It’s sometimes called “window-shopper’s disease.” As walking brings on leg cramps and pain, people with peripheral artery disease must frequently stop for breaks. When they rest, pain subsides. When they resume walking, PAD pain kicks back in.
PAD is common among older adults. About one in every 20 Americans over age 50 has PAD, with up to 12 million people affected overall, according to the National Heart, Lung, and Blood Institute.
People may mistakenly believe painful walking is part of normal aging. However, PAD is linked to higher risks of cardiovascular complications such as heart attacks or strokes. PAD shouldn’t be suffered stoically or in silence. If you have symptoms, you need a medical evaluation.
Exercise is a first-line treatment for PAD. The catch is that walking discomfort may cause PAD sufferers to shy away from movement. Fortunately, structured exercise therapy can help. Better walking ability, improved cardiovascular test results and increased quality of life occur in patients who complete these programs, multiple studies show.
Supervised by health care experts and now covered by Medicare, exercise programs help PAD patients build endurance and tolerance and learn how to safely walk past the point of discomfort.
[See: The 10 Best Exercises You Can Do for the Rest of Your Life.]
ABCs of PAD
Here are some of the basics of PAD and exercise treatment:
What is peripheral artery disease? Peripheral artery disease, also called peripheral arterial disease, is a painful, chronic condition involving blockages in the arteries supplying blood to the legs. PAD is a type of peripheral vascular disease, which refers to any disease involving the vascular system outside the heart.
Normally, healthy arteries carry oxygen-rich blood from the heart to the rest of the body. In patients with PAD, atherosclerosis, or narrowing and hardening of the arteries caused by fatty plaque, interferes with blood flow to the extremities — usually the legs, although arms are sometimes affected.
Cramping, pain and fatigue of the leg and hip muscles when walking or climbing stairs are the most common symptoms of PAD.
What is claudication? Claudication is the cramping pain particularly associated with PAD. Sometimes called intermittent claudication, it’s usually caused by a lack of blood flow while exercising, but can also occur at rest as PAD worsens. Advanced PAD symptoms may include skin ulcerations or sores and cold, discolored, bluish legs, feet and toes. Some patients experience weakness of the extremities.
How is PAD treated? Diagnosis for PAD is done with a simple, noninvasive test using blood pressure cuffs and Doppler ultrasound. If blood pressure in the ankles is lower than in the arms, that’s suggestive of PAD. Vascular specialists may order additional imaging tests of the blood vessels, called angiograms.
PAD is sometimes treated with medication such as blood thinners like aspirin to prevent clots, statin drugs to slow plaque buildup and blood pressure drugs.
Smoking and diabetes are strong risk factors for PAD. Diabetes management, smoking cessation, meticulous foot care and staying physically active are essential treatment components.
[See: 10 Health Pros and Cons of Aspirin.]
How does exercise help? “Exercise is one of the most effective therapies to improve symptoms of PAD,” says Diane Treat-Jacobson, a professor and the associate dean for research in the University of Minnesota School of Nursing. “It’s been shown, over and over again, if you do a structured, supervised exercise program, you can really teach people how to walk farther until they have to stop because of their pain.”
With exercise, people with PAD can regain needed ability to function, says Treat-Jacobson, a pioneer in developing and implementing PAD exercise and educational programs.
One challenge is overcoming the paradox concerning exercise and PAD. “Because we’re taught that pain is dangerous, we avoid pain,” Treat-Jacobson says. “So, people who start feeling pain when they walk — and don’t understand why they’re having it — just avoid walking. It’s a cycle of disability where the less they do, the earlier the pain starts.”
What is structured exercise for peripheral artery disease? Treadmill walking is the featured workout in supervised PAD programs. After light stretching to warm up, patients start on the treadmill at a pace comfortable for them, with an appropriate stride length.
Next comes the challenge. “We have them walk into discomfort,” Treat-Jacobson says. “It depends on the patients and how willing they are. We don’t want them to get to severe pain. But if they can get to a moderate level of pain, then they stop the treadmill.”
A brief rest period follows, with patients sitting or standing until pain goes away, usually in one to three minutes. “Then they resume and continue that cycle of walking and resting for a 60-minute session,” Treat-Jacobson says. The goal is to get 30 to 45 minutes of exercise in a session.” Patients repeat sessions three times a week.
Nurses or exercise physiologists typically supervise these programs. Programs usually take place at hospitals or other facilities with established pulmonary or cardiac rehab programs and available equipment in place. If PAD patients develop coronary symptoms while exercising, it’s possible to put them on a heart monitor for evaluation.
Improved performance and positive feedback motivate patients as they increase their treadmill time, walking speed and treadmill elevation. It helps to hear: “This is where you started: You could do six minutes a day at flat. Now you’re doing 20 minutes at a time on an incline.”
How can I start a supervised exercise program for PAD? Patients with PAD need referrals from their physicians to take part in supervised exercise programs. “The physician’s responsibility is to assure that they do not have underlying coronary artery disease, or other kinds of heart conditions or things that would make it risky for them to start a new exercise program,” Treat-Jacobson says. “They should be cleared before they start.”
In May 2017, the Centers for Medicare & Medicaid Services approved coverage for structured exercise therapy to help reduce symptoms in people with PAD. Insurance will pay for as many as 36 sessions over a 12-week period. Patients can reapply to have another round of sessions prescribed.
Which Exercises Work for People With PAD?
Dr. Iraklis Pipinos, a professor of surgery and researcher at the University of Nebraska Medical Center, likes to take a walk with his PAD patients on the hospital’s first floor. That way he better understands their symptoms, the extent of their limitations and how much walking pain affects their quality of life.
Exercise helps PAD patients on multiple levels, Pipinos says. First is overall heart, lung and musculoskeletal fitness — important for everyone.
For people with PAD, exercise may promote collateral circulation, in which the body compensates for blockages of blood flow by creating alternate pathways in the vascular system. It’s similar to opening detours around a blocked highway, Pipinos says — although it’s never as good as a main highway, it’s enough to get you to your destination. Exercise also helps the body’s cells extract oxygen from the limited circulating blood they receive, and use that oxygen more efficiently.
Following a structured exercise program with the PAD patient using a treadmill under the supervision of health-exercise professionals — ideally in a hospital-type setting — is the method recommended by both the Society for Vascular Surgery and the American Heart Association, Pipinos emphasizes.
However, Pipinos adds that many other types of exercise can help. Some of his patients simply go to the supermarket and walk around the aisles. Some head to the nearest mall. “I tell them: Walk in the mall, and when you have a little pain, stop at the storefront. Look at the things, get some rest and walk again. And again and again.”
Stationary bikes are useful home equipment, Pipinos says. Exercising in a swimming pool is another good choice. “It lifts your weight, so your legs aren’t carrying as much,” he explains. “You don’t have to swim — you can just walk in the pool.” Even arm exercises alone can help with your walking endurance. Resistance or strength training is another option. “The exercise that helps you most is the one you will do,” he concludes.
How Can I Build Exercise Tolerance on My Own?
If you’re interested in exercising to ease PAD, talk to your physician first, Treat-Jacobson advises. Doctors might not be aware they can refer patients with claudication to exercise programs, or know whether they’re locally available.
“For people with claudication, the safest way is to start with some supervision, to help them understand what it feels like, what they should be doing, how much they should push themselves and when they should rest,” Treat-Jacobson says.
New chest pain can arise when patients with hidden coronary artery disease begin walking longer distances, she explains: “That needs to be reported right away, or if they become more short of breath when exercising — rather than less, which should happen as they become more conditioned.”
[See: 7 Signs You Should Stop Exercising Immediately.]
To transition to exercising with PAD on you own, Treat-Jacobson recommends these starting steps:
— Make sure your walking shoes fit well.
— Inspect your feet for wounds or areas of skin breakdown before and after walking.
— Walk in well-lit, non-icy areas free of broken pavement or stones.
— Start walking at a comfortable pace. On a treadmill, that might be 1 to 2.5 mph.
— Increase treadmill inclines only gradually, by a percent or half-percent, depending on what you can tolerate.
— If you can go more than 10 minutes without much discomfort, try to pick up the pace.
— Avoid walking in too much pain. Stop if pain grows severe.
— Be alert to warning signs like chest pain or increased shortness of breath.
— Report any troubling symptoms to your health care provider.
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How Exercise Can Help in Peripheral Artery Disease originally appeared on usnews.com
