Daryl Buchanan | News & Views

AACVPR members will convene in West Palm Beach, Florida, this September to share new discoveries and insights and to hone their skills in the disciplines of cardiovascular and pulmonary rehabilitation.

Anna Hornstein, MS, ACSM-CEP, CCRP, and Amanda Gardner, MS, ACSM-EP, will be among them. In addition to soaking up two days of knowledge, they hope their own educational session will shed light on treatment options for people suffering from peripheral artery disease (PAD). The condition can be difficult to treat in some cases, but Hornstein believes there is a viable option for medical professionals and patients in need of alternative treatments.

PAD is caused by a build-up of plaque in the arteries of the limbs, which results in reduced blood flow — mainly in the legs. Patients typically report severe pain, burning sensation, and even difficulty walking. In severe cases, amputation may be required. Given these symptoms and risks, it’s easy to see how the lives of people with PAD can be greatly impacted. The inability to walk comfortably severely limits day-to-day activities.

“Patients with this disease won’t walk as fast or as far as they normally would. Often times they will require more frequent and longer breaks while walking. Even walking on flat ground can be limited. So, PAD can have a huge impact on the lives of patients,” Hornstein says.

Current medical guidelines recommend walking as the best treatment option for PAD, and Hornstein and Gardner’s presentation will partly focus on the benefits of exercise and how it can be used as an intervention to surgery. “We’re going to be discussing ways to complete exercise assessments for these patients, as well as prescribe exercise,” Hornstein reveals.

However, in her experience helping patients with PAD, Hornstein has discovered that exercise may be a serious concern for some. She explains, “One thing that I found in practice with these patients with peripheral artery disease, is that some of them don't feel comfortable on the treadmill. Also, a treadmill just may not be the safest mode of exercise for them from a fall-prevention standpoint.”

Hornstein says she has seen patients who have expressed fear of falling on a treadmill. She adds that PAD patients also may have peripheral neuropathy, which means they are unable to feel sensation in their feet. Hornstein says, “For these patients, walking on a treadmill, where the ground is moving underneath their feet, can be a little unsettling.”

In light of the concerns for patient comfort and safety, Hornstein plans for her presentation to raise awareness about modification of traditional supervised exercise therapy (SET), with seated exercise as a viable option — an approach known as SET PAD.

“SET has been researched extensively and has shown improvements for patient quality of life, improved blood flow, and improvement in various functional assessments. One area in particular is the 6-minute walk test. Using SET, patients have been able to improve how far they are able to walk in six minutes. People have also reported reductions in their PAD symptoms and, in some cases, avoided the need for surgical intervention,” says Hornstein.

She adds that incorporating SET programs into PAD treatment does not require overcoming major challenges. However, she continues, support from vascular physicians will be needed as well as education with the multidisciplinary team.

Implementing a SET program also requires careful planning with patients. “With peripheral artery disease, exercise is individualized to the patient. Depending on the protocol, we will establish a set speed or incline that patients will walk. There are no prescribed time goals, and patients will walk based on their symptoms,” explains Hornstein.

Exercise programs also factor in rest periods, a symptom rating scale, and different exercise equipment like recumbent bikes and recumbent stepper machines. This equipment, she says, has proved to be important to SET programs, as they are alternatives to treadmills that allow patients to remain safe while they exercise.

Hornstein is looking forward to sharing her insights at the 40^th AACVPR Annual Meeting. She believes her presentation will be of great interest to healthcare providers including but not limited to physicians, nurses, and exercise physiologists.

“I hope medical professionals will be able to take away a couple of things, one of which is they’ll be motivated to start a SET PAD program within their own cardiac and pulmonary rehab setting. It is very feasible to do,” says Hornstein.

“I’m also hoping that individuals will gain a better idea of how to modify and adjust current exercise protocols, which can seem restrictive for certain patients with PAD. I encourage people to get a little creative with their exercise prescriptions. I think our presentation at Annual Meeting will help with that.”