The prescription that should be offered first for peripheral artery disease (PAD) is walking, according to a clinical researcher at Brown University, Dr. Robert Patterson. He told Reuters Health that patients are getting too many stents without being encouraged to first take the more conservative approach of walking. His concern is that once a patient receives a stent, they develop other complications which eventually results in a continual need for replacements. Patterson went on to comment that it would be more cost-effective for the health care system if insurance companies would get on board and support preventative measures.
Recently published in the Journal of The American Heart Associatio, were the results of a study called “Home-Based Walking Exercise in Peripheral Artery Disease.” The study was conducted by Dr. Mary McDermott, professor at Northwestern University Feinberg School of Medicine in Chicago. The PAD trial consisted of 194 participants who were divided into two groups for 12 months. One group was instructed to follow a home-based exercise regimen, while the other group received the prescription to do nothing. Initially each participant took a six minute test before the walking program began for the purpose of having a base line for evaluation. They repeated the test at the end of the study. The requirement was to pace up and down a 100-foot long hallway. At the study’s conclusion, those participating in the home-based program were trotting farther and faster, while those who did nothing were not strolling as far as they had previously.
One appeal of the prescription home-based walking program is that patients find it easier to stay with because of the freedom it offers, as opposed to making frequent trips for a hospital-based plan which is more costly. Patients did better with the unsupervised program than those who were previously supervised. In the end, the personalized instruction seemed to be the best remedy, which affirms Dr. Patterson’s view that the best prescription for artery disease is walking.
Peripheral Artery Disease , according to the Mayo Clinic, occurs when the arteries become narrowed due to plaque build-up and reduce the flow of blood to the pelvis area and legs. Physical activity sometimes causes cramping that can be painful in the muscles of the hip, thigh or calf, as well as other notable symptoms such as coldness in lower leg and foot and weakness or numbness in the legs. Although PAD typically affects the arteries in the legs, it can also be problematic in carrying blood from the heart to the head, arms, kidneys and stomach. Over time, plaque limits the flow of oxygen-rich blood. If the blockage is severe enough, it can cause numbness in the limbs and even gangrene, which is tissue death. Leg pain, when walking or climbing stairs, is a warning signal to seek help.
PAD’s number one risk factor is smoking. Smoking increases one’s risk by up to four times. It also increase the risk for coronary heart disease, mini-stroke, stroke and heart attack. The underlying cause of PAD is atherosclerosis, which is plaque build-up, and though serious, it is treatable. Currently treatments include medication, surgery and lifestyle changes.
The National Institutes of Health has documented that one in 20 people over the age of 50 have PAD. The prescription to remain ambulatory could be as simple as lifestyle change through diet and walking – on a treadmill, at the park, on a track or in the neighborhood. Walking is known to do more than just boost circulation; it also stimulates cognitive function, while inactivity is a common denominator in many heart-related diseases. A recent study at the University of Porto in Portugal showed that older hearts do better in people who area active and follow a high fiber diet. In addition, olive oil is a rising star in warding off heart disease, and is known to help flex the arteries.
Dr. Patterson recommends that his patients set aside 40 minutes for walking every day. He is fine with starting out slow, perhaps 15 minutes, but says to work up to 40 minutes daily. Since the home-based study group significantly out-performed the inactive group, Patterson is confident that proof in the study could be translated into the health care model. Trying the conservative approach can save the hospitals and patients money and the benefits could far outweigh the ongoing side effects suffered from medications and stents. Patterson stands firm in recommending that the best prescription for Peripheral Artery Disease is walking.
By Jill Boyer-Adriance