Treatment for peripheral artery disease (PAD) focuses on reducing symptoms and preventing further progression of the disease. In most cases, lifestyle changes, exercise and claudication medications are enough to slow the progression or even reverse the symptoms of PAD.
An often effective treatment for PAD symptoms is regular physical activity. Your doctor, PA or NP may recommend a program of supervised exercise training for you, also known as cardiac rehabilitation. You may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs can ease symptoms. Exercise for intermittent claudication - poor circulation in leg arteries due to buildup of plaque - takes into account the fact that walking causes pain. The program consists of alternating activity and rest in intervals to build up the amount of time you can walk before the pain sets in. It's best if this exercise program is undertaken in a rehabilitation center on a treadmill and monitored. If it isn’t possible to go to a rehabilitation center, your healthcare professional may recommend a structured community or home-based program that's best suited to your situation.
The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.
The importance of physicians promoting physical activity for patients to prevent or ameliorate the risk for stroke, Alzheimer's disease, cardiovascular disease, and many other conditions has been promulgated by medical societies and researchers for years. However, no group has specifically addressed the feasibility, validity, and effectiveness of assessing and promoting physical activity in a healthcare setting — until now.
A new scientific statement from the American Heart Association (AHA) takes a pragmatic approach: highlighting recent research, offering solutions, and recommending a "systems change" approach.
Recognizing the challenges of counseling adults about behavior change, the 12 authors suggest healthcare providers no longer go it alone. Other clinicians, community leaders, and fitness experts can help get people moving and reduce their risk for morbidity and mortality from conditions associated with physical inactivity.
Physical activity plays a significant role, the authors state, for prevention and management of more than 40 diseases beyond cardiovascular disease. Obesity, diabetes mellitus, cancer, depression, Alzheimer's disease, arthritis, and osteoporosis are prime examples.
• Walking lengthened the life of people with diabetes regardless of age, sex, race, body mass index, length of time since diagnosis, and presence of complications or functional limitations.
• Among the study group, 62 percent reported doing any leisure-time physical activity; 46 percent reported walking for exercise.
• People with diabetes who walked for exercise at least 2 hours a week lowered their mortality rate from all causes by 39 percent.
• People with diabetes who engage in at least 2 hours of any leisure-time physical activity a week had a 29 percent lowered mortality risk compared with people who are inactive.
• Walking 3 to 4 hours a week reduced mortality from all causes by 54 percent.
• Among adults with diabetes, one death a year may be prevented for every 61 people who walk at least 2 hours per week.
• Risk of death from heart disease could be reduced by 34 percent by walking at least 2 hours per week.
• One cardiovascular death a year might be preventable for every 145 people persuaded to walk at least 2 hours a week.
• While the study found that walking at moderate-intensity levels reduced mortality, no reduction in mortality was associated with more intense levels of walking, indicating that vigorous levels of exercise are not as beneficial for people with type 2 diabetes.
Supervised exercise training has been shown to result in significant improvement in maximum walking time, pain-free walking, and maximum walking distance; however, despite the preponderance of data, this therapy is currently not reimbursed by CMS (2016). While unsupervised exercise has some advantages, a meta-analysis of 27 studies demonstrated that supervised exercise is effective at improving maximum walking and initial claudication distance whereas unsupervised exercise therapy alone provides little or no benefit. The benefit for supervised exercise therapy has been reported by the Agency for Healthcare Research and Quality (AHRQ) in its ‘Treatment Strategies for Patients With Peripheral Artery Disease. Therefore, the Coalition strongly recommends full coverage of supervised exercise training programs for Medicare patients with intermittent claudication.
Overall, the coalition felt that there was sufficient evidence for medical therapy, supervise exercise training, and revascularization in appropriate patients with intermittent claudication. The Coalition recognized the reported trend or increased use of endovascular procedures within the United States, but noted that arterial interventions were stable over 8 years whereas there was a significant increase in endovenous ablation procedures. Future analyses must separate endovenous procedures from intraarterial revascularization. While all patients with intermittent claudication should be considered for aggressive medical and supervised exercise training, revascularization should be limited to individuals with significant lifestyle-limiting claudication who have failed medical and exercise training, as recommended by the current ACC/AHA guidelines.
Effective May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) will pay for supervised exercised therapy (SET) for beneficiaries with intermittent claudication for the treatment of symptomatic peripheral artery disease. To implement this National Coverage Determination (NCD), CMS will pay separately for CPT code 93668. There may now be a proven SET treatment available at your health care professional’s office.
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