With peripheral arterial insufficiency, leg pain during rest can be reduced by:
A. Elevating the limb above heart level.
B. Lowering the limb so it is dependent.
C. Massaging the limb after application of cold compresses.
D. Placing the limb in a plane horizontal to the body.
Correct Answer: B. Lowering the limb so it is dependent
The cornerstone of treatment of PAD is exercise to improve peripheral circulation, walking economy, cardiopulmonary function, and functional capacity. The data to support the efficacy of supervised exercise in improving claudication are robust with the length of the program influencing the magnitude of increase in maximal walking distance of up to 150% (range 74% to 230%).
Option A: Functional benefits (increased walking speed, distance, duration, and decreased symptoms) accrue gradually and can occur in as early as 4 to 8 weeks, but greater benefit is conferred with programs of 6 months or longer. Typical improvements in walking distance include more than 100% increase in peak exercise performance and self-reported physical function. Longer walking interventions achieve greater benefit. However, most studies have been of short duration, 3 to 6 months,55 with few longer than 12 months.
Option C: Exercise recommendations have been extrapolated from clinical trials in patients with PAD. Based on these studies, walking is the most effective mode of exercise. Although resistance training does confer some benefit, it has been shown to be less effective than walking in improving walking distance in patients with PAD. Recently, pole striding exercise has been demonstrated to increase cardiovascular fitness, improve symptoms and quality of life in a small group of PAD patients.
Option D: Exercise intensity is based on the workload achieved during a treadmill test that elicited claudication pain within 3 to 5 minutes of walking. Once this workload has been determined, the patient is asked to walk at this set workload until claudication of moderate intensity. Once this point is reached the patient is allowed to rest (standing or sitting) until pain subsides. The exercise-rest-exercise pattern is repeated for the duration of the exercise session.
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