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Health & Exercise Forum

The Facts on Peripheral Arterial Disease

Oct 28, 2013

Dr. Mackarey's Health & Exercise ForumGuest Columnist: Janet Caputo, PT, DPT, OCS

Peripheral arterial disease (PAD), also known as peripheral vascular disease, is an obstruction or narrowing of the large arteries, usually in the legs. These narrowed or clogged arteries cause a lack of blood flow to your body’s tissues (i.e. muscles, tendons, ligaments, nerves, etc.). It can be caused by atherosclerosis or inflammation which may lead to stenosis and complicated by associated embolisms, similar to what occurs in the smaller arteries of the heart and brain. It can be painful and debilitating. It typically affects 12-14% of the general population, however, it is found in 20% of those over 75.

Have you seen the commercials on television for peripheral artery disease (PAD) recommending laser, electrical stimulation, or ultrasonic sound waves to alleviate symptoms?  While tempting, there is little to no scientific support for these treatments. Reliable sources, such as the American College of Cardiology and American Heart Association, advocate EXERCISE as the best treatment for PAD.

Peripheral Arterial Disease Symptoms:

    • Painful cramping (i.e. intermittent claudication) in the hip, thigh, or calf muscles during activity (e.g. walking, stair climbing) that disappears after a few moments of rest
    • Leg numbness
    • Leg weakness
    • Coldness in your lower leg or foot as compared to the other side
    • Sores on your leg or foot that will not heal
    • A change in the color of your legs
    • Hair loss or slower hair growth on your legs
    • Slower growth of your toenails
    • Shiny skin on your legs
    • Weak or absent pulses in your legs or feet.

Research has identified several factors that increase your risk for developing PAD.  You can control many, but not all, of these risk factors.  The uncontrollable risk factors include:

    • Age of 70 years or older
    • Being of African American or Hispanic descent

However, be optimistic and focus on the following controllable risk factors:

    • Smoking
      • Cessation is high priority
      • May require pharmaceutical intervention
    • High blood pressure
      • Optimal: < 140/90 mm Hg (130/80 mm Hg, if diabetic)
    • Diabetes
      • Strive for a 7% HbA1C value (represents glucose level in blood)
    • High cholesterol
      • LDL (i.e. “Bad” cholesterol) < 100 mg/dL
      • LDL < 70 mg/dL, if you have metabolic syndrome, a combination of:
        • Abdominal obesity
        • Elevated triglycerides,
        • Low HDL [i.e. “good” cholesterol]
        • High blood pressure,
        • Diabetes or pre-diabetes
    • High triglycerides

PAD affects men and women equally and is often associated with coronary artery disease (AKA: heart disease) which can cause a heart attack and cerebrovascular disease which can cause a stroke.  To reduce your risk of heart attacks and stroke, anti-coagulant therapy is recommended, with aspirin as the first choice.

PAD symptoms can interfere with your ability to maintain an active lifestyle.  This lack of “exercise” decreases your balance, strength, endurance, and walking ability.  You may succumb to a sedentary lifestyle which reduces quality of life and increases risk for disability and death!  Therefore, PAD requires aggressive management!

Proper management of PAD includes reducing not only the risk factors, but also the pain that you experience with activity!   The American Heart Association and the American College of Cardiology recommend a supervised exercise program because:

  • EXERCISE is the “one single intervention” that influences the greatest number of risk factors
    • Aides in smoking cessation
    • Improves cholesterol levels
    • Reduces blood pressure
    • Controls blood sugar
    • Reverses effects of a sedentary lifestyle
    • Promotes weight loss
    • Manages stress-induced increases in heart rate and blood pressure
    • Decreases inflammation
    • Improves mood
    • Alleviates depression
  • EXERCISE is more cost effective and has less medical complications
    • Exercise dilates blood vessels and allows your body to develop muscle fibers that are able to function despite reduced blood flow

The American College of Cardiology and the American Heart Association endorse a walking program, 30 to 45 minutes in duration, at least 3 times per week, for at least 12 weeks.  Other components of the ideal walking program need to be identified by a medical professional:

    • You should walk until near maximal pain intensity (if rated on a 0-10 best-worst scale: 0 to 3 [minimal pain], 4 to 6 [moderate pain], 7 to 10 [severe pain])
    • Train at moderate intensity: 40% of Age-predicted maximal heart-rate (220-age)
    • Three times per week
    • Supervised program should last at least 3 months
    • Noticeable improvements after 2 months
    • Results maintained with continued program performance
    • Rest after 1 to 5 minutes of exercise, or until symptoms arise. Allow 2 to 10 minutes of rest or until symptoms abate.
    • Increase duration, intensity, and frequency of exercise
    • Optimal level
      • 3 times per week
      • 45 minutes in duration (not counting rest periods)
      • 20 weeks or longer

In more severe cases of PAD, revascularization with surgical techniques should be considered if the above mentioned conservative measures have failed. Please consult with your doctor before beginning any exercise program!

Visit your doctor regularly and listen to your body.

CONTRIBUTING AUTHOR: Janet Caputo, PT, DPT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and neurological physical therapy.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.