot behaviors.
I C-LD In patients with PAD, prompt diagnosis and treatment of foot
infection are recommended to avoid amputation.
IIa C-LD In patients with PAD and signs of foot infection, prompt referral
to an interdisciplinary care team (Table 25) can be beneficial.
IIa C-EO It is reasonable to counsel patients with PAD without diabetes
mellitus about self-foot examination and healthy foot behaviors.
IIa C-EO Biannual foot examination by a clinician is reasonable for patients
with PAD and diabetes mellitus.
