Wednesday, May 04, 2016

Supervised exercise program for the claudicants

Claudication is the common symptom in peripheral arterial disease. It can be progressive or stable. In those patients with stable claudication medical managements and supervised exercise programs may be helpful. But in our hospitals there are very few such programs encouraging the patients to follow these practices. Doctors tell their patients about the benefits of regular walking, but rarely they are able supervise such measures. Even in the physiotherapy departments there is no such provision in many hospitals. Very few trials are conducted in India in this direction. The Angioplasty and Stenting of superficial femoral artery, popliteal artery is advocated in some places to save the limbs. Open surgery is performed to bypass the occluded FP segments in some centers.

Common site of Claudication in Femoral-Popliteal disease

A systematic review of the uptake and adherence rates to supervised exercise programmes in patients with intermittent claudication was conducted by A.E. Harwood et al from Hull Royal infirmary and published in Annals of vascular surgery.  
They said that reporting of SEP trials was poor with regard to the numbers of subjects screened and reasons for exclusions. Only approximately 1 in 3 screened IC patients was suitable for and willing to undertake SEP. Levels of adherence to SEPs and definitions of satisfactory adherence were also lacking in the majority of the current literature. Current clinical guidelines based upon this evidence base may not be applicable to the majority of IC patients and changes to SEPs may be needed to encourage/retain participants.
This type of papers should encourage us to do more detailed study on supervised exercise programs in Indian hospitals. This may help our patients and reduce burden of angioplasty or bypass surgery in Peripheral arterial disease patients. 

Reference
http://www.annalsofvascularsurgery.com/article/S0890-5096(16)30174-1/abstract 

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