Long walks through his hilly Pittsburgh neighborhood became frightening for Jagdish Bhatnagar when his left calf started to hurt so much he had to rest on the side of the road. Diagnosed in early 2021 with peripheral arterial disease (PAD), the 83-year-old retired medical physicist knew blocked blood vessels in his leg were the cause of his severe cramps.
But Bhatnagar did not undergo surgery or take medication for his condition. Instead, he participates in a supervised exercise therapy (SET) program that helps him overcome his pain on a treadmill three times a week while being monitored by a nurse or other healthcare professional. .
Since Medicare’s decision to cover SET in 2017, this PAD treatment has slowly spread in the United States. Studies show that SET can help people like it to walk longer and more comfortably.
“I feel like I’m rejuvenated with this exercise,” Bhatnagar says. “Before, I felt like a sick person. But now I feel like I’m getting healthy.
How exercise helps
Treadmill walking, the primary form of exercise therapy included in SET programs, is the gold standard for improving the main symptom of PAD, called claudication. Limping is the pain and cramps in the calf, thigh, or buttocks that occur while you walk because too little oxygen reaches the muscles in your legs.
“Basically, walking improves the way muscles use oxygen or helps develop more blood vessels to increase oxygen supply,” says Mark Jordan, senior clinical exercise physiologist who leads the SET sessions at University of Pittsburgh Medical Center in Pennsylvania. Translation: It improves circulation to the leg.
A typical SET program consists of up to 36 sessions over 12 weeks, each lasting 30 to 60 minutes.
You first do a walk test to measure how long and how fast you can walk until you feel pain in your leg. Your team will then tailor the SET sessions to your abilities, mixing periods of walking and rest depending on your symptoms. As you improve, your therapist will adjust your treadmill settings to increase speed, incline, and walk time, Jordan says.
“We use a pain scale of 1 to 5 for patients to rate their pain while walking,” he says. “Once they are 4 years old, we make them stop and sit down. They wait for their pain to go away, then leave. They continue to do this several times until they walk for a total of 60 minutes.
Some SET programs are mixed with other forms of exercise. These can include an ergometer – a bike that you pedal with your arms – as well as a stationary bike, rower, and weights for the arms and legs. SET programs also teach you about the disease itself and about healthy eating to improve your risk. (Some SET programs include a nutritionist on the medical team.)
“Really, any movement has proven to be beneficial,” says vascular surgeon Oliver Aalami, MD, associate professor of clinical surgery at Stanford University. “But, if you are trying to improve your discomfort with walking, then walking is best. You use different muscles when you cycle, for example, so it won’t always translate into pain relief. legs in PAD.
Embrace the pain
Research shows that SET programs work as well as more invasive PAD treatments, such as surgery to place a cage-like stent in your leg to support open blood vessels. The program may also lower your risk for other major conditions, such as a heart attack or stroke. This is why SET is one of four non-surgical treatments for PAD recommended and used to measure quality of care by the American College of Cardiology and the American Heart Association.
Compared to exercise alone, supervised exercise also offers several other advantages, explains Jordan. On the one hand, it holds you accountable, helping you stick to a course plan even if you’re tempted to slack off. In-person exercise therapy also means that a healthcare professional will monitor you for changes in your heart rate and blood pressure.
“We are not only able to guide and educate patients, we can push them a little beyond their comfort zone until they reach a mild to moderate level of pain, which they need to gain an advantage, ”Jordan said.
This is because although pain is normally the body’s signal to stop doing something, this symptom is expected and even necessary to successfully treat PAD through exercise.
“It’s okay to feel calf pain,” says Aalami, who notes that it can naturally discourage people from doing what’s right for them. But education about the benefits – and knowing what to expect – can help you overcome the discomfort.
People with PA “should expect leg pain,” Jordan agrees. “We always make sure they know that up front. Sometimes we have to accompany them and reassure them that they are safe.
One barrier to participating in a formal SET program is that you might have a hard time finding it near you. Ask your doctor if SET treatment is available in your area.
“So far, private insurance seems to cover it,” Jordan said. “Most of our patients have Medicare, but there are so many different plans. It is always best to call and check with your insurance provider to see if it is covered.
Virtual options to come
Doug Giller of Lansing, MI, does not have a SET program nearby. But the 63-year-old was able to participate in a pilot test of a new mobile phone app that will offer the option virtually. Developed by the Society for Vascular Surgery, the app also includes telephone consultations with a healthcare professional.
Giller, a grandfather of eight, was diagnosed with PAD in 2019 after feeling pain “like someone kicked you” in his right calf while walking. The self-proclaimed “type A personality” began a daily hour-long walking routine around his big house which he followed for over 2 years with his app.
“I received a new carpet last year and can almost see a path through it,” says Giller, a retired electrician. “It’s like a race track now. “
Aalami, one of the developers of the app, said the Society for Vascular Surgery would enroll its first 10,000 people with PAD on the SET app and then apply for insurance coverage.
Thanks to SET, Bhatnagar no longer feels pain in his leg while walking. He happily walks the hills and valleys of his neighborhood. “I don’t have that fear anymore – I’m just leaving,” he said. “It’s fantastic.”
Giller, on the other hand, still feels pain. But he sees this as a reminder to continue.
“It is nothing like the pain when I first started,” he says. “I’m making new paths for my blood to flow to my leg. “
Giller avoided surgery, and his doctor says the blockage in his right leg has improved enough that he doesn’t recommend surgery for the stents.
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