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 when the leg is elevated with relief when the leg is dangled over the side of the bed. Examination usually reveals a reduced pulse in the leg and a lower blood pressure at the ankle than at the arm via 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 of 55 have peripheral arterial disease. Risk factors include smoking, diabetes, high blood pressure, high cholesterol and inactivity. These also are risk factors for coronary artery disease, a life-threatening blockage of the arteries of the heart. In fact, patients diagnosed with peripheral arterial disease should also be checked for coronary artery disease.
People with peripheral arterial disease usually become less active due to pain and the fear that they are harming themselves by walking. Ironically, not walking can make the disease worse. There is excellent evidence that specific medically-supervised exercise plans, along with necessary lifestyle changes, can actually reverse peripheral arterial disease. After a thorough medical exam, an exercise prescription should be included in treatment of the disease.
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 the pain to be near the maximum tolerable level. Unfortunately, this is one of the few times that "no pain, no gain" actually is true. To stimulate healing in the vascular tissues, the tissues must be challenged by a high demand for oxygen in the leg muscles, which causes the familiar cramping or aching. Initially, 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.
Here is a typical patient scenario: Janice came to therapy with an 80-percent blockage of the circulation in her left leg. This vibrant 77-year-old woman previously enjoyed walking, bowling and dancing. But due to increasing leg pain for more than two years she stopped most activity, and could no longer climb stairs, go shopping or sleep. She considered vascular surgery, but first her physician prescribed medication and 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 falling asleep. No surgery was necessary. Having learned how to pace and monitor her own symptoms, Janice now is continuing her exercise program independently.
Suzanne Motsinger, P.T., D.P.T., C.W.S., C.S.C.S., is a licensed physical therapist with Flagstaff Medical Center's EntireCare Rehab and Sports Medicine Experts. She has both a master's and doctorate degree in physical therapy. Suzanne has been a physical therapist for 23 years and is a certified strength and conditioning specialist.