May 22, 2014
News Review From Harvard Medical School -- Home Program May Stretch Walking Distance
A home walking program may help people with poor blood circulation that leads to leg pain, a new study finds. The study focused on 168 people with peripheral artery disease. This condition is caused by narrowed arteries in the legs. The main symptom is pain or cramping in the legs while walking. People in the study were randomly divided into 2 groups. The first group took part in a program that trained them to increase their walking at home. After 6 months, they continued on their own, with phone calls for encouragement. They were told to try to walk at least 5 days a week and build up to 50 minutes a day. If their legs hurt, they were told to rest until the pain went away, and then start again. The second group received general health information only. After a year, people in the first group had increased their average distance for a 6-minute walk by about 87 feet, or 7.5%. There was no increase for the second group. The Journal of the American Heart Association published the study. HealthDay News wrote about it May 21.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Just like a car, the human body is a machine that requires fuel to function. And that means every organ and tissue needs enough blood to deliver oxygen and other nutrients. The heart pumps oxygen-rich blood through an extensive system of arteries to all parts of the body. The veins return the blood to the lungs for a "refill" of oxygen.
What happens when the arteries are severely narrowed or blocked? If the diseased artery supplies the heart, a heart attack may follow. If the artery is in the brain, the result could be a stroke.
When the trouble is in the arteries of the legs, the muscles of the legs cannot function normally. This is called peripheral artery disease. Walking becomes painful and limited. Surgery can open up clogged arteries or bypass the blockages. But nonsurgical options, such as medicines, are not particularly effective.
That's why a new study is important. The Journal of the American Heart Association published the results. The study included 81 people with peripheral artery disease. Researchers met weekly with them for 6 months to teach them about a home-based walking program. For the next 6 months, people got phone calls to encourage them to keep walking. They were asked to aim for 50 minutes a day at least 5 days a week. A comparison group also had educational meetings and phone calls. But these meetings were focused on health issues unrelated to peripheral artery disease.
Here are some of the results after one year:
- Those in the home-based walking program increased the distance they could walk in 6 minutes from 1,166 feet to 1,253 feet. That was a gain of 7.5%.
- Self-reported walking speed also increased significantly among those in the walking program.
- The comparison group had no significant improvement in their 6-minute walk distance or self-reported walking speed.
Previous studies have found that a supervised walking program in a cardiac rehabilitation facility could be helpful. However, it can be hard to stick with a long-term, supervised program. Insurance may not cover these programs. They also require repeated visits to a rehabilitation facility or other exercise facility.
You may wonder: if peripheral artery disease causes pain with walking, how can people with this condition use a walking program to get better? People in the study were instructed to stop if they developed pain. But they were encouraged to start walking again after they had rested and the pain had gone away. People were able to stick with this program. Eventually, walking improved.
This is yet the latest example of a benefit of exercise. And this time it rivals the results of our best medicines. Even though the improvement may seem modest, more could occur over time. And even small improvements in walking distance or speed can make a big difference in quality of life.
What Changes Can I Make Now?
Measures that may reduce your risk of peripheral artery disease are the same ones that also may help prevent heart attack and stroke. Here's what you can do:
- Don't smoke.
- Keep your blood cholesterol levels and blood pressure in an ideal range. Diet, exercise and loss of excess weight are enough for some. But sometimes medicines may be recommended.
- Avoid diabetes. Maintaining an ideal body weight is the most important preventive measure.
Many cases of peripheral artery disease cannot be prevented. If you have pain or cramping in the legs that occurs with exercise and goes away with rest, see your doctor.
Treatment options include:
- Modifying risk factors, as above
- Exercise -- As this latest research shows, a home-based walking program may be a good option. Other options, such as biking or swimming, may be just as effective.
- Medicines, such as
- Clopidogrel (Plavix)
- Cilostazol (Pletal)
- Pentoxifylline (Trental)
- A combination of these
- Surgery -- A tiny balloon can be inflated inside a narrowed artery. Then a stent can be inserted to keep the artery open. For the most severe disease, surgery can restore blood flow by bypassing the blocked artery.
Don't assume that pain with walking is expected as you get older. Peripheral artery disease is treatable, and this treatment may also reduce your risk of heart attack and stroke.
What Can I Expect Looking to the Future?
I hope that with increased awareness, many cases of peripheral artery disease can be prevented. But the older population is growing larger, and the obesity epidemic has spurred growth in related health problems, particularly diabetes. So it seems likely that peripheral artery disease will become even more common in the future.
This new research suggests that walking can be helpful. But important questions remain:
- Is walking the best exercise for peripheral artery disease?
- How much exercise is enough?
- Is more exercise better?
- Can researchers develop more effective medicines for this condition?
We'll have to wait for the results of future research to answer these questions.