Pilot Study Shows Promise for New Exercise Treatment for PAD and Offers Hope for Patients

Walking has been a proven treatment for patients with peripheral arterial disease (PAD), and can make a difference in the lives of many. Recent studies have shown that for some individuals, a structured walking program is excellent for reducing leg pain or cramps, but as the disease worsens, walking can become more and more difficult. In some cases, the leg pain, or claudication, may be so severe that performing everyday tasks such as climbing a flight of stairs or going to the store becomes challenging.

Lois Olson is one of the approximately nine million Americans affected each year in the United States by PAD. One in five people over the age of 70 have the condition. Olson, who is 85, found an ad for a research study funded by the National Institutes of Health (NIH) comparing the benefits of aerobic arm cycling exercise to more traditional treadmill exercise at the University of Minnesota. She signed up immediately to participate in the study. For Olson, the study has offered hope. Her doctors had told her that she was just getting old and that she would have to live with her leg pain.

"I couldn't find any help," said Olson. "My doctor just kept saying, 'Well, Lois, you just have to keep doing what you're doing.' But I never thought it was enough."

The current NIH-funded study follows a pilot study that tested the benefits of "arm cycling" (arm-ergometry) compared to walking on a treadmill, and the results have shown signs of hope for patients with PAD. During this study, each member participated in either supervised arm cycling or treadmill walking for an hour three times per week for a total of 12 weeks. Each participant's walking ability was tested before and after 12 weeks of supervised exercise training and also after 12 weeks of follow-up to see if there was any improvement. After 12 weeks of exercise training, all exercise groups improved their walking ability, with 53 percent improvement in the arm group and 69 percent improvement in the treadmill group. The arm exercisers also showed the most improvement (82 percent) in how far they could walk before their leg pain (claudication) symptoms started. The arm cyclers also showed an 11 percent decrease in resting blood pressure, while the others did not.

"We are not yet sure how or why the arm cycling exercise is working, but participants on the whole are not only showing improvement in their ability to walk, but also showing improvement in overall health measures such as lower blood pressure," said Diane Treat-Jacobson, PhD, RN, Associate Professor in the School of Nursing at the University of Minnesota, and Principal Investigator for the studies. "We know overall that exercise has many health benefits, and arm-cycling seems to have a systemic effect on the arteries throughout the body, even the legs."

With the first study showing such promising results, a second study, The EXERT Study, "Exercise Training to Reduce Claudication", funded by the NIH, has been launched with a larger sample size as well as additional measurements to try to understand why the arm exercise helps improve walking. As this study gets underway, Treat-Jacobson is hopeful about the potential results.

"We're going to be able to partially identify the mechanism of improvement, which will lead us to better understand what intervention might be best for which individuals," says Treat-Jacobson.

About the Author: Diane J. Treat-Jacobson, PhD – Associate Professor School of Nursing, University of Minnesota. She has been conducting studies on exercise interventions and quality of life in patients with PAD for the past decade and is a strong advocate for increased awareness, early detection and better treatment for patients with PAD.