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My PAD Exercise Program

Introduction

It is well known that regular exercise for everyone is a key to maintaining a healthy life. If you have Peripheral Arterial Disease of the lower extremities (PAD), exercise therapy is particularly beneficial to your well-being. This short document provides motivation for such exercise, how to do it, and how to monitor your progress with the validated questionnaire Estimation of Ambulatory Capacity by History (EACH) approach that is available through the Exercise tool on the MyPADMGT web site. EACH is very simple, and only requires you to estimate how much time you would be able to walk at particular speeds on level ground.

PAD Symptoms

People with PAD may have leg discomfort that arises during exertion. The classical symptom of PAD discomfort is called intermittent claudication (pain, aching, or cramps in the calves, thighs or buttocks), which occurs during walking. This usually stops after a few minutes of rest, but sometimes it does not stop. Do not assume that the pain is due to PAD, since it may also be caused by other diseases of the lower extremities such as osteoarthritis, neuropathy, sciatica, myopathy and spinal stenosis. Your doctor will be able to determine if one of these diseases is the cause, or if it is caused by PAD. If your claudication is caused by PAD, then the best way to treat it is through a regular program of walking. Whether or not you suffer from intermittent claudication, a walking program is one of the best ways you can improve your health and reduce the risks from PAD. Of course, for your general health and well-being you should exercise the rest of your body as well.

Diabetic Patients

Patients with PAD are at increased risk for non-healing skin ulcers, and careful foot and skin assessment is important, especially for those with diabetes and/or neuropathy. When diabetes is present, there is often neuropathy, which results in painful burning, tingling, numbness and foot ulcers. Foot self-examination is important before and after exercise. Shock-absorbing shoes that have lots of room should be used. Diabetic patients should check their glucose levels before exercise and take careful precautions during exercise for signs of hypoglycemia. Keep glucose tablets or gels available to take if needed.

Walking Exercise

Measured from the time you start walking to the time at which you first begin to feel claudication symptoms is called the pain-free walking time. The time at which you must stop walking because of the pain is called your maximum walking duration. Try to walk as far as you can while experiencing mild to moderate pain, because this will help you to improve your maximum walking duration as you continue with regular walking exercise. Patients with PAD who walk regularly usually experience improvement in walking distance in about six weeks. You must continue walking regularly in order to maintain the benefits you gain from exercise. As long as you are motivated to do so, you can walk wherever you wish, at home, or outdoors, or at a gym, while shopping, etc. Try to make this a habit, but walk at least three times a week to your maximum walking duration. In any case it is important that you make regular exercise a lifelong practice.

How to Monitor Exercise Progress on MYPADMGT

The MYPADMGT site includes a Web Tool called Exercise. This helps you to keep track of how long you are able to walk (or even jog) until you reach your maximum walking distance. To use this tool, click on Web Tools, and then on Exercise in the list at the left. You will see a statement "For each of the following walking speeds, how long can you perform the task easily on level ground without stopping to rest?" You should enter data into this record by clicking on estimates of the amount of time you can walk at the four levels indicated before reaching your maximum walking distance, and then submitting that data for that day. This information will be converted into one number by the system and stored for you. This allows you to compare your performance over a period of time to show whether or not your walking ability has improved.

After you have submitted exercise data for two or more days, you can get the system to plot your results, by clicking the "Patient View" icon at the top right. This opens up a view of a data plot indicating your performance. You will see the acronym "EACH" on the display. This is short for "Estimation of Ambulatory Capacity by History", which is a validated instrument for measuring walking ability, developed through a research study. If this plot doesn't show a result for all the days you have entered, simply click at the top of the chart to select the number of days you want plotted.

Setting a Target

To keep yourself motivated to continue your exercise program, you need to set a target. To do this, once you have entered data for several days on your estimated walking distances, click on the “Patient View” icon for the Exercise tool. You will notice that there is a Target you can set, just above the plotted area. You should set a target for yourself, based on the plot of your current performance (the value scale is at the left hand side of the plot). Don’t set it too high. Perhaps set your target at a value that is 25% above the best value you have achieved thus far. Here are some example targets: 1) If you experience little difficulty walking long distances for extended periods, or even jog for a few minutes, then your target might be 65 or more; 2) If you experience moderate difficulty walking for as long as 30 minutes, then your target might be 20 to 30; 3) If you have difficulty walking for as long as 5 minutes, then your target might be 5 to 15. But the main guideline to follow is to see how well you are doing now, and then set your target up to 25% above your average result.

Reaching Your Target

Once you reach your target, congratulate yourself and tell your friends and family. This is a major milestone that should be celebrated! Write down the target you reached and the date you reached it. Then you know you can probably do better, so edge the target up another 25%. As you achieve your targets, keep track of your achievements, and report them to your doctor at your next appointment. However, over time, you will notice that it is taking longer to improve to higher levels. So once you have achieved the initial large benefits from walking exercise, you will get to a point where you feel better and find that it is good enough to stay at the value you have reached. Of course at the same time you will probably notice that the other measures you are monitoring (e.g. blood pressure, smoking cessation) are also improving. Now you are really achieving what you want to do, which is to reduce the risks caused by PAD and at the same time improve your health and feeling of well-being.

Best of luck with your exercise program!