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Disease Information : PAD : Treatment : Exercise Therapy

Exercise Therapy

What is it?

Exercise therapy for intermittent claudication is an individualized exercise prescription (or plan) designed to restore health and prevent further disease. The prescription is written by a doctor or rehabilitation specialist such as a clinical exercise physiologist, physical therapist, or nurse. It takes into account your current medical condition and provides advice for what type of exercise to perform, how hard to exercise, how long, and how many times per week. Therapeutic exercise for individuals with claudication is usually prescibed as sessions that occur three or more times per week, an hour or more per session, for three months.  Click here to print out a "Walking Progress Log" to help you keep track of your time spent walking. 

This requires self-motivation and real time commitment, but such commitment is associated with powerful benefits.

Exercise for claudication is best done in a supervised setting such as a cardiac rehabilitation program and has been shown to relieve leg pain during walking, increase walking distance and time, and improve overall cardiovascular health. It also helps decrease any further build up of cholesterol, assists in weight loss efforts, and helps maintain healthy circulation.

Persons with intermittent claudication have about one half the walking ability of healthy persons of the same age. Some individuals with claudication can walk less than one block before they must stop and rest. Reduced physical activity further aggravates PAD as well as other medical problems such as high blood pressure, obesity, and diabetes.

A program of supervised exercise training is at the cornerstone of treatment for reducing claudication symptoms. The main activity to be performed is walking. A program of exercise can be expected to increase the speed, distance, and duration of walking before symptoms occur. The benefits from exercise occur gradually and become evident over 1-2 months, and continue to increase for 3-6 months and longer. An important goal of rehabilitation therapy for an individual with PAD is to relieve the claudication symptoms, restore exercise capacity, and to reduce cardiovascular disease risk.

More on Exercise Therapy

How is exercise therapy different?

Exercise for claudication is different than exercise advised for many other conditions since exertion to the point of leg pain is required for maximum benefits. The insufficient blood supply that causes the leg pain during walking is also the stimulus for many of the favorable changes that lead to the ability to eventually walk longer. For this reason, exercises that use muscles that do not result in claudication pain are not beneficial for improving claudication symptoms. For example, working out with the arms, would not produce leg pain. Bicycling, which primarily uses the upper thigh muscles, would not typically produce claudication pain of the calf muscle and is not as effective an exercise for improving claudication.

What should be done beforehand?

Because PAD is a form of atherosclerosis, individuals with this condition are also at risk for cardiovascular disease and stroke. Therefore, it is important for individuals who plan to participate in a claudication exercise program to see their physician before starting an exercise program to assure that they can safely participate. The physician will review your cardiovascular health history, perform a thorough physical examination and a resting electrocardiogram, and may recommend that you undergo an exercice stress test on a treadmill.

What happens during an exercise stress test?

During the treadmill test, the electrocardiogram, heart rate, and blood pressure will be monitored.  As well, the time walked until the onset of claudication and the total amount of time that you can walk on the treadmill will be recorded. In addition to measurement of blood pressure in the arms, the blood pressure in the legs may be recorded before and after the walking portion of the treadmill test. All of this information is used to evaluate your walking ability and the condition of your heart. Based on the results of the treadmill test, a change in medications might be needed or additional testing may be recommended. The treadmill test also provides information that will be used to create an exercise prescription that is tailored to your individual needs.

How long should I perform an exercise program?

An exercise workout should be done on a treadmill under medical supervision. If a treadmill-based program is not available, exercise can be effectively performed on a track. Exercise should be performed at least three or more times a week. The starting workload of the treadmill is set at a level that will bring on usual claudication symptoms within 3 to 5 minutes.

Walking continues at this workload until the pain is of moderate severity. On a scale from 1-5, where 1 is mild pain and 5 is very severe pain, a pain level of 3 is the target. After 8 to 10 minutes, there should be a brief period of rest to allow the symptoms to resolve. The exercise-rest-exercise cycle is repeated several times so that a total of 35 minutes of walking is achieved in the first few sessions of the program.

Should I increase my time?

Exercise time should be gradually increased by a few minutes each workout until a total of 50 minutes of walking can be achieved. A good sign that progress is occurring is when the first 8 to 10 minutes of walking can be completed with much less pain. This is also a sign that the workload should be increased so that a moderate level of pain always occurs during walking.

Should I take any other precautions?

A very important precaution is that while moderate pain in the leg is expected and desirable, pain that occurs elsewhere in the body is an indication to stop.

For example, pain that occurs in the chest, arms, neck, or throat could be a sign of insufficient blood flow to the heart. This type of pain should be reported immediately to the medical professional supervising the exercise session and to your personal physician.

Are there other benefits to exercise therapy?

Besides improving the ability to walk, exercise has numerous benefits that also improve the overall health of persons with PAD. Exercise helps maintain an ideal body weight, lowers blood pressure, increases HDL cholesterol (“good” cholesterol), lowers blood glucose (sugar) in persons with diabetes, reduces triglycerides, and improves the overall condition of the heart and blood vessels.


Peripheral Arterial Disease section was last modified: December 21, 2010 - 06:12 pm

All of the medical information contained on VDF's Web site has been written by medical professionals and then peer-reviewed by a multidisciplinary committee who edits the material appropriately.