Fighting Peripheral Arterial Disease Through Exercise
Last reviewed by Faculty of Harvard Medical School on January 27, 2012
By Paulette Chandler, M.D., M.P.H.
Do your legs hurt or become cramped while walking? When you stop to rest does the pain go away, but return when you start to move again? You may be experiencing classic symptoms of intermittent claudication from peripheral arterial disease (PAD). PAD, previously called PVD (peripheral vascular disease), refers to restricted blood flow in the legs due to blocked arteries.
How common is PAD? It affects about one in 20 people over age 50. People who have claudication usually have heart disease also. More than half of people with PAD have leg pain or numbness. The disease often goes undiagnosed. People may dismiss their symptoms as a normal part of aging. How can the diagnosis be confirmed in the doctor's office? A commonly used measurement is the comparison of the systolic blood pressure at the ankle and elbow (called the ankle-brachial index, or ABI). An abnormal ankle-brachial index (ABI less than 1) strongly suggests the presence of PAD.
A daily walking program should be No. 1 on your list. A number of research studies have demonstrated the benefits of exercise training in the treatment of claudication. The degree of improvement in pain-free walking is similar to or even greater than that occurring after surgery to unplug or bypass the arteries.
The greatest benefit occurs if an exercise program:
How does exercise improve claudication? Exercise may increase new blood-vessel formation, promoting increased blood flow to muscles and increasing the production of nitric oxide, a very potent blood-vessel dilator. Blood thickness also decreases with exercise. Free-flowing blood delivers oxygen and nutrients more efficiently.
Treadmill and track walking are the most effective exercises for claudication. Before beginning a walking program, work with your doctor to develop goals.
Goals should address the following four areas:
Bicycling on a stationary bike also can be helpful because it works the calves. Exercises that work the leg muscles also include toe raises, stair climbing, running in place, jumping rope and dancing.
Remember that an early, aggressive lifestyle-improvement program with a good exercise component can greatly improve the quality of life for people with peripheral arterial disease by promoting greater mobility and less pain.
Paulette Chandler, M.D., M.P.H. is a clinical instructor of medicine at Harvard Medical School and an attending physician at Brigham and Women's Hospital.