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Peripheral Artery Disease: This Is What Improves Walking Abilities of People With PAD The Most

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In the US, around ten million people suffer from Peripheral artery disease also known as PAD. Black people, American Indians, and people with poor socioeconomic standing are particularly affected by the condition.

Walking for exercise is good, but there is a better way to walk to improve the walking abilities of people with peripheral artery disease, says a new study.

The disease develops as the arteries that carry blood from the heart to all parts of the body become narrow, which lowers blood and oxygen flow.

It typically affects the legs and feet, producing symptoms such as cramping, weakness, weariness, soreness, and pain or discomfort while walking that go away after resting for 10 minutes.

According to earlier studies, individuals with PAD can walk farther and more easily when they exercise by walking, especially on a treadmill under staff supervision.

The possible impacts of walking at a rate that causes symptoms like leg pain on speed, strength, and balance were yet unknown.

This study investigated the effects of home-based walking for exercise in 264 PAD patients who were taking part in the Low-Intensity Exercise Intervention in PAD (LITE) randomized clinical trial, which involved 305 participants in total.

From September 2015 through December 2019, individuals from four U.S. medical centers joined in the LITE study (Northwestern University, Tulane University, University of Minnesota and University of Pittsburgh).

Their average age was 69 years, and 61 percent of the adults were Black and 48 percent were women.

Participants were randomly allocated to one of three groups and kept there for a year. The first group (38 percent) walked at home at a pace that was comfortable. The second group (41 percent) walked at home at a pace that made their legs hurt. The third group (21 percent) did not walk for exercise. Both groups of walkers wore an ActiGraph, which measured how hard they walked and how long they walked for.

For each person who was given an exercise intervention, personal thresholds were set for the ActiGraph intensity that corresponded to walking at a pace that caused leg symptoms (high intensity) and that corresponded to walking at a comfortable pace without leg symptoms (low intensity).

During walking exercise activities, participants who were randomly assigned to exercise wore their ActiGraph devices and uploaded data on exercise frequency, intensity, and duration to the study website.

At the beginning of the study and six and twelve months later, participants completed three tests of leg function: walking speed over a four-meter distance (13 feet) at their normal pace, walking speed over a four-meter distance (13 feet) at their fastest pace, and the short physical performance battery (SPPB), which included a four-meter walking velocity at their normal pace, a standing balance test, and the time for five repeated chair rise.

The main conclusions were:

  • Participants whose walking pace caused leg pain or discomfort walked more than 16 feet per minute faster than those whose walking pace did not cause leg pain or discomfort at six and twelve months, respectively. Participants in the group who walked for exercise at a tempo causing leg pain or discomfort improved their walking speed by about 13 feet per minute at six months, but this improvement was not statistically significant at twelve months.
  • People who walked for exercise while experiencing leg pain or discomfort at 12 months had an almost 1-point advantage over those who walked comfortably with no leg pain on the short physical performance battery’s total of 13 points (0–12). At six months or 12 months, there was no difference in walking speed between exercisers and non-exercisers for those who walked for exercise at a comfortable pace.

The Jeremiah Stamler Professor of Medicine in the division of general internal medicine and geriatric medicine at Northwestern University’s Feinberg School of Medicine in Chicago, Mary M. McDermott, says, “We were surprised by the results because walking for exercise at a pace that induces pain in the legs among people with PAD has been thought to be associated with damage to leg muscles.”

According to these findings, doctors should urge patients to walk for exercise at a rate that causes leg pain rather than one that is pleasant and pain-free.

This highlights the advantages of exercising by walking at a rate that causes leg pain or discomfort. 

“This finding is consistent with “no pain, no gain” with regard to walking exercise in PAD,” McDermott adds.

Leg-pain-inducing exercise is helpful yet challenging, according to McDermott. 

The results may not be applicable to walking on a treadmill in the presence of a health professional, which is the standard of care and first-line therapy according to clinical practice standards, it is vital to remember that the study participant walked at home.

These results were not pre-specified for this clinical investigation. Therefore, these findings need to be backed up by other studies in the future.

Source: 10.1161/JAHA.121.025063

Image Credit: Getty

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