PAD Rehabilitation

Question 1

A large majority of caridac pations also have ____

Answer 1

PAD

Question 2

Goals for PAD patients.

Answer 2

• Eliminate Ischemic Sx
• Prevent progression
  – Stop smoking
  – Drug Therapy
  – Surgery (Ex: PCI)
  – Physcial Activity

Question 3

Exercise and Control - Research

Answer 3

• Significant changes seen in walking time, VO2max and treadmill grade % after 12 weeks but no change in ABI.
• Due to angiogenesis, metbaoliv changes, more enzymes/mitochondria. No change in the amount of oxygen getting there (ABI).
• Allows for a finctional change. Gave them enough time and stimulus for adaptations to occur.

Question 4

Treadmill Walk vs Strength Training - Research

Answer 4

Treadmill
* 74% increase in walking time 12 weeks;
* 128% increase over 24 weeks
* Increase time to onset of claudication

Strength
* 36% increase in walking time
* No change in time to onset of Sx

Pain doesn’t change with strength training. Treadmill makes the time to be able to walk longer and increases the time before sx!

Question 5

PCI (surgery) vs Exercise

Answer 5

ABI
* Post surgery: Large change in ABI, but went back to before after 15 months.
* Exercise: No change

Max Walking Distance
* Post Surgery: No change
* Exercise: Significant increases starting after 6 months

Conclusions:
* If you DO NOT NEED immediate surgery, exercise may produce greater sx improvement over PTA (functional)
* PCI - increases circulation (up to 15 months)

Question 6

PAD - intensity

Answer 6

• PAD need to work at or very near symptoms (PT is assessing for Sx constantly)
• When they feel uncomfortable tell them to keep going. Near maximal tolerance of pain.

Question 7

Constraindicated for PAD guidelines

Answer 7

• Unstable angina;
• decompensated heart failure;
• uncontrolled cardiac arrhythmias;
• severe or symptomatic valvular heart disease;
• critical limb ischemia

Question 8

PAD - FITT

Answer 8

Freq: 3-5 days/wk aerobic; 2 days/week resistance

Intensity: 40-60% VO2R walk until pain level 3-4/ 5 (intense pain); rest until pain decreases and resume

Time: 30-60 min; may need to start with 10 min bouts to accumulate

Type: wt bearing aerobic ex; walking

Question 9

PAD Considerations

Answer 9

• Determine claudification threshold (Time when pt begins to feel Sx)
• Determine maximal walking time (Time when pt must stop exercise
• Monitor BP, HR, ECG (if available) & symptoms
  *

Question 10

PAD Exercise Progression

Answer 10

Intensity:
* * Initial workload typically 2 mph and when tolerate 8 min at 3-4 / 5 scale increase grade 1-2%.
* Tolerate 10% grade for 8 minutes; increase speed by .1 -.2 mph with lower grade

Duration:
* **Initial goal: ** accumulate 15 min or more of total walking time increases to 50 minutes (includes rest periods) in a 60-minute period.
* Progress toward 50 minutes (includes rest periods) in a 60-minute period.