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The term claudication is derived from the Latin word claudicatio, translated as “to limp.” In vascular disease nomenclature, claudication describes the symptom of exercise-induced muscle ischemia, most commonly due to peripheral artery disease (PAD). The patient with intermittent claudication typically describes leg pain that is caused and reliably reproduced by a certain degree of exertion. The pain is sufficiently intense to stop the activity and is promptly relieved by rest, usually within minutes. A given degree of exercise, commonly measured in pain-free distance able to walk, consistently reproduces symptoms. The Fontaine stages are commonly used to rate symptom severity (Table 51-1).

Healthcare systems throughout Europe are feeling the strain due to the ever increasing demands made upon them to provide treatments and solutions for many cardiovascular related diseases (CV). The corporate setting provides an ideal location for delivering both cardiac rehabilitation and preventative strategies that can help combat the ever increasing burden that cardiovascular illness is placing upon society.

Recent European guidelines for cardiovascular disease (CVD) prevention in clinical practice recommend the use of preventive strategies based on the identification of individuals at high absolute risk for CVD. To identify high-risk individuals these guidelines have chosen the Systematic Coronary Risk Evaluation (SCORE) risk model as a tool in clinical practice. Lipidlowering drugs are recommended in individuals with a 10-year risk of fatal CVD of ≥5%. These guidelines should be adapted to reflect practical, economic, and medical circumstances in each country.

Cardiac rehabilitation (CR) programs were first developed in the 1960s when the benefits of ambulation during prolonged hospitalization for coronary events had been documented. Exercise was the primary component of these programs. They were predominantly offered to survivors of uncomplicated myocardial infarction and initiated at a time remote from the acute event. Concern about the safety of unsupervised exercise after discharge led to the development of highly structured rehabilitation programs that were supervised by physicians and included electrocardiographic monitoring. The safety and benefits of moderate-intensity exercise training programs were intensively investigated in supervised programs. More recent data clearly indicate that unsupervised or home-based programs are also safe and effective in appropriately selected patients.–

The provision of multifactorial cardiac rehabilitation and secondary prevention strategies requires a range of skills and knowledge which, while understood by cardiologists, are delivered only in part by them. The role of the cardiologist in the initiation of cardiac rehabilitation programs is self-evident. As patient advisors, cardiologists are in an ideal position to recommend the benefits of cardiac rehabilitation to the individual patient. They are also in a prime position within the health services and individual medical institutions to espouse the establishment and appropriate financial support of such services.

In a comprehensive cardiac rehabilitation program, the different forms of physical training may put patients at risk, although a review of the literature has shown that cardiac or orthopedic events rarely occur. This may be further limited through adequate safety precautions. The risk is fully outweighed by the benefits of participation, independent of the indication for enrollment: after myocardial infarction (MI), percutaneous coronary intervention, coronary artery bypass grafting, in patients with chronic heart failure or in patients with implantable cardioversion devices (ICD).–

Comprehensive cardiac rehabilitation (CR) is beneficial for a wide variety of coronary patients: after a myocardial infarction (MI), following percutaneous transluminal coronary angioplasty (PCI), coronary artery bypass grafting (CABG), implantable cardiac defibrillators, cardiac rhythm surgery and ablation techniques, stable angina pectoris, and chronic heart failure., Yet in several countries CR is underused due to multiple factors, not least the unsatisfactory referral practices.

Although there is substantial scientific evidence that professional lifestyle intervention on smoking, diet and physical activity, together with control of blood pressure, cholesterol and glycemia, and selective use of cardioprotective drug therapies can reduce cardiovascular morbidity and mortality, the translation of that evidence into everyday clinical practice remains a challenge. The joint European Societies guidelines on prevention of cardiovascular disease (CVD) define priorities for preventive cardiology in clinical practice, thresholds for treatment, and treatment goals. The priorities are firstly patients with established atherosclerotic cardiovascular disease; coronary disease, and all other manifestations of atherosclerosis. The second priority is apparently healthy individuals in the general population who are at high risk of developing CVD because of hypertension, dyslipidemia, diabetes, or a combination of these and other risk factors.

Comprehensive cardiac rehabilitation (CR) is defined as: “The sum of activities required to ensure the best possible physical, mental and social conditions, so that the cardiac patient may resume as normal a place as possible in the life of the community.” This implies the use of an individually tailored combination of physiological, clinical, psychological and social methods. Measuring the outcome of a multifaceted intervention is a methodological and logistical challenge. At present quality assurance of CR is relatively uncommon even though guidelines recommend that data are routinely collected and presented. Thus, as CR programs must compete for resources with other healthcare modalities, caregivers will increasingly demand auditing of the service.