Top Things to Know: Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease

Published: August 26, 2019

Patients with lower extremity peripheral artery disease (PAD) have greater functional impairment, faster functional decline, increased rates of mobility loss, and poorer quality of life than people without PAD.
Supervised exercise therapy (SET) improves walking ability, overall functional status, and health-related quality of life in patients with symptomatic PAD.
In 2017, the Centers for Medicare & Medicaid Services (CMS) released a National Coverage Determination for SET programs, which should increase availability of exercise to millions of people in the U.S. who are disabled by PAD.
This advisory summarizes the CMS process and requirements for SET referral and coverage and provides guidance for implementation, including the protocol, options for outcome measurement, and transition to home-based exercise.
Optimal programs recommend exercise sessions of 30 to 60 minutes, a minimum of three times per week for 12 weeks. Patients who remain symptomatic following completion of 12 weeks of SET are eligible for 36 additional sessions.
The treadmill should be considered the primary exercise training modality. If there are contraindications to walking, consider non-treadmill modalities, including lower extremity cycling, recumbent total body stepping or upper body ergometry.
The duration and intensity of exercise should be increased at least monthly based on the patient’s general functional status at baseline.
Patient educational counseling is a CMS requirement and should include symptom characteristics, risk factors, foot care, smoking cessation (if applicable), proper foot inspection technique as well as exercise goals and the transition to community-based exercise after program completion.
Objective and patient-reported measures of walking ability, functional status and quality of life can help document the effectiveness of SET and provide tangible feedback about progress.
Exercise is the most effective medical therapy for improving walking ability and preventing disability in patients with PAD. Individualizing exercise therapy and helping patients transition to long-term maintenance of unsupervised exercise activity should help improve mobility and quality of life.

View the summary for Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease

Citation

Treat-Jacobson D, McDermott MM, Beckman JA, Burt MA, Creager MA, Ehrman JK, Gardner AW, Mays RJ, Regensteiner JG, Salisbury DL, Schorr EN, Walsh ME, on behalf of the American Heart Association Council on Peripheral Vascular Disease, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Council on Lifestyle and Cardiometabolic Health. Implementation of supervised exercise therapy for patients with symptomatic peripheral artery disease: a science advisory from the American Heart Association [published online ahead of print August 26, 2019]. Circulation. doi: 10.1161/CIR.0000000000000727.