Rehabilitation in patients with peripheral arterial disease.
Résumé
Rehabilitation is a recommended first-line therapy for patients with peripheral arterial disease (PAD) and consists of supervised exercise training and therapeutic education. Proved benefits are significant: improve pain-free walking distance, functional status and quality of life; reduce cardiovascular risk factors and mortality. At least three sessions weekly are recommended during 3 months. Exercise conditioning (global training and lower limb resistance training) is tailored by the preliminary evaluation of walking ability (free walking test, treadmill tests, 6-min walk test) and of the cardiac tolerance (maximal effort tests). Then the exercise workload is progressively improved. The four main goals of therapeutic education are: smoking cessation, prolonged physical activity, Mediterranean diet and observing pharmacological therapies. The limited compliance of the patients with PAD is often an obstacle for educational needs. The chronic patients with important functional limitations and unchecked risk factors will be preferentially enrolled in such programs. When a revascularization is discussed, rehabilitation can serve as trial treatment. Despite its efficacy, rehabilitation is still underutilized in clinical practice and should be promoted.