Using Your Feet to Build Up Weak Legs

Peripheral artery disease sufferers increase activity and ease pain during walking study

(RxWiki News) Limbs slowed and weakened by arteries with plaque build-up can benefit from exercise. Sometimes, patients with those problems have no choice but to create their own exercise plans.

A new study has found that people with peripheral artery disease in their legs were able to travel faster and farther by practicing walking at or near their own homes.

That's a good thing, the researchers noted, because a viable home-based exercise program can remove the potential barriers created by either insufficient insurance coverage or lack of transportation to supervised exercise programs.

"Take daily walks to increase fitness."

Mary McDermott, MD, of Northwestern University Feinberg School of Medicine in Chicago, was lead researcher for this study.

Dr. McDermott and her fellow researchers conducted a clinical trial enrolling 194 patients. About three-quarters of the patients experienced muscle pain in their legs during exercise because plaque build-up prevented proper blood flow, the researchers wrote.

Study participants were at least 65 years old. These participants were randomly divided into two groups of 97 people each.

One group met for 90 minutes each week. During those sessions, they spent half their time listening to health instructors discuss fitness topics such as the benefits of walking. They spent the other half of their time walking on an indoor track.

Members of this group also were told to spend five days a week, on their own, walking on the ground instead of on a treadmill. They tried to walk for 50 minutes.

Treadmills sometimes cause anxiety for older people who have difficulty maintaining their balance on that machine, the researchers noted. 

Members of this first group who experienced leg pain were asked to continue walking until they rated their pain as 4 on a scale of 0 to 5. After resting, they were to start walking again.

Those in this first group who had no leg pain were asked to walk until their heart rates reached a certain higher level. At the end of each week during those six months, members of the walking group completed a questionnaire about their experiences and their walking progress.

The second group met for 60 minutes each week to hear health professionals discuss such topics as managing high blood pressure and vaccinations. They did not walk.

In comparing the two groups, the researchers found that participants who walked an indoor track and on their own made more progress.

By the end of six months, they could walk 0.28 miles in six minutes. When they started, they could walk 0.22 miles within six minutes. As an additional benefit, members of the first group also increased the maximum amount of time they were able to walk on a treadmill without difficulty from 7.91 minutes to 9.44 minutes.

By comparison, the maximum amount of time that the second group, who did not practice walking, could spend on a treadmill without experiencing problems increased from 7.56 minutes to 8.09 minutes.

Those in the second group also lost ground slightly during the six-minute walking test. At the start of the study, they walked 0.218 miles during that six-minute test. After six months, they walked 0.212 miles in six minutes.

Overall, the researchers wrote, members of the first group eventually were able to both walk with less pain and raise their overall level of physical activity.

"The functional limitations experienced by patients with [peripheral artery disease, or PAD,] are associated with poor quality of life, high hospitalization rates, increased mortality and high medical care costs," the researchers wrote.

"However, only two medications are US Food and Drug Administration approved for treating [muscle pain from lack of blood flow]. Of these, pentoxifylline is not better than placebo and cilostazol is associated with an approximate 25 percent improvement in walking performance," they wrote.

These researchers continued, "Supervised treadmill exercise is associated with a 50 percent to 200 percent improvement in maximal treadmill walking performance in PAD. However, most patients with PAD do not participate in supervised exercise. Medical insurance typically does not pay for supervised exercise for patients with PAD and traveling to exercise sessions is burdensome. Home-based exercise could provide a feasible therapeutic option that is accessible to most patients with PAD."

The entire study ran from late July 2008 through mid-December 2012. 

This study was published July 2 in the Journal of the American Medical Association.

Dr. McDermott is an editor for that journal. Some of the researchers are pharmaceutical company consultants.

The National Heart, Lung, and Blood Institute; Intramural Research Program, National Institutes on Aging; and National Institutes of Health funded the study.

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Review Date: 
July 1, 2013