66 y/o, man, single, retired consultant

Step 1

• Reason for Referral: consulting vascular surgeon for IC complaints for 24 months (aug 2020)
• Lower Extremity Artery Disease
  • Aorto-bifemoral bypass + thrombectomy (lower leg arteries) + PTAS a. iliaca communis left (2005)
  • PTA right and left a. femoralis superficialis (2015)
• Cardiovascular risk factors
  • Active smoker
  • Dyslipidaemia (Med)
  • Hypertension (Med)
  • BMI: 17.4 kg/m²
  • Physically inactive (self-report)
• Other Relevant Medical History:
  • Respiratory
    • COPD: Gold stage II (2005)
  • Cardiac
    • Acute MI – CABG (2002)
    • ICD (2004)
  • Musculoskeletal
    • Multiple fractures (hip in 2016) + facet infiltration L3-S1 (2018)
• Medication and devices:
  • Beta-blockers
  • Cholesterol lowering medication
  • Anti-platelet therapy
  • Ace inhibitors
  • Anti-arrithmica
  • alpha blockers
  • anti-depressants
  • Sleep medication
  • ICD
    

Step 2 - CPET

• 10+10 Watt protocol: MAX 50 Watt
  • Reason termination: claudication pain in both legs
  • RER: 0,96
  • Borg: 15
  • VO2peak: 751 ml/min or 13 ml/min/kg or 42% of predicted
  • VT1: 30 Watt – HR 85bpm
  • BP evolution: 98/68 to 159/72 mmHg
  • HRrest: 73 to HRpeak: 94
    

Additional functional treadmill test

Other health-related fitness

• Handgrip strength: 21 kg
• Isometric strength biodex: 85Nm (56% of predicted)
  
• Fat mass: 15.1%

Step 3 - Defining goals of therapy

• Information, improving health literacy and disease-insight
• Improve maximal and functional exercise capacity
• Optimize activities and participation - individualize
• Support cardiovascular risk management
• Improve and SUPPORT long-term compliance to a heart/artery healthy lifestyle

Step 4 - Walking therapy to improve walking capacity

= Important to get familiar with pain mechanism!

-> Walking as core, cycling and resistance as adjunct

Step 5 - Progression

Ultimate goal - stimulate lifelong active lifestyle

• Supervised session + remotely monitored home-based sessions
• Center-based session: to bring something new
• Progressive decrease in supervision over time to stimulate self management and empowerment