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Feb 02, 2011

Exercise for PAD: Trying it at Home

Pedometers help increase physical activity and minimize symptoms in patients with peripheral artery disease.

Peripheral arterial disease (PAD) affects 8 to 12 million people in the United States. An estimated 5 percent of U.S. adults over age 50 have PAD. Among adults age 65 and older, 12 to 20 percent may have PAD. For the millions of people with peripheral artery disease (PAD), simple activities such as climbing a flight of stairs or a trip to the mailbox can bring on debilitating leg pain. PAD is caused build up of fatty deposits in the arteries of the arms and legs that prevent blood and oxygen from reaching the muscles. This is the same underlying process that is responsible for coronary artery disease, angina, and heart attacks. In fact, PAD raises your risk for heart disease and stroke. Untreated, PAD can lead to chronic pain (claudication), chronic infections and in the most severe cases, amputation of the limbs.

Research has shown that exercise can be highly effective in increasing leg circulation and reducing the pain that accompanies activity (called claudication). Optimum results have been achieved in structured exercise programs based on gradually increasing periods of supervised treadmill walking. However, these programs are rarely offered outside research medical centers and are not covered by insurance so, therefore out of reach for most people with PAD.

In an effort to extend the benefits of structured exercise to more people with PAD, researchers designed a trial to see whether a home-based program using a step activity monitor could approximate the success of supervised center-based programs.  One hundred and nineteen volunteers with PAD were randomly assigned to take part in home-based exercise, structured exercise at a medical center, or standard care which included only general advice on lifestyle changes from their doctors at follow up visits.

Individuals in the home exercise group were fitted with a step activity monitor that they wore on their ankles while walking.  In addition to being more accurate than the commonly-available belt pedometers, the ankle device captures detailed information on walking speed, incline, and number of steps taken rather than just measuring distance walked.  Both exercise groups participated in similar 12-week programs during which they gradually increased their walking time from 20 minutes to 45 minutes per session on three days a week. Individuals in both groups were allowed to set their own walking speed based on the amount of leg pain they felt was tolerable. Instead of treadmill exercise, people in the home group were instructed to walk on level ground in their own neighborhoods.  The home group also had seven brief meetings with an exercise physiologist during the course of the study to discuss their progress.

At the conclusion of the 12 weeks, the results of the two exercise groups were surprisingly similar.  In both groups, four out of five people stuck with their walking programs. Although the home exercisers generally moved at a slower pace, they chose to extend their walking sessions by an average of 11 minutes past the prescribed exercise time. When it came to reducing PAD symptoms, all the exercisers had far better results than the control group. Individuals in both programs significantly increased the amount of time they could walk without leg pain. There was no change in walking time or symptoms in the group that got standard care without an exercise program. 

Questions for You to Consider

  • What are the warning signs of PAD?

  • The first inkling that you have PAD is often a painful cramp in the calf or thigh that occurs repeatedly when you walk, but disappears when you’re at rest.  This symptom is known as intermittent claudication.  People with PAD often curtail their activity to avoid further pain. However, inactivity only worsens the condition, creating a downward spiral.

    As PAD becomes more advanced, other symptoms may develop including:

    • Aching or burning in your feet and toes, especially when lying down at night
    • Redness or other color changes to the skin on your feet
    • Skin on the feet that feels cool to the touch
    • Sores on your toes or feet that do not heal
  • How is Peripheral Arterial Disease diagnosed?

  • PAD is diagnosed based on general medical and family history, history of leg or heart problems, personal risk factors, a physical exam, and test results. An accurate diagnosis is critical, because people with PAD face a six to seven times higher risk of heart disease or stroke than the rest of the population. PAD is often diagnosed after symptoms are reported with a simple test called an Ankle-brachial index (ABI)  If you have PAD, your doctor also may want to look for signs of coronary artery disease (CAD).

    A simple test called an ankle-brachial index (ABI) can be used to diagnose PAD. The ABI compares blood pressure in the ankle with blood pressure in the arm to see how well blood is flowing. A normal ABI is 1.0 or greater (with a range of 0.90 to 1.30). The test takes about 10–15 minutes to measure both arms and both ankles. It can help the doctor find out if PAD is affecting the legs, but it will not identify which blood vessels are blocked. The ABI can be performed yearly if necessary to see if the disease is getting worse.

  • How do I start a home walking program if I have PAD?
  • Walking is a safe activity for most people, however always talk to your doctor before starting any exercise program. The components of a good program include:

    • Warm up and cool down. You should spend the first 5 minutes walking at a slower pace to loosen your muscles and allow your heart rate to increase gradually.  Slow down for the last 5 minutes of your walk to let your heart rate to return to normal.
    • Conditioning. This is the main part of your workout. Try to start with 20 minutes of walking at least 3 times a week. Increase the length of your walking sessions by 5 minutes each week until you reach 45 minutes of total walking.  This will take several weeks, but you should see an improvement in your symptoms after 3 to 6 months of regular walking.
    • Safety. If you have chest pain, shortness of breath, irregular heartbeats, or dizziness stop exercising immediately and call your doctor.
  • How can I cut down on my risk for PAD?
  • The risk factors for PAD are similar to those for heart disease. Some factors you cannot control—being older or having a family history of heart disease—but there are many that you can.

    • Get active. Exercise is good for your heart and circulation. It can help limit pain and disability when you have PAD.
    • Don’t smoke. Smoking is a key risk factor for PAD. Smokers are four times more likely to develop the condition than non-smokers.
    • Maintain a healthy body weight. Excess body fat is a risk factor for all forms of cardiovascular disease. Try to maintain a BMI of 25 or lower.
    • Control high blood pressure, high cholesterol, and diabetes. All of these conditions damage your arteries and reduce blood flow to all parts of your body. Adopt a healthy diet and lifestyle, and take the medications your doctor may have prescribed.

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