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Overview of PAD

PAD results from atherosclerosis of the arteries that extend through the extremities. Narrowing of the arteries reduces blood flow to the limbs, which results in pain, pallor, and paresthesias. Intermittent claudication is associated with PAD, with individuals describing burning and cramping pain in the legs during walking activities. Risk factors for PAD include smoking, hypertension, and low levels of high-density lipoprotein cholesterol. Clients with PAD have limited standing and walking abilities due to intermittent claudication, which slows their walking speed and changes their gait pattern. The presence of coronary heart disease also limits their capacity for physical activities. As the disease process advances, the patient tolerates fewer standing and walking activities.

Common Signs and Symptoms of Arterial Insufficiency

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Painful walking Redness in the distal limb
Elevated lower extremity develops pallor Poor venous filling after extremity is elevated
Skin dryness Tissue necrosis

Comorbidities to Consider

  • Individuals with PAD typically also have coronary heart and cardiovascular disease.

Client Examination

Keys to Examination of Clients

  • Assess for signs of hypertension and other signs of cardiovascular disease.

  • Pulses and skin color and intactness at the feet and ankles should be assessed.

  • Determine an ankle-brachial index by taking systolic blood pressure at the ankle and the arm. Ratios of ankle-to-arm pressure below 0.90 indicate a significant decrease in systolic pressures in the lower extremities.

Recommended Baseline Testing of Fitness Levels

  • A walking or treadmill walking test is used to determine a baseline for distances. The client is asked to walk at a normal pace until unable to walk due to leg pain. The walking distance before the initiation of leg symptoms and absolute walking distance are noted for baseline measurement.1

Exercise Prescription


Type: Walking, treadmill walking, and lower-extremity exercises

Intensity: Mild to moderate intensities

Duration: 3–5-minute bouts with rest periods

Frequency: Three to five times per week

Getting Started

Walking on a treadmill is the most effective mode of exercise to control intensity and duration of walking. Clients may need to use an assistive device or the railing of the treadmill to initiate the program. Clients with severe leg pain or pain at rest may need to start their exercise program using a cycle ergometer. Because clients with PAD typically have severe pain with walking activities, the purpose of testing and exercising should be thoroughly discussed before starting the program. Clients with PAD may experience unsteadiness and balance problems as the complaints of intermittent claudication increase; clients may self-limit their activities to avoid or in expectation of leg pain. Walking programs of ...

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