Management of claudication in older adults and the role of exercise therapy

Abstract

Claudication from peripheral artery disease is a common mobility-limiting condition in older adults. Exercise therapy, whether delivered through supervised programs or structured home-based programs, plays a central role in claudication care for older adults, offering substantial functional gains with minimal risk, and should be the cornerstone of management alongside optimized medical therapy. This review examines contemporary management of claudication in the aging population, with emphasis on exercise therapy. Treatment modalities, including best medical therapy, supervised exercise therapy, home-based exercise programs, and invasive interventions (endovascular and open surgery) are critically evaluated. Pharmacotherapy (eg, cilostazol) can modestly improve walking distance, and aggressive risk factor control (eg, smoking cessation and statins) is imperative for all patients. Invasive revascularization is reserved for select individuals with lifestyle-limiting claudication unresponsive to conservative measures, given procedural risks and the potential for repeated interventions. Recent society guidelines (American College of Cardiology and the American Heart Association 2016 and European Society for Vascular Surgery 2024) and the Society for Vascular Surgery's 2025 focused update uniformly endorse exercise and medical therapy as initial management, restricting revascularization to severe claudication after conservative therapy trials and emphasizing individualized shared decision-making approaches. Claudication outcomes (ankle–brachial index changes, 6-minute walk improvements, and patient-reported outcomes) across treatments are reviewed alongside indications, contraindications, and benefits of each strategy.