What is Peripheral Artery Disease (PAD) and is it safe to exercise with it?
Peripheral arterial disease (PAD), also known as Peripheral Vascular Disease is the reduced circulation of blood flow to a body part, other than the brain or heart due to narrow or blocked blood vessels. Arthroscerotic disease most commonly affects the arterial supply of blood flow to the lower limbs, however it may also affect the arteries of the upper limbs too. Physiologically PAD is characterised by atherosclerotic stenosis (narrowing) or occlusion (blockage) of the arteries due to the build up of fatty deposits within the blood vessels reducing blood flow to the working muscles. When these physiological changes occur, it presents in a number of symptoms whilst also affecting an individual’s functional ability and reducing their exercise tolerance.
How common is it?
It is estimated that 3-10% of the general population have PAD, with this number increasing to 15-24% in people aged 70 years and older.
Diabetes, smoking, obesity, sedentary lifestyle, hypertension (high blood pressure), dyslipidemia (elevated cholesterol or fats in the blood).
People with PAD are at an increased risk of cardiovascular events such as heart attack and stroke.
What are the symptoms of PAD?
Intermittent claudication pain is the most common symptom of PAD, which is typically described as a ‘cramp-like’ pain, ache or tiredness affecting the calf and sometimes the thigh and buttocks when walking or other similar activities. Pain typically increases with an increase in exertion and is only relieved by rest. Other symptoms which may present are non-healing skin ulcers, blue or purple tinge to the skin, swelling, coldness of the affected body part, numbness, pins and needles and muscular weakness.
One of the most effective treatments for improving exercise capacity and functional ability is exercise therapy which is recommended as the first line of treatment for those with intermittent claudication pain due to PAD.
Is it safe to exercise with claudication pain?
Claudication pain develops due to the build up of plaque of the inner arteries, therefore narrowing the channel for blood to flow through. During exercise this decrease in blood flow reduces the amount of oxygen that’s received by the working muscles, resulting in leg pain. It is safe to exercise at a moderate intensity with intermittent claudication pain, however exercise should stop if claudication pain becomes severe.
For individuals with PAD, it is recommended to begin with 10-20 minutes of continuous aerobic type exercise 3x per week, and gradually build up to 40 minutes of continuous moderate intensity exercise per session. A long term goal for individuals with PAD would be to meet 150 minutes of aerobic activity each week as recommended for older adults as aerobic exercise leads to significant improvements in pain-free and maximum walking distance.
It is recommended that individuals with PAD engage in resistance based exercise training at least 2 to 3 training sessions per week performing 3 sets of 8-12 repetitions on non-consecutive days. Resistance exercise sessions should be progressive and gradually work towards moderate to high intensity (60-80% of 1 repetition maximum), where it is safe and appropriate ensuring whole body movements are incorporated to increase muscular strength and endurance of individuals.
Benefits of exercising for those with PAD:
Exercise aims to alleviate symptoms, improve functional capacity and reduce the risk of cardiovascular diseases such as heart attack and stroke in those with PAD. Further to this, exercise improves pain-free walking distance, reduces cholesterol, improves blood pressure and muscle morphology, meaning increasing an individual’s ability to exercise tolerance.
Askew, C. D., Parmenter, B., Leicht, A. S., Walker, P. J., & Golledge, J. (2014). Exercise & Sports Science Australia (ESSA) position statement on exercise prescription for patients with peripheral arterial disease and intermittent claudication. Journal of Science and Medicine in Sport, 17(6), 623-629.