Walking may be the best place to start.
Fatty blockages in the leg arteries can cause pain in the thigh or calf muscle that occurs when walking and disappears with rest. Pain occurs when the blockages restrict blood flow to the working leg muscles. This condition is called intermittent claudication, and it can become disabling.
At the point when leg pain prevents a person from walking very far, treatment may include medication, exercise, or a procedure to restore blood flow. Harvard doctors recommend starting with walking.
“Exercise makes your muscles more efficient and improves your overall condition,” says vascular specialist Dr. Joshua Beckman, an associate professor of medicine at Harvard Medical School.
In order to obtain benefit from walking, Dr. Beckman says you need to spend 30 to 50 minutes walking three to five times a week. This may be difficult at first, but it should become easier over time. Stop when you feel pain in your legs, rest until the pain resolves, then start walking again.
Although you can walk anywhere, Dr. Beckman recommends using a treadmill in a gym where you can be supervised. “This may help prevent you from making excuses not to exercise,” he says.
If you are unable to walk a short distance or perform your regular daily activities, it may be time to consider undergoing a revascularization procedure to restore blood flow. There are two choices. One involves inserting a plastic tube (catheter) tipped with a balloon into the leg artery. The balloon is inflated to open the narrowing, and a small mesh tube is inserted to hold the artery open. The other choice is a surgical bypass procedure that reroutes blood around the blockages.
At this time only one drug—cilostazol (Pletal)—is approved for the treatment of intermittent claudication. It is not as effective as exercise or revascularization alone, but can be combined with exercise to increase the distance that can be walked before leg pain begins.
ACE inhibitors (a type of blood pressure medication) may be much more effective than cilostazol. A study in the Feb. 6, 2013, Journal of the American Medical Association found that people who took the ACE inhibitor ramipril (Altace) for six months could walk significantly longer and farther without feeling pain than those who took the placebo. Dr. Beckman says these results will be a “game-changer,” if they can be repeated in another study. He expects ACE inhibitors will be added to the treatment guidelines for intermittent claudication.
And there’s even better news for people with intermittent claudication: the benefits of ACE inhibitors go far beyond helping people walk farther.
“There is evidence that people with peripheral artery disease given ACE inhibitors experience a significant reduction in risk of heart attack and stroke. So even if ACE inhibitors didn’t improve walking distance, I would use them anyway,” says Dr. Beckman.