Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 12 Sept 2026Clinical review pending
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Exercise is inappropriate in limb threat
Sudden ischaemic symptoms, rest pain, tissue loss or rapidly progressive foot infection requires urgent vascular assessment rather than pain-limited claudication exercise.
Action: Stop the planned exercise pathway, assess limb viability and infection, and contact the vascular service with urgency determined by the clinical threat.
Synopsis
Deliver evidence-based exercise for intermittent claudication, assess response, use naftidrofuryl selectively, and refer appropriately when disability persists.
Offer a supervised exercise programme to all suitable people with intermittent claudication.
NICE suggests two supervised hours weekly for three months, encouraging exercise to maximal claudication pain.
Sudden severe limb pain, coldness, sensory loss or weakness requires immediate vascular assessment.
Rest pain, ulceration or gangrene requires urgent limb-threat assessment rather than routine exercise progression.
Exertional chest pain, syncope, unstable breathlessness or uncontrolled arrhythmia requires medical assessment before supervised training continues.
A new wound, blister or pressure injury during training needs prompt foot and footwear review, especially with diabetes or neuropathy.
Cardiovascular warning symptoms
New exertional chest pain, syncope, unstable breathlessness or symptomatic arrhythmia requires clinical assessment before progressing exercise intensity.
Limb-threat features
Rest pain, ulceration, gangrene or sudden sensory or motor change requires urgent vascular assessment instead of routine claudication exercise.
Investigation priorities
01
Baseline walking assessmentFirst step
Quantify symptom onset, maximum tolerance and functional change during the programme.
Management branches
Supervised exercise programmeDeliver a safe three-month walking intervention
Stable intermittent claudication limits walking and the safety screen identifies no reason for urgent or stabilising treatment.
Agree a personal walking goal and record reproducible baseline pain-free and maximum walking measures, foot status and cardiovascular symptoms.
Offer approximately two hours of supervised exercise each week for three months, divided into practical sessions by the delivering service.
Key medicines
Naftidrofuryl oxalate (Accord 100 mg capsules)The Accord product uses one or two 100 mg capsules orally three times daily, during or after food with a glass of water, for at least three months unless the clinician changes the plan. Apply NICE review at three to six months and stop if symptoms do not improve.Do not use with previous hyperoxaluria or recurrent calcium-containing kidney stones. Maintain adequate fluid intake and take capsules with water to reduce stone and oesophagitis risks. Stop for symptoms suggesting liver damage; avoid during pregnancy and do not use while breastfeeding.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 12 Sept 2026; clinical approval remains outstanding.