Professional Practice Guide -FCSV-EN

21 for the Management of Peripheral Artery Disease 4.5 EXERCISE PROGRAMS AND PAD Although walking remains the most effective form of exercise, several other methods shown to be associated with improvements can also be offered to patients living with PAD. Supervised walking program A supervised walking program has the highest level of evidence and should include the following characteristics, with supervision ideally provided by a kinesiologist: • Walking should be the primary exercise for patients with intermittent claudication (IC). • Structured, individually tailored program that includes: Ԕ Duration: 30 to 60 minutes Ԕ Frequency: 3 days per week Ԕ Minimum duration: 12 weeks • Exercise intensity should progress over time, by increasing walking speed, duration, or both. • Warm-up of 3 to 5 minutes (slow, low- intensity walking inducing pain rated 1 to 2/5 on the claudication pain scale). • Cool-down of 3 to 5 minutes (slow, low- intensity walking inducing pain rated 1 to 2/5 on the claudication pain scale). → See Section 9, Appendix 1: Sample walking program session. The warm-up is a short period of activity that gradually increases heart rate, blood pressure, body temperature, and joint lubrication, while also promoting arterial dilation, allowing increased blood flow to deliver oxygen to the muscles. Cold temperatures may worsen IC symptoms. In such circumstances, a longer warm-up period may be necessary. Most people with walking-induced IC tend to reduce activities that cause pain, which contributes to deconditioning and eventual disability. It is important to teach individuals livingwith PADthat experiencing mild to moderate pain in the lower limbs during exercise is recommended, as it helps induce the physiological adaptations associated with exercise. This contrasts with angina symptoms in individuals with heart disease, who must stop exercising when chest pain occurs because of the risk of ischemia-induced arrhythmias.