Improving functional outcomes in patients with intermittent claudication

Objective: To provide an overview of therapies for improving functional outcomes in individuals with intermittent claudication due to lower-limb peripheral arterial disease (PAD). Methods: Literature review. Results: Treatment approaches that aim to improve functional outcomes (and walking performance specifically) in individuals with intermittent claudication include exercise training, lower-limb revascularization, and prescription of various drugs, including peripheral vasodilators. Supervised exercise training, particularly that which involves walking as the main exercise modality, is an effective treatment for improving walking performance in individuals with intermittent claudication; however, few supervised exercise programs exist specifically for these patients, limiting access to this therapy. Consequently, most patients with intermittent claudication do not participate in supervised exercise. The evidence for the effectiveness of unsupervised exercise programs is currently weak and mixed, and lack of motivation and pain have been cited as major barriers to participation in self-managed exercise. Lower-limb revascularization procedures (angioplasty or bypass surgery) can improve walking performance; however, such procedures are not feasible for some patients (eg, in the case of extensive multi-segmental disease) and are invasive and expensive. Medications used to treat PAD-related functional impairment (eg, cilostazol, pentoxifylline, inositol nicotinate, and naftidrofuryl oxalate [not approved in the US]) all have limited efficacy. Conclusion: Supervised walking exercise is a cheap and effective approach for improving walking performance in individuals with intermittent claudication. Therefore, efforts should be made to provide patients with access to a supervised exercise program, or to promote self-managed walking when supervised exercise is not available or practical.