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09-28-2017 | Physical activity | Book chapter | Article

22. Peripheral Artery Disease and Exercise in Patients with Diabetes

Authors: PhD, MPH, MS Ryan J. Mays, BA, BSN, RN, PHN, CCRP Mary O. Whipple, PhD, RN Diane Treat-Jacobson

Publisher: Springer International Publishing

Abstract

Peripheral artery disease (PAD) represents a serious health issue and is estimated to effect up to 30% of the ~23 million US adults who have diabetes. PAD occurs as the result of the development of plaque in the arteries of the lower limbs. The development of PAD can be attributed to a number of factors such as deleterious lifestyle behaviors (e.g., smoking, inactivity); however diabetes is one of the primary risk factors for developing the disease. Claudication is the most pronounced symptom of PAD and is described by patients as pain, aching, or cramping in the muscles of the legs during exertion that is relieved with rest. Claudication typically limits a patient’s ability to walk which ultimately leads to an exacerbation of poor metabolic control of the patient with diabetes. Patients with both PAD and diabetes who limit ambulatory activity have markedly lower functional ability and poor patient-reported outcomes and have an increased risk of adverse cardiovascular events and premature mortality. Exercise therapy is a cornerstone treatment option for patients who have both diseases, but it is considerably underused. This is attributed to a number of challenges for providing an ideal exercise prescription given the numerous physical limitations of patients. This chapter will provide a synthesis of the available literature using exercise therapy for PAD and diabetes and will propose future directions for treating patients who have both diseases.

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