Fighting Peripheral Arterial Disease Through Exercise - Focus on Fitness - Harvard Commentaries

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.

Continues for at least six months
Involves walking three times a week or more until nearly maximum pain is reached
Contains exercise sessions that are at least 30 minutes in duration.

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.

Intensity — The initial speed and grade of the treadmill are set at a level that causes claudication symptoms within three to five minutes. If you are walking on a track, then your initial distance will be determined by the speed of walking at which you develop symptoms after three to five minutes. Continue to walk at this intensity until moderately severe pain occurs. Then stop and rest for a few minutes while symptoms resolve before walking again.
Duration — The exercise pattern should be repeated for at least 30 minutes. The initial session should include about 30 minutes of intermittent walking. Walking can be increased by five minutes each session until 50 minutes of intermittent walking can be accomplished. A warm-up and cool-down period should be included along with some stretching exercises.
Frequency — Exercise at least three to five times per week.

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.

Stop smoking. Carbon monoxide present in cigarette smoke rapidly enters the blood and combines with the oxygen-rich hemoglobin, preventing the hemoglobin from delivering oxygen to muscle and other tissues. The nicotine constricts blood vessels, further impairing blood flow.
Check your feet for breaks in the skin. Non-healing foot sores that become festering infections are the major cause of amputation in patients with PAD. Inspect feet carefully each day. If you have a cut or blister that develops redness, swelling, or pain, seek immediate medical help.
Know your blood pressure, glucose and cholesterol levels. Hypertension, diabetes and elevated cholesterol contribute to the buildup of fatty deposits that can markedly reduce blood flow to the legs.
Shed the pounds. Obesity traumatizes muscles and blood vessels of the feet and legs, further jeopardizing skin with poor blood flow.
Eat a healthful diet low in saturated fat and rich in fruits, vegetables, nuts and whole grains for abundant nutrients that promote healthy circulation.

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.