Supervised Exercise Therapy for Patients with Symptomatic Peripheral Artery Disease: It’s a Big Deal
Who is covered?
Diane Treat-Jacobson, PhD, RN, FAHA and Chair of a recent American Heart Association Science Advisory wants prevention nurses to know that supervised exercise therapy (SET) is covered for patients with symptomatic peripheral artery disease (SPAD) by Medicare and Medicaid. So do not miss the opportunity to review the 2019 advisory and the accompanying clinical guideline for specific program details. (1,2)
What can the prevention nurse do to help patients understand that Supervised Exercise Therapy may be for them?
As those frequently interfacing with SPAD patients, prevention nurses can get the word out about this chance for symptomatic patients to get real results. At least three recent major studies plus 50 years of research support the translation of research to practice on a large scale across the United States. According to the advisory, (1) studies have shown that the effect of SET is real in improving function and quality of life and reducing functional decline and rates of loss of mobility in PAD patients compared to non-PAD patients. Key documented improvements have been significant improvements in the distance people can walk until symptoms begin and peak walking distance. (1) Nurses can discuss SET in prevention newsletters, patient information materials, and websites as well as at interdisciplinary and patient-centered clinical conferences.
Patients first undergo a physical exam to be evaluated. Exercise sessions are supervised three times a week for twelve weeks (36 sessions), and an additional 36 sessions can be covered. (1) Research on the intensity of treadmill exercise and the increase in the intensity over time is lacking in these symptomatic patients, so increase the intensity slowly as tolerated. Although most patients use the treadmill, other modes of exercise are also done such as stationary bicycling. (1)
What options are there if the patient cannot afford the 20% out of pocket cost under Medicare?
The idea of SET exercise is to facilitate exercise as tolerated in SPAD patients. If they cannot afford out of pocket costs, the science advisory suggests alternatives. A patient who wants to start an exercise program may have coverage for Phase III cardiac rehab and can get guidance on how to do the SET program at the cardiac rehab setting. Also, patients can work with their health care provider and accomplish the SET program at home under their care. (1)
Where do we go from here with PAD patients?
The first challenge is that not all patients are symptomatic, yet they have PAD and could benefit from an exercise program like SET. A second challenge is that sometimes patients have adverse events necessitating SET interruption (1) and need to be followed closely so they can continue SET when cleared by their health care professional. Finally, given that improvement in walking performance takes 4-6 weeks, patients should be encouraged to continued participation (1) even though there might not be early gains.
- Step on It – Peripheral Artery Disease Patient Handout
- Provider Tools Peripheral Artery Disease Screening Toolkit and Exercise Program instruction sheet
- Treat-Jacobson D, McDermott MM, Beckman JA., Burt MA, Creager MA, Ehrman J, et al. Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease: A Science Advisory From the American Heart Association, DOI: 10.1161/CIR.0000000000000727
- Treat-Jacobson D, McDermott MM, Bronas UG, Campia U, Collins TC, Criqui MH, Gardner AW, Hiatt WR, Regensteiner JG, Rich K; on behalf of the American Heart Association Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Council on Cardiovascular and Stroke Nursing. Optimal Exercise Programs for Patients With Peripheral Artery Disease: A Scientific Statement from the American Heart Association. Circulation. 2019; 139:e10–e33. doi: 10.1161/CIR.0000000000000623