Long walks in his hilly Pittsburgh neighborhood became frightening for Jagdish Bhatnagar when he left calf so started getting hurt, he had to rest along the way. Diagnosed early in 2021 with peripheral artery disease (PAD), the 83-year-old retired medical physicist knew blocked blood vessels in his leg were causing his serious cramps.
But Bhatnagar did not have or have undergone surgery medication for his condition. Instead, he participates in a supervised exercise therapy program (SET) that helps him push past his ache on a treadmill three times a week while being monitored by a nurse or other medical professional.
Since Medicare‘s 2017 decision to cover SET has slowly captured this PAD treatment across the US. Studies show SET can help people like him walk longer and more comfortably.
“I feel I am being rejuvenated with this exercise, ”Says Bhatnagar. “Before, I felt like a sick person. But now I feel I am getting well. ”
How exercise helps
Treadmill walking, the main form of exercise therapy included in SET programs, is the gold standard for improving PAD’s main symptom, called claudication. Claudication is the pain and cramps in the calf, thigh or buttocks that occur while walking because too little oxygen reaches your leg muscles.
“Basically, walking improves the way muscles use oxygen or helps develop more blood vessels to increase the supply of oxygen,” says Mark Jordan, a senior clinical exercise physiologist who leads SET sessions at the University of Pittsburgh Medical Center in Pennsylvania. Translation: It improves circulation to the leg.
A typical SET program includes up to 36 sessions over 12 weeks, each lasting 30-60 minutes.
You first take a step test to measure how long and fast you can walk until you feel pain in your leg. Your team will then adapt SET sessions to your abilities, and mix periods of walking and rest based on your symptoms. As you improve, your therapist will adjust your treadmill settings to increase speed, steepness, and time step, Jordan says.
“We use a pain scale of 1 to 5 for patients to assess their pain while walking,” he says. “As soon as they reach 4, let’s stop them and sit down. They wait for their pain to go away, and then go again. They do this several times until they have walked for a total of 60 minutes. ”
Some SET programs mix in other forms of exercise. This could include an ergometer – a bike you pedal with your arms – as well as a stationary bike, rowing machine and arm and leg weights. SET programs also teach you about the disease itself and about healthy eating habits to improve your risks. (Some SET programs include a nutritionist on the medical team.)
“Really, any movement has shown it to be beneficial,” says vascular surgeon Oliver Aalami, MD, a clinical associate professor of surgery at Stanford University. “But if you try to improve your discomfort with walking, then walking is best. You do use different muscles when you ride a bike, for example, so it will not always ‘translate’ into leg pain lighting in PAD. ”
Embrace the pain
Research shows that SET programs work just 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 can also reduce your risks of other major conditions, such as a heart attack or stroke. Therefore, SET is one of four non-surgical treatments for PAD recommended by the American College of Cardiology and the American Heart Association and used to measure the quality of care.
In comparison with exercise on your own, supervised exercise also offers several other benefits, Jordan says. For one, it keeps you accountable and helps you stick to a walking plan, even if you are tempted to relax. Personal exercise therapy also means that a medical professional will monitor you for changes in your heartbeat and blood pressure.
“Not only are we able to guide and educate patients, we can push them a little out of their comfort zone until they reach a mild to moderate level of pain, which is what they need to gain an advantage. reach, “says Jordan.
Indeed, although pain is usually the body’s signal to stop doing something, this symptom is expected and even necessary to treat PAD successfully through exercise.
“It’s okay to experience calf pain,” says Aalami, who notes that it can understandably discourage people from doing what is good for them. But educating yourself about the benefits – and knowing what to expect – can help you work through discomfort.
People with PAD “should expect pain in their leg,” Jordan agrees. “We always make sure that they know this in advance. We sometimes have to coach them through it and assure them they are safe. ”
One obstacle to participating in a formal SET program is that you may struggle to find it near you. Ask your doctor if SET treatment is available in your area.
“So far, private insurance it seems to cover, ”says Jordan. “Most of our patients are on Medicare, but there are so many different plans. It’s always best to call and check with you insurance provider to see if it is covered. ”
Virtual options coming soon
Doug Giller of Lansing, MI, does not have a SET program nearby. But the 63-year-old was able to take part in a pilot test of a new mobile app that will virtually offer the option. Developed by the Association for Vascular Surgery, the application also includes telephonic consultations with a medical profession.
Giller, a grandfather of eight, was diagnosed with PAD in 2019 after suffering pain “like someone kicked you” in his right side calf while walking. The self-described “Type A personality” started an hour-long daily walking routine around his big house that he maintained with his app for over 2 years.
“I got a new rug last year, and I can almost see a path through it,” says Giller, a retired electrician. “It’s like a racetrack now.”
Aalami, one of the application’s developers, says the Association for Vascular Surgery enrolls its first 10,000 people with PAD on the SET application and will then search insurance coverage.
Thanks to SET, Bhatnagar no longer feels pain in his leg while walking. He happily pulls up the hills and valleys in his neighborhood. “I no longer have that fear – I’m just going,” he says. “It’s fantastic.”
Giller, on the other hand, still feels pain. But he sees it as a reminder to keep going.
“It’s nothing like the pain when I first started,” he says. “I make new paths for myself blood to flow to my leg. ”
Giller avoided surgery, and his doctor says the blockage in his right leg has improved enough that he would not recommend surgery for stents.