Walking pace that induces leg pain may improve walking velocity, leg function in PAD
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Walking at a pace that induced ischemic leg pain in patients with lower-extremity peripheral artery disease improved 12-month walking velocity and Short Physical Performance Battery score vs. a pace that did not induce pain, findings show.
The post hoc analysis of the Low Intensity Exercise Intervention in PAD (LITE) randomized trial was published in the Journal of the American Heart Association.
“For patients with lower extremity PAD, walking for exercise in or around home can significantly improve walking speed and measures of mobility and balance, so long as the walking exercise is conducted at a pace that induces ischemic leg symptoms from the PAD,” Mary M. McDermott, MD, the Jeremiah Stamler Professor of Medicine in the division of general internal medicine and geriatric medicine and of preventive medicine at Northwestern University Feinberg School of Medicine, told Healio. “In contrast, walking for exercise in or around the home at a pace that does not induce these leg symptoms is not effective for people with PAD.
“Barriers consist of discomfort associated with walking exercise,” McDermott told Healio. “However, it may be helpful for patients to understand that the leg discomfort or pain that they experience during walking exercise is helpful — it results in meaningful benefits. We also encourage people to walk with a friend or ‘buddy’ or to listen to music or a book on tape in order to help manage the pain experienced during walking exercise.”
The LITE trial
For the LITE trial, researchers compared a home-based low-intensity exercise intervention with a home-based high-intensity exercise intervention to improve walking ability at 12 months in 305 patients with PAD. Controls assigned to no exercise were also compared.
As Healio previously reported, the results of the LITE trial, previously presented at the 2020 American Heart Association Scientific Sessions published in JAMA, indicated that patients assigned to low-intensity walking exercise had less improvement in the 6-minute walk test compared with those assigned to high-intensity walking exercise. In addition, researchers reported no difference in change of 6-minute walk distance among patients assigned to low-intensity walking compared with controls assigned to no exercise at all.
For this post hoc analysis of the LITE trial, researchers evaluated effects of the high-intensity walking intervention that induced ischemic leg symptoms compared with low-intensity walking that did not induce ischemic leg symptoms at home, as well as a control group assigned to no exercise. The outcomes of interest were change in walking velocity over 4 m and change of the Short Physical Performance Battery (SPPB; scale of 0 to 12, with 12 being the best) at 6- and 12-month follow-up.
The SPPB is an objective assessment tool developed by the NIH National Institute on Aging for evaluating lower-extremity function in older adults.
Researchers reported that ischemic leg pain inducing walking improved change in usual walking velocity over 4 m at 6-month (mean change, 0.056 m/second; 95% CI, 0.019-0.094; P < .01) and 12-month follow-up (mean change, 0.084 m/second; 95% CI, 0.049-0.12; P < .01) compared with walking intensity that did not induce leg pain.
Findings were similar when patients were evaluated for change in fast-paced walking velocity over 4 m at 6-month follow-up (P = .03).
The benefits of ischemic leg pain inducing walking compared with non-pain inducing walking on SPPB became significant at 12-month follow-up (mean change, 0.821; 95% CI, 0.309-1.334; P < .01). The effect was not significant at any timepoint among patients who participated in leg pain-inducing exercise compared with controls.
“As people improve, they can typically walk for a longer distance before experiencing these leg symptoms,” McDermott told Healio. “However, in the trial, even as people improved, we encouraged them to walk at a pace that induced leg symptoms within 10 minutes of the start of walking.
“PAD is common and often underdiagnosed,” McDermott told Healio. “Patients who are over age 50 and who have difficulty walking longer distances — one to two blocks — and have a history of diabetes, smoking, high cholesterol or hypertension should speak to their physician about whether they might have PAD. It can be diagnosed noninvasively with the ankle brachial index, a ratio of BP in the lower and upper extremities.”
The PAD National Action Plan
In May, the AHA and 24 collaborating organizations released the PAD National Action Plan, which acts as a roadmap for reducing the burden of PAD, according to the release.
“PAD is a lifelong medical condition, but people with PAD can lead active and long lives,” Joshua Beckman, MD, director of the vascular medicine section, professor of medicine at Vanderbilt University in Nashville, Tennessee, and AHA volunteer expert and PAD National Action Plan writing group member, said in the release. “If you notice walking is becoming more difficult, keeping up with others is hard, or you have pain when you walk, talk with a doctor and describe when it happens and how it feels.”
For more information:
Mary M. McDermott, MD, can be reached at mdm608@northwestern.edu.
References:
- McDermott M, et al. JAMA. 2021;doi:10.1001/jama.2021.2536.
- “No pain, no gain” approach improves walking ability with peripheral artery disease. newsroom.heart.org/news/no-pain-no-gain-approach-improves-walking-ability-with-peripheral-artery-disease. Published July 27, 2022. Accessed July 27, 2022.
- Peripheral Artery Disease (PAD) National Action Plan. www.heart.org/en/health-topics/peripheral-artery-disease/pad-resources/pad-action-plan. Published May 2022. Accessed July 27, 2022.
- Short Physical Performance Battery (SPPB). www.nia.nih.gov/research/labs/leps/short-physical-performance-battery-sppb. Accessed July 27, 2022.
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