IJCS | Volume 32, Nº6, November / December 2019

DOI: 10.5935/2359-4802.20190021 Introduction Peripheral arterial occlusive disease (PAOD) is a chronic, initially subclinical, and characteristically inflammatory disease that mainly affects the carotid arteries and lower limbs. 1,2 When in the lower limbs, it causes intermittent claudication, associated with a shortened leg gait, cyanotic extremities and decreased muscular force associated with sarcopenia below the obstruction site. At more advanced stages, it can cause ulcerations that are difficult to heal, due to the decrease in blood flow. The final stage of pathophysiology is completed with a trophic lesion and consequent amputation of the affected limb, leading to a decrease in the quality of life and to functional limitations in activities of daily living. 3 This results in increased costs generated by the treatment and impaired productive capacity of these patients. 3,4 Chronic systemic arterial hypertension (SAH), diabetes, smoking, and dyslipidemia are the four main triggers of atherosclerotic disease. Usually individuals with lower- limb PAOD are associated with one or more of these four factors. Therefore, all patientswith one of these four factors should be investigated for the presence of PAOD. 2,3 One of the most efficient ways to diagnose lower- limb PAOD is through the Ankle-Brachial Index (ABI), where the systolic blood pressure in the ankle is divided by the systolic blood pressure of the arm. A result < 0.9 means a diagnosis of PAOD, even in the absence of specific symptoms. 4 The nosological diagnosis of lower-limb PAOD is based on pain-free walking time. The Fontaine classification is themost commonly used one. It is divided into four stages: I - asymptomatic (presence of PAOD without symptoms); IIa - claudication above 200 meters and IIb - claudication below 200 meters; III - pain at rest; and stage IV - trophic lesion and consequent amputation of part of the affected limb. 4 The maximum walking tolerance test is used for both the diagnosis and classification of lower-limb PAOD as the basis for treatment of this condition, since a cardiovascular and metabolic rehabilitation (CMR) program, using treadmill walking, is considered the treatment that shows the best cost-benefit relation for this disease. 5,6 Therefore, this report aims at describing how a CMR program using a treadmill improved the clinical and functional condition and stimulated the healing of a heel skin ulceration in a patient with lower-limb PAOD. Case report IAS, a 65-year-old female patient, whoseweight was 55 kilos, and height, 1.62meters, entered the Cardiovascular 645 CASE REPORT International Journal of Cardiovascular Sciences. 2019;32(6):645-649 Mailing Address: Marvyn de Santana do Sacramento Rua Rio Grande do Sul, n 356. Postal Code: 41830-140, Pituba, Salvador, BA - Brazil. E-mail: marvynsantana@gmail.com, marvynsantana@hotmail.com Physical Exercise for Active Skin Ulceration Secondary to Peripheral Arterial Occlusive Disease Jefferson Petto, 1,2,3,4, 5 M arvyn de Santana do Sacramento, 1, 5 Fernanda Oliveira Baptista de Almeida, 1,3, 5 J orge Bomfim Frós de Farias, 6 E uvaldo de Almeida Rosa 6, 7 Faculdade Social da Bahia (FSBA), 1 Salvador, BA - Brazil Escola Bahiana de Medicina e Saúde Pública (EBMSP), 2 Salvador, BA - Brazil Faculdade Adventista da Bahia (FADBA), 3 Cachoeira, BA - Brazil Universidade Salvador (UNIFACS), 4 Salvador, BA - Brazil Clínica Cordis, 5 Salvador, BA - Brazil Secretaria de Estado da Saúde da Bahia (SESAB), 6 Salvador, BA - Brazil Urgências Médica Cirúrgicas (URMEC), 7 Santo Antônio de Jesus, BA - Brazil Manuscript received May 09, 2018; revised manuscript October 01, 2018; accepted November 01, 2018. Peripheral Arterial Disease/complications; Skin Ulcer/complications; Risk Factors; Exercise; Intermittent Claudication; Sarcopenia. Keywords