Comprehensive cardiac rehabilitation program for peripheral arterial diseases

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Rehabilitation Medicine

Background:

• Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis, frequently co-occurring with coronary and cerebrovascular diseases.
• Patients with PAD experience a higher annual incidence of cardiovascular events (5.4%) compared to those with isolated coronary or cerebrovascular disease.
• Early detection and management of PAD are critical for preventing severe cardiovascular complications.

Purpose of the Study:

• To outline the screening, diagnosis, and comprehensive management strategies for peripheral arterial disease (PAD).
• To emphasize the role of the ankle-brachial pressure index (ABI) in PAD screening and diagnosis.
• To detail the components of effective cardiac rehabilitation programs for PAD patients, including exercise therapy and pharmacotherapy.

Main Methods:

• Screening for PAD is recommended using the ankle-brachial pressure index (ABI) in individuals with lower limb symptoms, those aged 65+, and those aged 50-65 with risk factors like smoking or diabetes.
• Diagnosis of PAD is confirmed when the ABI is less than 0.9.
• Comprehensive cardiac rehabilitation involves smoking cessation, blood pressure and glycemic control, antiplatelet agents, statins, and a multidisciplinary team approach.

Main Results:

• Supervised exercise therapy is strongly recommended (Class I, Level of Evidence A) for PAD management, with home-based programs also feasible (Class IIa, Level of Evidence A).
• Exercise parameters (type, frequency, intensity, duration) should be individualized based on stress test results, with a minimum of 3 sessions per week for 12 weeks.
• Cilostazol is a highly recommended medication (Class I, Level of Evidence A) for PAD treatment.

Conclusions:

• The ankle-brachial pressure index (ABI) is a key screening tool for peripheral arterial disease (PAD).
• A multidisciplinary approach integrating pharmacotherapy, risk factor modification, and tailored exercise programs is essential for comprehensive PAD management.
• Exercise therapy, particularly supervised programs, plays a crucial role in improving outcomes for PAD patients, excluding those with critical limb ischemia or infection.