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The Ultimate Exercise Rx for Peripheral Artery Disease

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If your calves cramp while walking or climbing stairs—especially if the pain eases when you stop—it’s a red flag that you may have peripheral artery disease (PAD). With PAD, your arteries are narrowed due to plaque buildup, which prevents the muscles in your extremities (usually your legs) from getting enough blood flow to keep up with the increased oxygen demand when you are active.

It’s no small matter—if PAD goes untreated, the condition can lead to infection, loss of the function of the limb and, in severe cases of blockage, amputation.

Here’s the irony of treating PAD: People who have this circulatory problem, with its telltale pain while walking, are often prescribed (you guessed it!) walking to relieve their pain. Even though it hurts, walking—when done according to certain guidelines (see below)—does actually improve the symptoms of PAD and slow its progression. In fact, exercise works as well as any medication or surgery, according to research published in Circulation.

WALK THIS WAY

What’s so great about walking? When you repeatedly put one foot in front of the other, it brings more oxygen to your muscles, which improves your circulation and eases the pain of PAD. The exact reasons why walking helps aren’t known, but it’s well-established that the more you walk, the farther you’ll be able to walk…and with less pain.

Important: If you suspect that you have PAD but haven’t been diagnosed, it’s important to see your doctor for an evaluation. This will include an ankle-brachial exam, which compares the blood pressure in your arms to that in your feet, to show how well your blood is flowing, and possibly other tests such as an ultrasound. You may also have other related factors, such as high blood pressure, that need to be addressed.

To get the best results from your walking program…

• Stretch. Before getting started, your calf muscles need a good stretch to increase blood flow to the area. What works best: Stand in front of a low step (a curb works fine, too). Place the toes of one foot on the step and drop your heel just enough to feel a stretch in your calf. Don’t overdo it…stop at the point of tightness. Hold it for 10 to 15 seconds, then switch feet.

To warm up your thigh muscles, stand on one leg and raise the other foot behind you by bending the knee. Do not pull up on your foot…just rest that ankle in your hand and hold that position long enough to feel a slight stretch in your thigh (usually 10 to 15 seconds). Switch legs and repeat. (If you can’t reach your ankle, try standing with a wall behind you and place that foot against the wall to hold it up.)

• Walk. Find a flat, safe surface for your walks (neighborhood streets, a local track, a shopping mall or a treadmill). What works best: Start by walking for five minutes at a pace that causes some pain. On a pain scale from one to five, where one is mild pain and five is severe pain, aim to walk at a three or four.

• Rest. After walking for five minutes with moderate pain, stop and rest until the pain goes away. Helpful: If you like to walk in an area where there aren’t any benches for your rest period, treat yourself to a cane with a folding seat attachment. It’s not too heavy to carry and gives you a place to sit during your rest stops.

• Repeat. Once the pain has dissipated, try to walk for another five minutes. If you find that it’s impossible to do the additional five minutes without severe pain, try slowing down your pace to achieve a few extra minutes.

• Stay focused on your goal. Try to walk at least three—ideally, five—times a week. During the first two months, build up slowly to a total of 35 minutes of walking during each session, not counting the rest breaks. After you can manage that, keep adding a few minutes each week until you’re at the ultimate goal of walking 50 minutes per session.

• Cool down. You should always finish by walking slowly for five minutes. Then stretch your calf and thigh muscles again to help minimize muscle soreness after walking.

SMART STRATEGIES

To give yourself the best possible odds of succeeding at your walking program, you should also…

• Track your progress. To stay motivated, jot down the total time and distance of your walks. Or wear a fitness tracker, such as Fitbit, or use a phone app, like MapMyWalk, to help track your time, effort and distance.

• Avoid boredom! If you walk outside, vary your route. If you prefer a treadmill, listen to music or a podcast…or watch a 30-minute TV show. Also helpful: Find a walking buddy—the social aspect can help keep you on target.

FOR AN EXTRA BOOST

Working with a physical therapist to start a walking program is smart, since supervised programs seem to be more effective by helping to ensure that you keep up with your walking program and hit the required pain thresholds. You’re also likely to get help paying for your sessions with a physical therapist.

Recent development: Medicare Part B now covers comprehensive cardiac rehabilitation programs that include exercise, education and counseling for patients with PAD. The specific amount you’ll owe may depend on several things, such as the Medigap insurance (if any) you have and the type of facility you choose. Check with your insurer.

AN ALTERNATIVE TO WALKING

If any amount of walking is too painful or too dangerous for you, don’t give up. New research shows that you can get comparable results with arm exercises.

Important recent finding: In a study that was conducted at University of Minnesota School of Nursing in Minneapolis, researchers randomly divided 28 people with PAD (average age 65.6) into three different groups—no exercise…treadmill walking…or arm exercise. Participants assigned to arm exercises used an arm ergometer (a device with bicycle-like pedals that are operated by the arms). After three months of training for three hours a week, people in both exercise groups could walk farther without pain.

Other possibilities: It’s likely that bike riding, dancing, swimming or pool walking, which haven’t yet been tested in people with PAD, may also help relieve symptoms. If you enjoy those activities, talk to your doctor about giving them a try!

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Source: Neel P. Chokshi, MD, MBA, assistant professor of clinical medicine at Perelman School of Medicine, University of Pennsylvania in Philadelphia, and medical director of the university’s Sports Cardiology and Fitness Program. His research has been published in American Journal of Cardiology and other professional journals. Date: April 1, 2018
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