News
Exercise Helps Stabilize Leg Pain
Leg pain while exercising that is caused by clogged leg arteries may get worse at a slower rate for people who walk regularly, researchers reported January 3 in the journal Annals of Internal Medicine.
The 417 study participants were evaluated according to how fast they could walk and how far they could go without pain, then reassessed after a year. Those who walked three times weekly had less decline in speed and in how long they could walk than those who walked less often or not at all.
What Is the Doctor's Reaction?
If you have pain in one or both legs or buttocks after walking a distance, your pain is called "claudication." This symptom occasionally results because of a pinched nerve, but the most common cause is peripheral artery disease (also called peripheral vascular disease).
Peripheral artery disease is caused by thick cholesterol deposits in the arteries of the legs. These deposits limit the flow of blood through the muscles in one or both of your legs, causing episodes of pain shortly after you begin to exercise. Like any circulation problem, it can worsen over time.
If you did not seek the advice of a doctor, you might imagine that the best treatment for claudication was to take it easy, to give the legs a rest. Actually, you should do just the opposite. There is abundant evidence that exercise can improve symptoms of claudication.
Now, a study just published in the Annals of Internal Medicine takes the benefit of exercise one step farther. It found that exercise can slow down the rate at which your claudication will worsen.
This study observed more than 400 people with claudication. Researchers measured the distance that participants could walk in six minutes and how fast they could walk four meters. Those with more severe disease needed to walk more slowly or take rests.
The researchers also asked how frequently participants exercised, and they checked after a year to take new walking measurements and to reassess exercise habits.
The people who walked for exercise at least three times per week were able to walk almost 80 feet farther on average compared with non-exercisers on their second six-minute walk test. They also did better in the four-meter walk test.
It is hard to say for sure why exercise is so helpful. It may be that well-conditioned muscles release a different mix of chemicals during exercise, or that effort is spread out across the muscles more evenly when you are in good shape. Exercise probably does not change the amount of narrowing inside your arteries.
About one out of 14 people between the ages 55 and 74 has claudication. It is much more common in people older than 75.
What Changes Can I Make Now?
If you have peripheral artery disease, do everything you can to make sure you get regular exercise. You do not need to participate in a structured rehabilitation program, unless you need this structure to help you stick with your routine.
If you want to begin an exercise program on your own, try starting by spending 35 minutes walking at one time. Rest each time that pain occurs, permitting your pain to clear completely.
You can increase your walking time (still with as many rests as needed) by five minutes each session until you reach 50 minutes per session. Exercise three times a week, if possible.
If you keep up with your walking program, it is likely that you will be able to extend the distance you can walk without symptoms to about one-and-a-half times the former distance.
If you are a smoker, quit your cigarettes. This can improve symptoms noticeably even in the first several days and can slow down worsening of your disease.
Also, work with your doctor to take good care of your heart. Since artery disease in the heart frequently accompanies artery disease in the legs, it is wise for claudication patients to take aspirin, a beta-blocker medicine (such as atenolol (Tenormin), metoprolol (Toprol, Lopressor) or others), and a statin cholesterol medicine.
With your doctor, you also can consider a blood flow medicine that can increase your symptom-free walking distance. These medicines are costly and provide only a small improvement, but some people find them worth their expense. Various medicines have been modestly effective, including cilostazol (Pletal), pentoxifylline (Trental), aspirin plus dipyridamole (Aggrenox), and ticlopidine (Ticlid).
What Can I Expect Looking to the Future?
If peripheral artery disease worsens, surgery can help a portion of patients. However, surgery carries serious risks. We need better treatments.
Several new possible treatments may be on the horizon. I am particularly hopeful that drug-coated stents may help as a long-term strategy. A stent is a coil of metal or other material that can be placed into a blood vessel to open it without surgery. Doctors use a catheter that is inserted through the skin to maneuver a stent into position.
Unfortunately, the earliest stents tended to narrow or clog. Newer stents are coated with anti-inflammatory medicines that limit scar-tissue formation during healing. These "drug-coated" or "drug-eluting" stents lower your risk of having a clog or new narrowing after the stent is placed.
Drug-coated stents that are large enough to be used in the leg arteries have only recently been developed. The first drug-coated stents that were developed for large peripheral arteries were placed into living patients in June 2005. Doctors and researchers will keep an eye on these patients to learn the long-term results.