Exercise Should Be First-Line Treatment For Intermittent Claudication

Discomfort in the calf and upper legs during walking is a hallmark of intermittent claudication, but walking more—not less—can help ease the pain, experts say.

Research shows that a supervised exercise program can help, and should be the first treatment tried, a group of exercise and rehabilitation experts writes in a new infographic.

If a supervised program isn't available, patients can follow a walk-rest-walk pattern on their own, which the authors illustrate in the British Journal of Sports Medicine.

"The condition is underdiagnosed and undertreated despite it being common and associated with mobility limitation and an increased risk of heart attack, stroke, amputation, and death," said coauthor Garry Tew of Northumbria University in Newcastle, the United Kingdom.

"The public is not well informed about peripheral artery disease or its main symptom of intermittent claudication," Tew told Reuters Health by email. "Clinical guidelines recommend exercise as a first-line approach."

Intermittent claudication affects about 4% of people over age 60 and is the most common symptom of peripheral artery disease, according to the UK's National Institute for Health and Care Excellence (NICE).

NICE guidelines recommend a 3-month supervised exercise program to reduce pain, improve heart health, boost mood, improve sleep, maintain a healthy weight and ultimately lower the need for vascular procedures on the legs.

Supervised exercise classes have shown the greatest benefits, the authors write, and patients should feel comfortable asking their doctor what's available locally.

"There is good quality research evidence showing that it can improve walking ability and quality of life," Tew said. "Some types of exercise are more effective than others, so it is useful to highlight the type that will benefit patients the most."

If a program isn't available, patients can exercise on their own, alternating between walking for 3 to 10 minutes until moderate-to-strong pain develops, resting until the pain subsides, and then walking for 3 to 10 minutes again.

Patients should aim to complete 30-60 minutes of walking per session, according to the infographic, and three to five sessions per week. On at least 2 days per week, they should also incorporate strength and balance activities, such as yoga, dance, tai chi, bowling and lifting weights at a gym.

In addition, the experts recommend wearing comfortable clothing and staying hydrated. It's also important to choose walking routes with resting places, to exercise with others and to build in variety to keep the walking routine fun.

Overall, the exercise researchers write, it typically takes several weeks of exercise to improve symptoms.

"It may take a while to achieve significant improvements after you have started exercising or walking, so be patient," Ukachukwu Abaraogu advises patients. Abaraogu, who researches intermittent claudication and chronic diseases at Glasgow Caledonian University in the UK, wasn't involved with the infographic; he reviewed it for Reuters Health.

"Be intentional about exercising and aim to do it for 30-60 minutes per day several times a week," he tells patients. "But do not be afraid to start, even if you cannot achieve this at the beginning."

—Carolyn Crist

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