October 13, 2023

A New Hope for PAD Patients: Home-Based Walking Exercises Outshine Supervised Treadmill Workouts

Imagine the joy of taking a leisurely walk in the park, feeling the gentle breeze on your face, and enjoying the simple pleasure of moving without pain. For millions of people worldwide battling Peripheral Artery Disease (PAD), this seemingly ordinary activity has been elusive, overshadowed by leg pain, cramps, and the frustrating struggle to walk. 

However, a groundbreaking study, published in JAMA Network Open on September 21, 2023, has challenged the conventional approach to exercise therapy for patients with peripheral artery disease, potentially offering a game-changing solution.

Understanding peripheral artery disease and claudication

Peripheral Artery Disease, or PAD, is a widespread cardiovascular condition affecting approximately 236 million people globally. It occurs when cholesterol-laden plaque clogs the arteries supplying blood to the legs and feet, causing discomfort and cramping, especially during physical activity. While some individuals with PAD may experience no symptoms, others face the classic challenge of intermittent claudication—leg pain, cramps, numbness, weakness, or tingling during walking.

Treatment for peripheral artery disease

For many years, doctors have been recommending supervised treadmill exercise as the primary therapy for peripheral artery disease. These supervised exercise programs, often conducted in hospital settings, have shown remarkable effectiveness in improving exercise capacity, reducing symptoms, and enhancing overall cardiovascular health. 

However, they come with their share of challenges, including limited accessibility, issues with reimbursement, transportation hurdles, and patient motivation. Even the Centers for Medicare & Medicaid Services (CMS) requires a co-pay in order to approve supervised exercise therapy.

Despite their proven benefits, supervised exercise therapy (SET) programs remain underutilized and often fail to engage patients in the long term. In fact, they may not be suitable for everyone, with some individuals experiencing a lower response to the treatment, especially those with more severe disabilities.

The recent paradigm shift comes in the form of structured home-based (SHB) exercise programs, carried out in the comfort of the patient’s own environment. These programs aim to break down the barriers to exercise, such as the availability of specialized facilities and financial constraints. Moreover, they address the inconvenience associated with travel and the obligatory co-pay required for supervised treadmill exercise.

Current research

In this new approach, patients having peripheral artery disease engage in home-based walking exercises, which, according to a study led by Thangada et al published in 2023, have shown remarkable promise. 

The home-based regimen involves walking in or around one’s home for up to five days a week, starting with 15-20 minutes a day and gradually increasing to 50 minutes. On the other hand, supervised treadmill exercise requires three sessions a week for up to 50 minutes, conducted under the guidance of an exercise physiologist at a specialized exercise center.

The study’s results were nothing short of remarkable. Both home-based walking and supervised treadmill exercise led to significant improvements in the six-minute walk distance (6MWD) compared to non-exercise controls. The 6MWD increased by 50.7 meters with home-based walking and by 32.9 meters with supervised treadmill exercise, both statistically significant improvements.

Supervised treadmill exercise vs. Home-based walking

However, the true revelation was in the comparison between the two exercise programs. Home-based walking outperformed supervised treadmill exercise in terms of improving 6MWD, with a remarkable between-group difference of 23.8 meters, favoring the home-based approach. Similar trends were observed in the Walking Impairment Questionnaire walking speed score, highlighting the potential of home-based exercises to provide a more effective solution.

Despite these impressive findings, it’s essential to note that there was significantly less improvement in maximum treadmill walking distance with the home-based approach. While this may raise questions, it underscores the complexity of peripheral artery disease management and the need for personalized treatment plans.

These findings support home-based walking exercise as a first-line therapy for walking limitations in peripheral artery disease,” write the authors of the study. This strategy not only yields promising results but also addresses the most common barriers that deter individuals from participating in supervised treadmill exercise, including travel inconveniences, facility availability, and financial considerations.

Dr. Mohler, a key figure in the field of peripheral artery disease research, emphasizes the importance of this discovery. While other activities like bike riding or swimming haven’t been extensively studied in PAD patients, the study’s results highlight only the unique benefits of walking. However, he cautions that the same benefits may not necessarily extend to other forms of exercise.

It’s crucial to approach any exercise regimen with caution, especially when dealing with a condition like peripheral artery disease. Before embarking on a new exercise routine, always consult your vascular specialist. They can provide personalized guidance tailored to your specific health status and needs.

Final Thoughts

One vital message resonates from this research: improving your ability to walk with peripheral artery disease is not an overnight journey. Just as the condition took time to develop in your legs, it will take patience, dedication, and time to see significant improvements. Dr. Mohler advises, “It’s important to be patient with yourself.” If you suspect you or a loved one has peripheral artery disease, don’t hesitate to reach out to a vascular expert who can guide you through the process of starting a walking program. 

In conclusion, the traditional approach to treating peripheral artery disease is undergoing a transformative shift. Home-based walking exercises are emerging as a powerful and accessible therapy, offering newfound hope and improved mobility to millions of PAD patients worldwide. With the guidance of vascular specialists and a commitment to regular exercise, a brighter future beckons—one step at a time.