Exercise recommendation for peripheral artery disease, a very welcome document

The paper we discuss is a consensus document resulting from the collaboration of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases with the European Society of Vascular Medicine and the European Society for Vascular Surgery.

It is a very welcome consensus and a total reading recommendation for all of us who dedicate ourselves to clinical practice. As the authors remember physical exercise is strongly recommended as a pillar of the management of patients affected by lower extremity peripheral artery disease (PAD). Dynamic exercise training induces extensive remodelling of the vascular system – aspect which is perfectly captured in the document through a very illustrative figure-. The paper begins with a nice graphical abstract that summarises the objective of the project and the recommended exercise programs. Likewise, the Consensus Statement at the beginning perfectly summarises the objective of the document.

Throughout the text, the different aspects of peripheral vascular disease are reviewed, from its pathophysiology to the diagnostic aspects. Also the aspects to be assessed and taken into account in this patient profile are very well summarised in an algorithm; taking into account both quality of life questionnaires and conditions that require cardiological evaluation and contraindications for exercising.
From a practical point of view, the review contemplates both the exercise modalities and their duration, frequency and intensity, aspects that are well collected in the form of a table that makes it easy to read and consult. The benefits before and after revascularisation, the benefit in quality of life and mental health of patients are also mentioned.

Finally the document highlights the disparities in access to supervised exercise programmes across Europe and the gaps for evidence requiring further research.