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Blocked arteries may be causing that leg pain when you walk

Regular exercise helps you walk farther with less discomfort.

Leg pain that starts when you walk for a while but subsides when you rest is the signature symptom of a condition called intermittent claudication. This occurs when fatty deposits in the walls of leg arteries impede the free flow of blood to exercising muscles, depriving them of oxygen. The cramping and pain can strike in the foot, calf, thigh, or buttock, depending on the site of the blockage.

Ironically, walking is the key to relief from the pain of intermittent claudication. “The benefit of walking until you feel pain is that you will be able to walk farther and with less pain,” says Dr. Joshua Beckman, a vascular medicine specialist and associate professor of medicine at Harvard-affiliated Brigham and Women’s Hospital.

Benefits of walking

Intermittent claudication is just a symptom of a more widespread problem: peripheral artery disease (PAD). Its underlying cause is atherosclerosis, or “hardening” of the arteries, which causes most strokes and nearly all heart attacks. About half of those with PAD also experience intermittent claudication.

Avoidance of walking only brings further declines in fitness and more disability. To break the cycle, walk until it hurts, stop until the pain subsides, and then start walking again. The pain is not dangerous unless it doesn’t go away when you rest. “With repeated training, it makes muscles more efficient and better able to use the blood they receive,” Dr. Beckman says. Exercise also lowers the stroke and heart attack risks associated with PAD.

Medications for leg pain from blocked leg arteries

Benefit

Cautions

ACE inhibitor
(captopril, lisinopril, ramipril, others)

Reduces risk of heart attack, stroke, and death. One study suggests ramipril increases walking distance.

May cause dry cough in some people.

Low-dose aspirin or clopidogrel (Plavix)

Lowers the risk of heart attack, stroke, and death. Does not increase walking distance.

Higher risk of bleeding.

Cilostazol (Pletal)

Increases walking distance and reduces pain.

Requires a 3-month trial to see if it works.

Cholesterol-lowering statin drugs (atorvastatin, simvastatin, pravastatin, others)

Several studies suggest these drugs increase pain-free walking time. They also reduce the risk of heart attack, stroke, and death.

Do not increase total walking distance.

What works best?

Medically supervised walking therapy boosts the distance a person can walk on a treadmill by up to 200%. The trouble is that insurance usually doesn’t pay for this service, and people with leg pain face extra hurdles getting to therapy appointments.

Research also confirms that walking on your own boosts endurance—if you do it regularly. “It’s much harder to be motivated to exercise when there’s no one to supervise you,” Dr. Beckman says.

Walking with others

Strive to walk 30 to 45 minutes a day, three to five times per week. For extra motivation, team up with a walking buddy or join the society of “mall walkers” at a local shopping center.

Walking with others helps people with PAD to make significant gains. In a recent study, 200 people with PAD met weekly for group education and to walk together on a track. They were also advised to walk at home on level ground for 50 minutes five times per week.

After six months, the participants could walk 12% farther than when they started, which is considered a significant gain for people with PAD. Meanwhile, people in a comparison group who received counseling but no group exercise were actually able to walk less than when they started.

The study suggests that walking with others exerts a healthy social pressure for everyone to walk more. The benefit depends entirely on how much you walk and how regularly. Dr. Beckman has seen many of his patients double or even triple their walking distances.

The role of medication

Medications may also help to relieve leg pain from PAD, but can’t take the place of exercise. If leg pain is disabling and does not respond to usual treatments, it may become necessary to undergo a surgical procedure to widen the blocked areas of the arteries.

Dr. Beckman says medications and surgical procedures are complementary to walking: each therapy reduces the leg pain from PAD, but none can also claim the extra gains associated with a regular exercise program.

Posted by: Dr.Health

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