Optimising Exercise Prescription in Patients with Intermittent Claudication: A United Kingdom Perspective

Abstract

The National Institute for Health Care Excellence guidelines (NICE) recommend supervised exercise programmes (SEPs) as the first line of treatment for patients with intermittent claudication (IC). However, there are inconsistencies between guidelines regarding the optimal level of claudication pain prescribed. This thesis aimed to synthesis the current evidence in the literature and undertake a randomised control trial to understand which level of claudication pain was optimal in improving functional outcomes for patients with IC. In addition, it aimed to assess barriers, uptake and adherence to SEPs. Additional components of this thesis including a systematic review identifying how many studies had directly compared exercise prescription at differing levels of claudication pain on walking performance and a commentary highlighting the limitations of current guidance to clinicians and exercise professionals which could lead to variability in care.

Evidence from this thesis indicates that maximal claudication pain appears to elicit a larger benefit in treadmill related maximal walking distance compared to pain-free and moderate claudication pain, supporting the current NICE guidelines. However, at the time of submission we had not fully recruited and therefore results may be subject to change.

In addition, the evidence indicates that adherence to exercise in this clinical population is poor. Although, this was largely associated with non-PAD related health issues. Common barriers to attending the SEP included time and location of the class. Therefore, centres should engage with their patients to develop an effective accessible rehabilitation programme.