Peripheral arterial disease, or PAD, is the medical term for poor circulation in the legs due to blockage of the arteries. This serious but often misdiagnosed condition will likely show no symptoms until an artery is already more than 60 percent blocked. Typical symptoms include increasing pain in the muscles of the lower leg while walking, and possibly burning pain with the leg elevated which goes away when the leg is dangled over the side of the bed. Examination usually will find reduced pulses in the leg and a lower blood pressure at the ankle than at the arm (a simple test called the Ankle/Brachial Index). In the later stages of PAD, the skin may be pale, dry, shiny, cold and prone to wounds and ulcers that don't heal.
Up to four percent of men and women over the age 55 have PAD. Risk factors to developing PAD include smoking, diabetes, high blood pressure, high cholesterol and inactivity. These also are risk factors for coronary artery disease (CAD), which is the similar but life-threatening blockage of the arteries of the heart. In fact, when PAD is found, a patient should always be checked for CAD also.
People with PAD usually become less active because of pain and the fear that they are doing harm by walking. Ironically this can make the disease worse. There is excellent evidence that specific medically supervised exercise plans, along with necessary lifestyle changes, can actually reverse PAD. After a thorough medical exam, an exercise prescription should be included in treatment of PAD.
The exercise plan should involve walking on a treadmill for at least 30 minutes, a minimum of three times per week, at a speed and incline that causes PAD pain near the maximum level tolerated. Unfortunately, this is one of the few times that "no pain, no gain" actually is true. To stimulate healing changes in the vascular tissues, the tissues must be challenged by a high demand for oxygen in the leg muscles, which also causes the familiar cramping or aching.
Initially, the exercise sessions should be medically supervised, such as in a cardiac rehabilitation gym or outpatient physical therapy gym. This training should continue for at least six months to make permanent changes in the circulation, even though improvements in walking tolerance can be noted within weeks.
Margaret, who agreed to be an example for this article, presented with 80 percent blockage of the circulation in her left leg. This vibrant 87-year-old woman previously enjoyed walking, bowling and dancing. But with increasing leg pain for more than two years she stopped most activity, and could no longer climb her stairs, go shopping or sleep. Vascular surgery was considered, but first her physician put her on medication and prescribed exercise. After six weeks of supervised treadmill walking, she could walk a mile on an incline for 30 minutes. She experienced no pain in her legs while climbing stairs or at night while trying to sleep, and no surgery was necessary. Having learned how to pace and monitor her own symptoms, she continues her exercise program independently now.
Suzanne Motsinger, P.T., D.P.T., C.S.C.S., is a licensed physical therapist and certified strength and conditioning specialist in the Therapy Services Department at Flagstaff Medical Center. For more information on supervised exercise to treat PAD, contact your physician or the FMC Therapy Services Department at 773-2125. Is there a health topic you'd like to know more about? Please write to Mountain Medicine, c/o FMC Public Relations, 1200 N. Beaver Street, Flagstaff, AZ 86001, or visit FMC's web site at FlagstaffMedicalCenter.com.