Peripheral Artery Disease: are Exercise Therapy Gains Long-lasting?By: Lindsay Davey, MScPT, MSc, CDT
September 27, 2012
Editors: Ryan Davey, PhD and Lindsay Davey, MScPT, MSc, CDT
Supervised exercise therapy is a commonly prescribed treatment for peripheral artery disease, improving both quality of life and functional capacity. But after exercise therapy ends, do these gains disappear?
Peripheral artery disease is a common condition that is often associated with considerable pain, reduced physical function, and diminished quality of life. Commonly characterized by muscle pain during walking (“intermittent claudication”), it is a chronic and progressive disease caused by a restriction of peripheral arteries in the legs. This leads to reduced blood perfusion and long-term complications including ulceration and gangrene. Treatment for peripheral artery disease typically involves pharmacological interventions to address any underlying atherosclerosis, lifestyle modifications, and supervised exercise therapy. Supervised exercise therapy has been shown to decrease pain and improve walking distance, in part by promoting increased efficiency of oxygen utilization in the affected muscles.
While supervised exercise programs work, are the gains made with them maintained long after cessation of the program? A new paper in the Journal of Disability and Rehabilitation (Guidon, M., and McGee, H. One-year effect of a supervised exercise programme on functional capacity and quality of life in peripheral arterial disease. Disabil Rehabil. 2012 Jul 19 Epub ahead of print) examined patients enrolled in a 12 week supervised exercise program to answer this question. As expected, patients receiving exercise therapy experienced improvements in functional capacity and quality of life that exceeded patients who did not receive exercise therapy. Importantly, at a one year follow-up these benefits were shown to be maintained, with both greater functional capacity and greater quality of life reported in patients who had previously received exercise therapy.
Although this result is not altogether surprising to rehabilitation specialists with experience working with peripheral arterial disease, it is heartening to see empirical evidence of longer-term maintenance of rehabilitation gains. Working at Toronto Physiotherapy I’ve seen first-hand that exercise-induced soft-tissue adaptation is a powerful rehabilitation tool for a variety of conditions, but it is also a double-edged sword. If the underlying issue is not managed, or an appropriate maintenance plan not put in place, a return of symptoms may be inevitable.
I have came across Toronto physiotherapy webpage as I was doing some research regarding my dad’s’ condition, and it seems like PAD is what my dad is experiencing at the moment, occasionally weakness on left leg and couldn’t walk long distance, soreness on his left leg’s side muscle, but surprisingly no pain according to him. He was a stroke patient about 10 years ago, but was able to walk independently all these years (until recent few years he’s been walking slower though with his walking stick). A medical record of diabetes, hypertension and high cholesterol too. I am looking on some physio exercises which could help him improve his current condition, really appreciate if you can share your experience and provide some valueble advice, as we are based overseas. Thank you! :)
Thank you for your post. I’m sorry to hear about your father’s symptoms and recent change in his level of function. The pattern with P.A.D. is fairly consistent, in that pain is experienced when walking, which eases at rest. This “claudication pain” is typically felt in the calf, and can be in both legs or just a single leg. It’s difficult without assessing him to determine if he does indeed have P.A.D., but a visit to his family physician could help illuminate this. Soreness on the outside aspect of the leg that he does not describe as painful, would be somewhat atypical for P.A.D.
Typically how we approach things with our PAD patients, should this end up being his diagnosis, is to do an initial assessment which involves a couple of walking tests (on the ground and on the treadmill), to get a baseline for how soon into a walk their claudication pain onsets, as well as a hands-on assessment of the patient’s feet and legs. Patients are asked to consult with their physician regarding the initiation of an exercise program, since with PAD we want to make sure that the patient’s arterial/cardiovascular status is such that their physician has no concerns about them engaging in a graduated walking program.
We have taken our cues from the research, and from St. Michael’s Hospital’s Vascular Surgery department guidelines (Toronto, ON) as to how to create the individualized walking programs for each P.A.D patient. The research shows that a supervised walking program can be very effective in reducing leg pain significantly, and that results are best if patients do the walking program over a period of 3 months time. For this reason, we typically suggest that after the initial assessment visit and program design, we see these patients at least at the 2,4,6,9, and 12 week marks, for a follow-up visit and to progress them as able. Patients then are recommended to be walking a minimum of 3x per week on their own, with specific guidance from us as to how far/fast/etc, based on our findings from the physiotherapy assessment.
I hope that helps!