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Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners
  1. Amy E Harwood1,2,
  2. Sean Pymer3,
  3. Lee Ingle4,
  4. Patrick Doherty5,
  5. Ian C Chetter3,
  6. Belinda Parmenter6,
  7. Christopher D Askew7,8,
  8. Gary A Tew9
  1. 1 Centre for Sport and Exercise Life Sciences, Coventry University, Coventry, UK
  2. 2 Faculty of Health Sciences, University of Hull, Hull, UK
  3. 3 Academic Vascular Unit, Hull York Medical School, Hull, UK
  4. 4 Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
  5. 5 Department of Health Sciences, University of York, York, UK
  6. 6 Department of Exercise Physiology, Faculty of Medicine, University of New South Wales, Sydney, Australia
  7. 7 School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, Australia
  8. 8 Sunshine Coast Hospital and Health Service, Birtinya, Australia
  9. 9 Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
  1. Correspondence to Amy Harwood; amy.harwood{at}


Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or ‘self-facilitated’ exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.

  • Exercise physiology
  • Cardiovascular
  • Review

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  • Twitter Amy Harwood @AmyHarwood91.

  • Contributors AH, LI, PD, IC and GT were involved in the initial concept of the statement. AH and GT were responsible for the main drafting and editing of the manuscript. All authors provided revisions and critical analysis of the manuscript at each stage of the process and contributed equally to producing and approving the final document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Not applicable.

  • Provenance and peer review Not commissioned; externally peer reviewed.