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Walking relieves leg pain linked to blocked arteries, study shows

| Sunday, Aug. 4, 2013, 5:21 p.m.

Vickie Powell-Bass could barely walk half a block before the pain became overwhelming.

Fatty plaques had built up in the arteries that supply blood to her legs, a condition called peripheral artery disease that affects as many as 12 million Americans. And as many as 4 million suffer leg pain.

“I was embarrassed,” said Powell-Bass, 60, of Chicago. “I didn't want people to see me barely walking. If I had to stop, I'd try to play it off.”

Most patients with PAD get a stent, which acts like a scaffold to prop open blocked blood vessels, said Alan Hirsch, director of vascular medicine at the University of Minnesota Medical School.

Powell-Bass wasn't crazy about the idea of surgery. But she agreed to enroll in an exercise study at the Northwestern University Feinberg School of Medicine in Chicago.

Participants in the six-month intervention were randomly assigned to walk in their community and attend support group meetings, or to attend health lectures.

Powell-Bass said she can walk at least 10 blocks. “I didn't believe it would work. But now I can do what I need to do without pain.”

After six months, people assigned to the exercise program increased the distance they could walk in six minutes by 138 feet, according to a study of 194 adults released in July in the Journal of the American Medical Association. Those not assigned to exercise — who attended weekly health lectures instead — grew weaker, walking 30 feet less than when they started.

Patients assigned to exercise increased the amount of time they could walk on a treadmill from eight minutes to 9½ minutes.

Those changes may seem small, but they're enough for patients to notice changes, said study author Mary McGrae McDermott, a professor at Northwestern.

Patients' improvements on the treadmill are about equal to the improvement seen in patients prescribed cilostazol, the main medication for PAD, Hirsch says.

Powell-Bass said the support group taught her ways to cope with pain and push through a workout.

“It's better to walk and stop than to stop walking,” Powell-Bass said. “When I feel it, and it gets overbearing, then I stop for 30 seconds, stretch my legs and start again.”

While these findings are encouraging, Hirsch notes that doctors don't yet know if others would enjoy the same benefits. While almost anyone can begin walking around the block, Hirsch notes that the support group was a key part of the study. Without that support and education, others who try to walk to relieve their leg pain may give up.

And while earlier studies of home-based walking for PAD have produced mixed results, McDermott said, her study suggests that doctors should recommend it.

Walking in the community is less expensive than alternatives, including medication, surgery to place a stent in the blocked artery or even bypass surgery to reroute blood flow.

McDermott's study didn't compare these three options to see which was most effective.

Still, other studies have shown that supervised walking on a treadmill — overseen by a personal trainer — improves symptoms as much or more than surgery, says Emile Mohler, director of vascular medicine at the Perelman School of Medicine at the University of Pennsylvania.

While walking may sound like a simple remedy, Hirsch said there are barriers for some patients. Medicare doesn't cover the cost of a supervised walking program. Others may not live near a gym or have transportation there.

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