Exercise for Intermittent Claudication

Exercise for intermittent claudication. Physical Therapy. 2011 Jul;91(7):997-1002 Brunelle CL, Mulgrew JA.

My Comments

This was short review paper but I liked it because it gave consensus recommendations from both the TASC II (Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease) as well as the program from the American Heart Association.

 The TASC II program is as follows:

  • Begin treadmill walking at a speed that causes calf pain within 3-5 minutes
  • Walking should be stopped when claudication pain is moderate (2 on 4 point scale)
  • Rest until pain has resolved, walk, rest, walk… (progressing from 30-60 minutes)
  • If the patient can walk 10 minutes without a break (increase either the speed or incline on treadmill)
  • Train 3 times per week for 3 months

 The American Heart Association guidelines are as follows:

  • Begin walking on treadmill or track with an intensity starts pain (1 on claudication pain scale) in 3-5 minutes
  • Walk until pain reaches 2 on scale then rest by sitting or standing
  • Repeat cycle for 35 minutes
  • Increase the exercise program by 5 minutes to 50 minutes total
  • Train 3-5 times per week for a minimum of 12 weeks

 Pain Scale (used in paper):

  1. Minimal discomfort
  2. Moderate pain (patient can be distracted)
  3. Intense pain
  4. Unbearable pain

Looking at the two programs I see more similarities than differences, so I would expect them to work about the same. They are very similar to the protocol I’m starting my patients with. The paper mentions that supervised exercise still works substantially better than independent exercise, and looking at the program I’m not sure why that is. Possibly it could be that walking with claudication is painful and maybe it helps to have someone tell you when to get up and start walking again. However neither of these programs encouraged the patients to work up to higher levels of pain. It might also be that people who end up with intermittent claudication generally aren’t the kind of people who enjoy cardiovascular exercise for it’s own right (I know I sure don’t), so maybe they need that extra push to get going. I’ll try to learn more about differences found as I read through some of the individual studies, because eventually virtually everyone with PAD is going to need to transition to an independent exercise program.

Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember Spinal Flow Yoga for you or someone you know in the future.


Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.

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Hello! Thanks for checking out Spinal Flow Yoga®!

This is one of my older “legacy” blogs from my prior physical therapy site. If the information you find here seems only moderately related, or a bit technical for yoga, it’s because I wrote it with a different, but still overlapping, audience in mind. However, I think each blog does showcase my thought processes and research base, both of which very much influenced what evolved into Spinal Flow Yoga®.

Further, given that spine pain has long been a favorite topic of mine, much of the content within these older blogs will be directly relevant to Spinal Flow® even if at times I criticized yoga. In fact, that’s why I created Spinal Flow Yoga®, to correct what were, and still are, many physical problems in modern yoga sequences. Time permitting, I may revisit some of my favorites blogs add some content relating them to newer Spinal Flow® concepts that aim to cure neck and back pain as well as improve overall health and fitness from the comfort of your own home without the need for equipment. Hopefully that will make more sense out of why this blog is here. And if you have neck or back pain, you're in luck. Before you needed a gym to utilize my methods, but I've been working hard, gearing it towards home training, and efficiency and effectiveness have been remarkable. Hit the button to learn more about SC5 and SF5, my 5-minute flows, both of which I'm very proud of.