Peripheral artery disease (PAD) is a chronic medical condition that occurs as a result of plaque build-up in the peripheral arteries, causing sufferers of the condition to experience pain in their lower limbs. Despite being a condition that affects approximately 230 million people worldwide, a recent study found that only 9% of samples were familiar with PAD.1,2 Researchers have not underestimated the importance of investigating the most effective ways those diagnosed with peripheral artery disease can manage their condition. Exercise, especially walking, has been identified as an extremely effective tool in the fight against PAD. However, it would appear those diagnosed with peripheral artery disease are unaware of the benefits exercise can provide. Research indicates that of those diagnosed with peripheral artery disease, only 3.4% meet the weekly exercise guidelines.3
What is peripheral artery disease?
Peripheral artery disease is a cardiovascular condition that is primarily caused by plaque build-up in the arteries that supply our legs with oxygenated blood. As plaque builds up within the arteries, they become narrower and narrower, meaning that blood flow through them becomes restricted. Consequently, the muscles in our legs receive a smaller supply of oxygenated blood, causing them to become weaker, less healthy and experience pain. This is known as claudication.
Whilst arterial plaque build-up has been identified as the primary cause of peripheral artery disease, many additional factors can increase our risk of developing the condition. Below are some of the risk factors that have been identified to have the largest influence on our risk of developing PAD:
- Sedentary lifestyle
- Consuming a diet high in fats and sugars
- Age (35+ most at risk)
- High blood pressure
Up to 50% of those with peripheral artery disease experience mild symptoms or even no symptoms at all, making it a difficult condition to spot.4 In those that do experience symptoms, experiencing leg pain whilst walking or engaging in physical activity is one of the key warning signs you may have PAD. Whilst less common, below are some more symptoms those with PAD may suffer from.
- Reduced leg muscle size
- Experiencing numbness in one or both legs
- Loss of leg hair
- Legs feeling colder than the rest of the body
- Wounds that don’t heal or take much longer to heal
- Leg ulcers
- Erectile dysfunction
Initially, your healthcare provider/doctor will likely ask questions regarding your condition as well as potentially enquiring about your individual and family medical history. Your doctor will then likely conduct a visual assessment, looking for some of the more visible signs and symptoms of PAD, such as loss of leg hair and leg ulcers. If your doctor/GP believes you may have PAD, you will then likely be referred for an ankle brachial pressure index test (ABPI).
A painless test that uses sound waves measures to compare the blood pressure in your upper body (arms) and lower body (ankles). In healthy individuals, the two scores should be the same or similar. However, in those with PAD, the scores would likely be different due to poor circulation.
A dye is injected into the bloodstream before an X-ray image of the body is taken. This allows physicians to identify if and where any blockages have occurred within your arteries.
Sound waves are passed through the leg to provide medical professionals with an image of the arteries within it, once again allowing them to identify if and where any blockages have occurred.
Whilst there is no specific cure for PAD, there are several ways in which those diagnosed can help to manage or improve this condition. The treatment options available to PAD patients can vary depending on their condition. In most cases, patients will be prescribed medication and advised on ways they can lead a healthier lifestyle. However, those with a more severe condition may require further medication interventions such as surgery.
- Exercise: Research has identified that exercise can be an extremely effective method of reducing the severity of symptoms experienced by PAD patients, as well as reducing their long-term risk of complications such as heart attacks and strokes.5
- Dietary changes: Reducing the number of saturated fats and sugary products can help PAD patients control blood pressure and blood sugar levels, reducing the risk of worsening their condition and suffering from further complications.
- Stop smoking: Smokers who chose to continue smoking after being diagnosed with PAD are severely at risk of suffering from further complications. Statistics emphasise the importance of quitting smoking after PAD diagnosis, for example, the drastic difference in ten-year survival rates in those who quit vs those who don’t (82% vs 46%).6
- Naftidrofuryl Oxalate: A medication prescribed to PAD patients to help improve blood flow to the lower areas of the body. Naftidrofuryl Oxalate is most commonly prescribed to PAD patients that experience pain whilst walking.
- Blood Thinning Medication: Blood thinning medications such as rivaroxaban, clopidogrel or low-dose aspirin may be prescribed to PAD patients to help reduce the risk of blood clots developing.
- Artery bypass graft: Surgeons take a blood vessel from another part of the body and use it to redirect blood flow around the blocked or narrowed part of the body, helping increase blood flow to the lower limbs.
- Angioplasty: A very small balloon is inserted into the patient's bloodstream before being directed to the site of the blocked/narrowed artery. Once there, the balloon is inflated, helping increase the width of the blood vessel, and increasing blood flow.
Unfortunately, if left untreated peripheral artery disease can raise an individual’s risk of suffering from further complications, including more severe symptoms and other chronic health conditions. Whilst treatment doesn’t eradicate the risk of the possible PAD complications listed below, it does significantly lower the risk of an occurrence.
- Heart attack
- Heart failure
- Coronary heart disease
- Critical leg ischemia
- Leg amputation due to muscle tissue damage
What is the best exercise for peripheral artery disease?
It is suggested that simply going for at least 4-5 walks per week is the best exercise for someone recently diagnosed with PAD. Studies have found that exercise incentives such as supervised walks can be extremely beneficial for those suffering from PAD, especially when performed in groups of people from the same community.7 For example, walking has been shown to reduce the risk of heart attacks and critical leg ischemia in PAD patients.
Walking has also been shown to improve the quality of life of PAD patients. For example, one study found that after taking part in a walking-based exercise programme, PAD patients were able to walk an incredible 180% further before they experienced leg pain in comparison to when they first began the programme.8
What other exercises are beneficial?
In addition to walking, other exercises can be beneficial for those that have been diagnosed with PAD. It is extremely important to note that you should contact your local GP for advice before incorporating new physical activity into your routine. Other exercises that are good options for people with PAD include:
- Cardiovascular exercise: Whilst walking is the perfect introduction to exercise for PAD patients, many may reach a point when the health benefits of walking begin to plateau. Once an individual has reached this point, they may eventually experience greater health benefits by moving on to slightly more intense cardiovascular exercises such as jogging, cycling and swimming.
- Yoga: Offering a wide range of health benefits, yoga has been shown to directly help reduce some of the health problems commonly found in those with PAD. For example, yoga can help reduce blood pressure levels and the amount of stress experienced by an individual, both of which are common in PAD patients.
- Resistance training: PAD patients should be extremely careful when it comes to resistance training and should always be supervised when performing resistance-based exercises. However, if medically cleared, research has found that resistance-based exercises (such as body weight exercises) can help improve how far PAD patients can walk or run before they begin to experience pain.9
When should I contact my doctor?
Anyone who regularly experiences any of the aforementioned signs and symptoms of peripheral artery disease, such as pain whilst walking, leg hair loss and sores, should contact their healthcare provider immediately to book an appointment. Whilst leg pain may not seem like a particularly serious issue or even be mistaken as growing older, PAD is a serious condition and requires immediate medical attention to help prevent further complications.
Despite its growing prevalence, peripheral artery disease remains a fairly unknown disease to most. Because of this, it is very easy for an individual to experience leg pain and not realise it could be a warning sign of PAD. If you regularly experience leg pain or any of the other aforementioned symptoms, be sure to visit your local GP for an appointment. Whilst not everyone who suffers leg pain will have PAD, catching the disease earlier plays a vital role in managing the condition for those that are diagnosed with PAD.
- Aday, Aaron W., and Kunihiro Matsushita. ‘Epidemiology of Peripheral Artery Disease and Polyvascular Disease’. Circulation Research, vol. 128, no. 12, June 2021, pp. 1818–32. ahajournals.org (Atypon), https://doi.org/10.1161/CIRCRESAHA.121.318535
- Bauersachs, Rupert, et al. ‘International Public Awareness of Peripheral Artery Disease’. VASA. Zeitschrift Fur Gefasskrankheiten, vol. 50, no. 4, July 2021, pp. 294–300. PubMed, https://doi.org/10.1024/0301-1526/a000945
- Gerage, Aline Mendes, et al. ‘Physical Activity Levels in Peripheral Artery Disease’. Arquivos Brasileiros de Cardiologia, vol. 113, no. 3, Sept. 2019, pp. 410–16. PubMed Central, https://doi.org/10.5935/abc.20190142
- Shu, Jun, and Gaetano Santulli. ‘Update on Peripheral Artery Disease: Epidemiology and Evidence-Based Facts’. Atherosclerosis, vol. 275, Aug. 2018, pp. 379–81. PubMed Central, https://doi.org/10.1016/j.atherosclerosis.2018.05.033
- Hamburg, Naomi M., and Gary J. Balady. ‘Exercise Rehabilitation in Peripheral Artery Disease: Functional Impact and Mechanisms of Benefits’. Circulation, vol. 123, no. 1, Jan. 2011, pp. 87–97. PubMed Central, https://doi.org/10.1161/CIRCULATIONAHA.109.881888
- Faulkner, K. W., et al. ‘The Effect of Cessation of Smoking on the Accumulative Survival Rates of Patients with Symptomatic Peripheral Vascular Disease’. The Medical Journal of Australia, vol. 1, no. 5, Mar. 1983, pp. 217–19. PubMed, https://doi.org/10.5694/j.1326-5377.1983.tb99395.x
- Mays, Ryan J., et al. ‘Community-Based Walking Exercise for Peripheral Artery Disease: An Exploratory Pilot Study’. Vascular Medicine (London, England), vol. 20, no. 4, Aug. 2015, pp. 339–47. PubMed Central, https://doi.org/10.1177/1358863X15572725
- Haas, Tara L., et al. ‘Exercise Training and Peripheral Arterial Disease’. Comprehensive Physiology, vol. 2, no. 4, Oct. 2012, pp. 2933–3017. PubMed Central, https://doi.org/10.1002/cphy.c1100659. Machado, Isabel, et al. ‘Combined Aerobic and Resistance Exercise in Walking Performance of Patients With Intermittent Claudication: Systematic Review’. Frontiers in Physiology, vol. 10, 2020. Frontiers, https://www.frontiersin.org/article/10.3389/fphys.2019.01538