Implementing a community-based structured exercise programme for patients with peripheral arterial disease in conjunction with an existing cardiac rehabilitation service results in better outcomes

Abstract

Structured exercise has been shown to improve intermittent claudication symptoms in patients with peripheral arterial disease, and the National Institute for Health and Care Excellence recommend it as a first-line treatment. A community-based podiatry-led lower limb arterial assessment service implemented a structured exercise programme for claudicants by liaising with a cardiac rehabilitation team to incorporate claudicants into an existing exercise programme for cardiac patients, thus using the skills, manpower and facilities already in place. Key findings of an audit of the first 12 months were: (1) higher than average uptake by claudicants compared with other supervised exercise programmes; (2) 72% reported an improvement in claudication symptoms; (3) 24% reported no deterioration in walking distance; (4) only 17% of patients were referred on for a surgical opinion on completion of the programme: prior to the community-based exercise programme all claudicants were seen in secondary care for assessment before being offered hospital-based structured exercise; (5) high level of patient satisfaction. Patients were supported to address modifiable cardiovascular risk factors such as smoking cessation, weight management, increasing physical activity and commencing best medical therapy. The audit indicates a high level of patient satisfaction, improvement in claudication symptoms and prevention of unnecessary surgical referrals. Patients were empowered to take ownership of their cardiovascular health. This has implications for financial savings and better use of resources and may contribute to a long-term reduction in cardiovascular-related morbidity and mortality, although further research into long-term outcomes should be considered.