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Exercise training for intermittent claudication: A narrative review and summary of guidelines for practitioners

Harwood, Amy; Pymer, Sean; Ingle, Lee; Doherty, Patrick; Chetter, Ian C.; Parmenter, Belinda; Askew, Christopher; Tew, Garry


Amy Harwood

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Mr Sean Pymer
Academic Clinical Exercise Physiologist

Patrick Doherty

Ian C. Chetter

Belinda Parmenter

Christopher Askew

Garry Tew


Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or a € self-facilitated' exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.


Harwood, A., Pymer, S., Ingle, L., Doherty, P., Chetter, I. C., Parmenter, B., …Tew, G. (2020). Exercise training for intermittent claudication: A narrative review and summary of guidelines for practitioners. BMJ Open Sport and Exercise Medicine, 6(1),

Journal Article Type Review
Acceptance Date Oct 18, 2020
Online Publication Date Nov 6, 2020
Publication Date 2020-11
Deposit Date Oct 20, 2020
Publicly Available Date Nov 9, 2020
Journal BMJ Open Sport and Exercise Medicine
Print ISSN 2055-7647
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 6
Issue 1
Article Number e000897
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Published article (419 Kb)

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Copyright Statement
Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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