12/1/2022 0 Comments Tibia 8.6 exp x999The loss of this BF reserve seems benign until the flow demands of the limb muscles require a BF that exceeds the reduced flow capacity. The initial narrowing of an artery reduces the flow capacity to the limb. This atherosclerotic condition often affects a large primary conduit artery (e.g., iliofemoral/femoral artery region), but it can also be multilevel and diffuse, causing complex and generally more severe complications. PAD is due to atherosclerosis that causes chronic narrowing of arteries, which can precipitate acute thrombotic events. Peripheral arterial disease (PAD) is a fairly common degenerative vascular condition that leads to inadequate blood flow (BF), typically in the legs. Obviously, selecting for a life style pattern, that includes enhanced physical activity prior to the advance of PAD limitations, is the most desirable and beneficial. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. 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. Pre-clinical 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, mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. Extended exercise programs that involve walking ~5 times/wk, at a significant intensity that requires frequent rest periods, are most significant. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. The presence of PAD predicts a 50–1500% increase in morbidity and mortality, depending on severity. It is estimated that 12–15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. 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. Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients.
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