Exercise and Peripheral Artery Disease

Posted on by Jesse Santiano, M.D.

This article is about how Peripheral Artery disease. What it is, why it happens, what the effects are, and what to do about it.

Peripheral Artery Disease (PAD) is the hardening of the arteries that supply the legs. It is part of the more systemic problem, Peripheral Vascular Disease (PVD), which is the hardening and blockage of the arteries, veins, and lymphatics outside the heart and brain.

PVD and PAD affect many people, especially the elderly, but they can start at a much younger age.

What happens to the arteries in Peripheral Artery Disease?

Normal arteries are elastic and rubbery. The blood from the heart comes in waves. You can feel it when you feel your pulse on the wrist and the neck. The arteries have to expand as each wave comes to accommodate the flow. The arteries’ expansion creates potential energy that becomes kinetic energy as it helps push the blood downstream when it contracts again to resume its shape.

Normal arteries lessen the work of the heart as it helps push the normal flow of blood.

The inside lining of the arteries or endothelium is prone to injuries. Long-standing high blood sugar, high-fat diet, and smoking are the common causes.

The endothelium can repair itself, but if the damage is recurring, the injuries pile up, and the repair process becomes a disease called atherosclerosis. Atherosclerosis blocks the blood flow and makes the arteries and other blood vessels stiff.

Stages of Atherosclerosis

Causes of Peripheral Artery Disease

  • Diabetes
  • Smoking
  • Age more than 50 years
  • Sedentary lifestyle
  • Being overweight or obese
  • Hypertension
  • High LDL cholesterol levels, high triglycerides, and low HDL

Effects of Peripheral Artery Disease

Organ dysfunction and failure – the lack of blood supply to an organ like the kidney or intestines can lead to kidney failure or bowel ischemia. All organs require an adequate supply of blood to meet the demands of their function. Blood carries oxygen, antioxidants, and immune cells that help repair and replace any damaged or old cells.

Gangrene is when a body part completely loses its blood supply and dies. The feet are the ones usually affected. Gangrene is managed by amputation since the feet or toes by that time have no chance of recovery.

Nerve damage or neuropathy can happen in PVD since the small nerves also depend on an adequate blood supply to continue their normal function. The result can be chronic pain, an unusual sensation of the feet or fingers like needles poking them all the time, and loss of sensation or numbness.

Numbness can lead to a minor injury to the feet, go unnoticed, and progress to a larger and deeper infection involving the bone. A condition called osteomyelitis.

Eye problems. The small blood vessels of the retina can also get damaged. A study has shown that people who had abnormalities in the eye’s small vessels have double the odds of developing PVD and almost 3.5 times the odds of developing critical blood supply loss to the limbs.

Lack of awareness about an injury resulting from poor eyesight and the feet numbness can make a minor skin injury worsen and spread to the muscles and bones.   This raises the chance of gangrene.

Symptoms of Peripheral Vascular Disease

Toenail fungus – the limited blood flow prevents the body’s normal fungus fighting cells from reaching the toes.

Skin changes of the legs – thin, shiny skin, hairless legs, and decreased skin temperature. The changes happen as the body diverts the blood from the skin to the working muscles.

Leg pain happens initially with walking. Diseased arteries cannot provide the increased blood that muscle activity demands. Painful substances are produced that produce pain. The pain acts as a defense mechanism to stop walking to prevent further damage to the legs.

Weakness or heaviness of the legs is due to decreased muscle fibers’ size and increased fat content. The mitochondria of the muscle cells cannot produce enough ATP or fuel. This leads to oxidative damage and a lack of energy.

Burning and aching of the toes at rest and night are due to nerve damage.

Impotence. Healthy blood vessels are essential for penile erection. Vascular disease happens simultaneously all over the body. That is why impotence is also a sign of heart disease. Read: Erectile Dysfunction is a Sign of Coronary Artery Disease

Wounds that take too long to heal.

Paleness of the legs when elevated

Exercise for Peripheral Vascular Disease

Studies have shown that exercise improves peripheral arterial disease. Supervised walking with a physical therapist is one method to get started. 

You can do ten minutes of walking exercise at the initial sessions.

The duration of activity can be increased by 5 min each week until the
PAD patients can walk at least 30 min/session.

People who can walk for more than 30 min/session should be encouraged to increase their walking exercise duration to 45 to 50 min/session. 

The walking frequency should at least be 5 times/ week.

Pole striding or Nordic walking is a way to do a total body workout while walking. It involves the use of specialized poles and helps with walking uphill and downhill.

The poles also help balance and add additional exercise to the upper limbs and the chest, the whole back, and abdominal muscles.

The walk’s intensity should be enough to produce some discomfort in the legs and require frequent rest.

How does Walking improve PAD?

The discomfort while walking in a person with PAD is a sign that working muscles are not getting enough blood. The pain triggers growth factors like vascular endothelial growth and hypoxia-inducible factor-1  alpha.

Walking increases the blood flow across the arteries and veins and causes shear stress. Shear stress is the expansion and relaxation of the arteries as the flow of arterial blood passes thru.

The shear stress makes the cells lining the inside blood vessels or endothelium produce nitric oxide.

Together, the growth factors and nitric oxide increase collateral blood vessel formation and enlargement of the arteries with exercise stimulation.

Related: The Magical Endothelium

Muscles need a power source to contract. The mitochondria in the muscle cells supply that power. Walking increases the production of more mitochondria and results in more energy supply.

Frequent walking suppresses chronic inflammation.

Overall, walking enhances oxygen delivery, improves the muscles and blood vessels’ workings, delays the disease’s progression, and extends longevity.

Other things you can do about Peripheral Vascular Disease and Peripheral Arterial Disease

  1. If you have the symptoms, talk to your doctor, and they may run some tests to verify the diagnosis of PVD. Ask about a need for a cardiac stress test.
  2. Quit smoking. Read: How Effective is Quitting Cigarettes?
  3. Take statins is prescribed.
  4. Blood thinners like aspirin and others may be prescribed to you by your doctors to thin the blood and prevent blockage.

Lastly, if PAD is a symptom of arterial disease all over the body, the benefits gained with walking are not limited to the legs but also the whole body, including the blood supply to the heart and brain.

It is also a lifelong healthy activity.

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Related readings:

  1. High Blood Sugar, Even for a Short Period, Causes Atherosclerosis
  2. How Effective is Quitting Cigarettes?
  3. Physical Activity Correlates with Life Span
  4. The Good and Faithful Servant
  5. Exercise as a Solution to Erectile Dysfunction
  6. The Magical Endothelium

 

References:

  1. Exercise Rehabilitation in Peripheral Artery Disease: Functional Impact and Mechanisms of Benefits Naomi M. Hamburg, Gary J. Balady. Circulation. Author manuscript; available in PMC 2012 Jan 4. Published in final edited form as Circulation. 2011 Jan 4; 123(1): 87–97. doi: 10.1161/CIRCULATIONAHA.109.881888
  2. Exercise Training and Peripheral Arterial Disease. Tara L. Haas, Pamela G. Lloyd, Hsiao-Tung Yang, Ronald L. Terjung. Compr Physiol. Author manuscript; available in PMC 2013 Oct 1. Published in final edited form as Compr Physiol. 2012 Oct; 2(4): 2933–3017. doi: 10.1002/cphy.c110065. PMCID: PMC3767482
  3. EXERCISE REHABILITATION FOR PERIPHERAL ARTERY DISEASE: A REVIEW
    Mary M. McDermott. J Cardiopulm Rehabil Prev. Author manuscript; available in PMC 2019 Mar 1. Published in final edited form as J Cardiopulm Rehabil Prev. 2018 Mar; 38(2): 63–69. doi: 10.1097/HCR.0000000000000343. Correction in: J Cardiopulm Rehabil Prev. 2018 Sep; 38(5): 347. PMCID: PMC5831500

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