By Carolyn Crist
(Reuters Health) - Discomfort in the calf and upper legs during walking is a hallmark of narrowed blood vessels due to heart disease, but walking more - not less - can help ease the pain, experts say.
This type of pain comes from intermittent claudication, when too little blood reaches the muscles, and it is usually a sign that blood vessels in the legs are clogged by atherosclerosis, a condition known as peripheral artery disease.
Research shows that a supervised exercise program can help, and should be the first treatment tried, a group of exercise and rehabilitation experts writes in a new infographic.
If a supervised program isn't available, patients can follow a walk-rest-walk pattern on their own, which the authors illustrate in the British Journal of Sports Medicine.
"The condition is underdiagnosed and undertreated despite it being common and associated with mobility limitation and an increased risk of heart attack, stroke, amputation and death," said coauthor Garry Tew of Northumbria University in Newcastle, UK.
"The public is not well informed about peripheral artery disease or its main symptom of intermittent claudication," Tew told Reuters Health by email. "Clinical guidelines recommend exercise as a first-line approach."
Intermittent claudication affects about 4% of people over age 60 and is the most common symptom of peripheral artery disease, according to the UK's National Institute for Health and Care Excellence (NICE). It leads to impaired quality of life and increased risk of death from heart attack and stroke.
NICE guidelines recommend a three-month supervised exercise program to reduce pain, improve heart health, boost mood, improve sleep, maintain a healthy weight and ultimately lower the need for vascular procedures on the legs, such as clearing blood vessels and placing a stent.
Supervised exercise classes have shown the greatest benefits, the authors write, and patients should feel comfortable asking their doctor what's available locally.
"There is good quality research evidence showing that it can improve walking ability and quality of life," Tew said. "Some types of exercise are more effective than others, so it is useful to highlight the type that will benefit patients the most."
If a program isn't available, patients can exercise on their own, alternating between walking for 3 to 10 minutes until moderate-to-strong pain develops, resting until the pain subsides, and then walking for 3 to 10 minutes again.
Patients should aim to complete 30-60 minutes of walking per session, according to the infographic, and three to five sessions per week. On at least two days per week, they should also incorporate strength and balance activities, such as yoga, dance, tai chi, bowling or lifting weights at a gym.
The experts also recommend wearing comfortable clothing and staying hydrated. In addition, they say, choose walking routes with resting places, exercise with others and build in variety to keep the walking routine fun. Of course, don't exercise if unwell, and seek medical advice if chest pain, dizziness or sickness occurs during walking.
Overall, the exercise researchers write, don't fear walking with leg pain, and build up the walking speed and time gradually. It typically takes several weeks of exercise to improve symptoms.
"It may take a while to achieve significant improvements after you have started exercising or walking, so be patient," said Ukachukwu Abaraogu of Glasgow Caledonian University in the UK. Abaraogu, who wasn't involved with the infographic, researches intermittent claudication and chronic diseases.
"Be intentional about exercising and aim to do it for 30-60 minutes per day several times a week," he told Reuters Health by email. "But do not be afraid to start, even if you cannot achieve this at the beginning."
SOURCE: https://bit.ly/2PspCGb British Journal of Sports Medicine, online February 12, 2020.