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Aug 16

Exercise reduces clogged leg arteries – Marquette Mining Journal

Anyone perusing the headlines these days certainly has read a thing or two about heart disease. How could you not, with heart disease being the cause of one-third of all deaths in individuals over 35 years of age. That is a fairly impressive number. Likely, you know someone who has suffered a heart attack or has some kind of heart disease. The type of heart problem most commonly discussed is coronary artery disease, aka CAD, a condition in which the blood vessels that provide the muscles of the heart with blood are clogged or diseased. Statistics from 2016 reveal that 15 million Americans have CAD.

Studies about the latest research on heart disease, and the newest drug treatments, can be seen daily. These stories are hard to avoid. But what exactly is occurring in coronary artery disease? Generally, it is the development of plaque, which are clogs, in the arteries around the heart. But this process of plaque deposition (which occurs to everyone in varying degrees as we age) is not selective of the vessels supplying the heart. On a cellular level, there is nothing special about these arteries.

Atherosclerosis, the process of plaque deposition in an artery, can occur inside the tubes which run down to the legs and feet. This produces an entirely different collection of symptoms from CAD. Unfortunately, although the one most often discussed is that of leg pain when walking (claudication), many people with peripheral artery disease have minimal obvious symptoms.

Classic claudication symptoms include muscle pain or cramping in your legs or arms thats triggered by activity, such as walking, but disappears after a few minutes of rest. This is sometimes referred to as the walk-pain-rest-relief cycle, since the pain reliably develops after walking some specific distance, and resolves with rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location.

The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity. But recent studies have revealed that many with PAD do not experience the usual claudication symptoms. Apparently, a minority of patients with PAD experience classic claudication, with up to 50 percent describing atypical leg symptoms that interfere with mobility. This is big news since many physicians assume that if an individual does not have typical claudication symptoms, they cannot have mild or moderate PAD. According to this well-constructed research, this is not an accurate assumption.

Other symptoms of arterial disease in the leg may include numbness or weakness, coldness of the lower leg or foot (especially when compared with the other side). Also, often noted is a change in the color of the affected leg, as well as hair loss. Additionally, a change in the appearance of the toe nails may be noted, whereby they become thickened and discolored (similar to your classic fungal nail infection). The skin may take on a thin or shiny appearance, and sores on your toes, feet or legs wont heal in a timely fashion. The pulse in your legs or feet may be weak or absent. If the clogging of the arteries is severe, pain may even occur when youre at rest or when youre lying down. It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

People with PAD have a markedly reduced health-related quality of life. Studies have demonstrated a much greater risk of death due to a heart attack, and other heart and cardiovascular events. There is even a higher prevalence of depression. It is now clearly established that PAD accelerates a functional decline leading to physical disability. This is more than just a matter of disease, but also a quality of life issue: individuals with PAD are more sedentary, and have greater physical limitations.

A very important question is whether exercise can be a beneficial therapy. In most cases, lifestyle changes and exercise can slow the progression or even reverse the symptoms of PAD. But how does one go about exercising sufficiently to alter the progression of the disease? A regimented program is necessary to produce these changes, since PAD tends to occur most significantly in those who are sedentary. Thus, an exercise program is an obvious change in lifestyle. While unsupervised home exercise programs can be developed and be effective, a structured, supervised exercise program generally has superior outcomes. Unfortunately (and predictably), rarely is there insurance coverage for these types of programs.

Home-based programs can be beneficial, but are so much more difficult to perform consistently. Studies have demonstrated that they should include several important components. These include monitoring of the exercises and results, and some type of group support system. Also important is the establishment of the desired goals. One of these should be to walk 5 days per week. This may seem like a lot, but its important to make this part of a daily routine something you get into the habit of doing. Start with 10 to 15 minutes of walking per exercise session. Walk until the onset of leg, calf or foot pain. Stopping to rest is completely acceptable. If one can increase the walking time by 5 minutes each week, over time, you really can see improvement.

Experts recommend an increase in walking duration until you are walking at least 30 minutes per session, and preferably 45-50 minutes per session, excluding rest periods. Write down your walking goals, including where and when you will walk, and the duration of walking. This will improve compliance, which can slip when people experience acute illness or family trials and tribulations. As mentioned, it is helpful to have someone to check in with for support. To maintain improvements, you need to understand this must be a permanent program. Unfortunately, if you dont stick with it, you will slide back, and lose those gains you have made.

Surprisingly, even arm exercises can relieve leg pain in people with peripheral artery disease. Instituting an arm exercise program can lead to improved pain-free walking distance and a reduction of PAD-associated complications. Particularly for PAD patients who are quite disabled, walking can be difficult. Arm aerobics may offer a better option than traditional workouts on a treadmill.

Physical disability is a major contributor to morbidity and mortality among older adults, and it also carries a high economic cost for society. A structured exercise program may improve mobility even among the most obese elderly patients. Prior data suggested that obesity blunted the benefits of physical activity for the prevention of mobility disability, but this has been disproven. An exercise program can lead to a healthy, strong body which fights off infection and sickness easier and quicker. Rather than sapping energy reserves entirely, recovery from an illness will take less of a toll on the body if the person exercises regularly.

So now you know: you can reduce your risks for major mobility disability. The benefits of exercise throughout life cannot be proclaimed loudly enough. When performed appropriately, it is safe for even older seniors. Almost all older people can benefit from additional physical activity. Regular exercise can reduce the effects of many chronic diseases including peripheral arterial disease, as well as improving mood and lowering the risk of injury. Dont give up because it looks like the odds are stacked against you.research tells us its never too late to start!

Editors note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.

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Exercise reduces clogged leg arteries – Marquette Mining Journal

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