By Jonathon Stavres MS, ACSM-EP-C
Peripheral artery disease (PAD) is a condition characterized by a blockage in an artery other than a coronary artery, and most often affects the lower legs. PAD limits exercise by causing ischemia (lack of blood flow) to the muscle supplied by the blocked artery. In most patients, this manifests as pain of the lower leg during early-exercise and the pain increases with intensity.
This introduces a paradox; patients with PAD need the cardiovascular benefits of exercise, but they’re limited in how long they can exercise due to the pain. For that reason, walking is often prescribed to those with PAD.
Walking stimulates blood flow
Walking is an exercise that can keep the pain associated with ischemia low, but still elicit the cardiovascular benefits of other aerobic exercise. Walking is also selected because it is weight-bearing, and stimulates blood flow to the lower limbs which are most often affected by PAD. Arm ergometry is a good substitute for walking when PAD affects the upper limbs.
One benefit of light exercise in the effected limbs is the stimulation of angiogenesis
Angiogenesis is the formation of new blood vessels from existing vessels, and can help redirect blood around a blockage. Mays et al. (2015) found that both supervised and non-supervised walking increased circulating angiogenic cells in a group of patients with PAD. The study also found that supervised walking was much more effective than non-supervised walking.
This could be due to the motivation provided by an instructor. Even a light exercise can elicit pain, which could cause a participant to slow their walking pace, or even stop walking. However, exercise should be performed at a level of 3 on a 0-4 scale, with 0 being no pain, 4 being unbearable pain, and 3 being “intense pain” (Pescatello, 2010). Therefore, working with an exercise professional could provide the motivation required to work at that level of pain.
If you have PAD, or any other chronic disease, it is important to consult with your physician before beginning a regular exercise program. Your physician can determine if you have any underlying health issues (related or unrelated) that would prohibit exercise. Once you are cleared to begin exercise, you should then consult with an exercise professional to analyze your goals and generate a plan to achieve those goals.
In summary, PAD can limit an individual’s functional ability and reduce their physical endurance. However, research indicates that low-intensity exercise (such as walking) can benefit PAD patients by simulating angiogenesis and eliciting global cardiovascular benefits.
*For more examples of other variations/exercises look under Multimedia-VDF Exercise Tips
**Consult with a physician and/or medical healthcare provider before starting any exercise regimen
Article’s Resources
Dopheide, J. F., Geissler, P., Rubrech, J., Trumpp, A., Zeller, G. C., Daiber, A.,… & Espinola-Klein, C. (2016). Influence of exercise training on proangiogenic TIE-2 monocytes and circulating angiogenic cells in patients with peripheral arterial disease. Clinical Research in Cardiology: Official Journal of the German Cardiac Society. Epub
Mays, R. J., Hiatt, W. R., Casserly, I. P., Rogers, , R. K., Main, D. S.,… & Regensteiner, J. G. (2015). Community-based walking exercise for peripheral artery disease: An exploratory study. Vascular Medicine, 20(4), 339-347. doi: 10.1177/1358863X1557275
Pescatello, L. S. (Ed.). (2010). ACSM’S Guidelines for Exercise Testing and Prescription. Baltimore, MD: Lippincott, Williams, & Wilkins