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Peripheral artery disease: Walking the walk with structured home exercise

The Bottom Line

  • Peripheral artery disease (PAD), a type of cardiovascular disease, is characterized by the narrowing of the arteritis due to plaque build-up, and as a result, reduces blood flow to affected areas of the body.
  • This disease can impact physical functioning, increase cardiovascular issues, and reduce quality of life. 
  • Structured home exercise programs can increase walking distance and levels of physical activity in people with peripheral artery disease in their legs. 
  • Speak with your health care provider about developing a structured exercise program that you can follow at home. Consider your individual condition, physical limitations, and safety.    

Globally, disorders that impact blood vessels and the heart, known as cardiovascular diseases (CVDs), contribute to nearly 18 million deaths every year. One condition that also belongs under the umbrella of CVD but that may not always be front and centre is peripheral artery disease or PAD (1).


PAD is a condition caused by the accumulation of plaque in the arteries. This build-up triggers the narrowing of these arteries, thereby decreasing the flow of blood to affected areas of the body (2). The legs are a common site where PAD occurs (2;3). People with PAD experience the disease differently when it comes to symptoms and complications. Some may have no symptoms, whereas others may deal with mild or severe symptoms—such as pain in the legs when physically active (2-5). Symptoms like leg pain can lead folks with PAD to become less active, further diminishing their heart health (3;6-8). The ability to perform activities of daily living may also be affected, and in severe cases, amputation may become necessary. Together these issues set the foundation for a reduced quality of life among people with PAD (4).


Currently, a recommended treatment option is engaging in exercise, namely facility-based supervised exercise programs (3;9). However, even outside of a pandemic, there are many barriers to accessing such programs including the lack of widespread availability of programming (3;10), remote or rural living, mobility issues, and challenges around transportation. 


Can such barriers be overcome? Let’s turn to a recent systematic review investigating whether structured home exercise is an effective option for people living with PAD in their legs (3).


What the research tells us

Within the review, home exercise programs generally included: walking as a form of physical activity; contact with a professional—psychologist, counsellor, or exercise specialist—for motivation; and recommendations to exercise three to five times a week. The treadmill test (i.e., walking performed on a treadmill) and the 6-minute walking test (i.e., the distance a participant is able to walk over six-minutes) were used to measure walking performance, while accelerometers or pedometers were used to measure activity levels.


The results show small but statistically significant improvements in the maximum distance walked and the distance walked before experiencing leg pain in people with PAD in their legs who engage in structured home exercise programs, compared to those not exercising. Physical activity levels also went up. All of these enhancements were seen over the short-term (6 months or less).


For those with leg PAD who can’t access a supervised exercise program or prefer non-facility based exercise, speak with your health care provider (e.g., physician, vascular specialist, cardiologist, etc.) about whether a structured home exercise program is the next best option for you. Work with your provider to develop a program that takes into consideration your limitations, individual needs, and safety.


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References

  1. World Health Organization. Cardiovascular diseases (CVDs). [Internet] 2017. [cited February 2021]. Available from https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases
  2. Mayo Clinic. Peripheral artery disease (PAD). [Internet] 2021. [cited February 2021]. Available from https://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/symptoms-causes/syc-20350557 
  3. Golledge J, Singh TP, Alahakoon C, et al. Meta-analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease. Br J Surg. 2019; 106:319-331.
  4. Khan MS, Zou F, Khan AR, et al. Meta-analysis comparing endovascular treatment modalities for femoropopliteal peripheral artery disease. Am J Cardiol. 2020; 1:181-188. doi: 10.1016/j.amjcard.2020.05.015.  
  5. Dumville JC, Lee AJ, Smith FB, et al. The health-related quality of life of people with peripheral arterial disease in the community: The Edinburgh Artery Study. Br J Gen Pract. 2004; 54:826-831.
  6. McDermott MM, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease: Associated clinical characteristics and functional impairment. JAMA. 2001; 286:1599-1606.
  7. McDermott MM, Liu K, Greenland P, et al. Functional decline in peripheral arterial disease: Associations with the ankle brachial index and leg symptoms. JAMA. 2004; 292: 453-461.
  8. Morris DR, Rodriguez AJ, Moxon JV, et al. Association of lower extremity performance with cardiovascular and all-cause mortality in patients with peripheral artery disease: A systematic review and meta-analysis. J Am Heart Assoc. 2014; 3:e001105.
  9. Aboyans V, Ricco JB, Bartelink MEL, et al. Editor’s Choice – 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018; 55:305368.
  10. Makris GC, Lattimer CR, Lavida A, et al. Availability of supervised exercise programs and the role of structured home-based exercise in peripheral arterial disease. Eur J Vasc Endovasc Surg. 2012;44: 569-575.

DISCLAIMER: Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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