Peripheral arterial disease is a prevalent but underrecognized and undertreated disorder. Intermittent claudication markedly diminishes functional status and quality of life for many patients. Patients with IC should be offered adequate information on all the therapeutic options that might be suitable on the basis of their desired functional improvement and individualized risk-benefit ratio for each intervention (eg, exercise rehabilitation, pharmacotherapy, endovascular care, or surgical bypass). Exercise rehabilitation for PAD should be considered a first-line therapeutic method for most patients with IC. Exercise rehabilitation has long been recommended as an effective first-line therapy to reduce symptoms and improve quality of life for patients with IC.2,39 Despite its proven efficacy, PAD rehabilitation is not widely used as a primary therapeutic choice. Many patients and medical professionals are unaware of the multiple benefits from exercise rehabilitation and the possibility that it could be a mainstay of therapy for most patients with IC. Some of the perceived barriers to incorporation of exercise rehabilitation programs into care standards for IC are summarized in Figure 3. Health professionals face the challenge of recognizing these barriers and beginning to overcome them through promoting PAD awareness among physicians and their patients, and by developing programs that offer state-of-the-art PAD exercise rehabilitation services that incorporate exercise training and cardiovascular disease risk factor modification.
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