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Exercise Training and Peripheral Arterial Disease

  1. Tara L. Haas1,
  2. Pamela G. Lloyd2,
  3. Hsiao-Tung Yang3,
  4. Ronald L. Terjung4

Published Online: 1 OCT 2012

DOI: 10.1002/cphy.c110065

Comprehensive Physiology

Comprehensive Physiology

How to Cite

Haas, T. L., Lloyd, P. G., Yang, H.-T. and Terjung, R. L. 2012. Exercise Training and Peripheral Arterial Disease. Comprehensive Physiology. 2:2933–3017.

Author Information

  1. 1

    Angiogenesis Research Group, Muscle Health Research Centre, Faculty of Health, York University, Toronto, Ontario, Canada

  2. 2

    Department of Physiological Sciences, Oklahoma State University, Stillwater, Oklahoma

  3. 3

    Department of Biomedical Sciences, University of Missouri, Columbia, Missouri

  4. 4

    Departments of Biomedical Sciences and Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri

Publication History

  1. Published Online: 1 OCT 2012


Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12 to 15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50% to 1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking approximately five times per week, at a significant intensity that requires frequent rest periods, are most significant. Preclinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, and mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a lifestyle pattern that includes enhanced physical activity prior to the advance of PAD limitations is the most desirable and beneficial. © 2012 American Physiological Society. Compr Physiol 2:2933-3017, 2012.