Lower extremities exercise therapy

The clinical manifestations of PAD are associated with reduction in functional capacity and quality of life, but because of the systemic nature of the atherosclerotic process there is a strong association with coronary and carotid artery disease. Consequently, patients with PAD have an increased risk of cardiovascular and cerebrovascular ischemic events [myocardial infarction (Ml), ischemic stroke, and death] compared to the general population (4,5). In addition, these cardiovascular ischemic events are more frequent than ischemic limb events in any lower extremity PAD cohort, whether individuals present without symptoms or with atypical leg pain, classic claudication, or critical limb ischemia (6). Therefore, aggressive treatment of known risk factors for progression of atherosclerosis is warranted. In addition to tobacco cessation, encouragement of daily exercise and use of a low cholesterol, low salt diet, PAD patients should be offered therapies to reduce lipid levels, control blood pressure, control blood glucose in patients with diabetes mellitus, and offer other effective antiatherosclerotic strategies. A recent position paper... 

Baumgartner 1998 Critical lower extremity ischemia Critical ischemia, resistant to maximal medical therapy, not surgical candidates Naked plasmid VEGF 165 Intramuscular injection Phase I 2-11 months Improved Ankle-Brachial index, exercise time, new vessels on angiogram, limb salvage, improved tissue integrity... 

Exercise Therapy for Lower Extremity Arterial Disease... 

Rationale for Exercise and Therapy for Lower Extremity Arterial Disease Patients Exercise Therapy Findings Potential Mechanisms Designing an Exercise Program References... 

RATIONALE FOR EXERCISE AND THERAPY FOR LOWER EXTREMITY ARTERIAL DISEASE PATIENTS... 

The editors have four chapters devoted to the management of claudication and lower extremity arterial disease nonpharmacological (exercise), medical therapy, angioplasty, and endovascular stent placement and revascularization. These comprehensive chapters are very clinically oriented and help the reader to understand when nonsurgical versus surgical management should be considered. 

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