Walking pace that causes leg pain can improve walking speed and leg function in PAD

Walking at a pace that caused ischemic leg pain in patients with lower extremity peripheral artery disease improved 12 months of walking speed and Short Physical Performance Battery score versus a pace that did not cause 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 limb PAD, walking for exercise in or around the home can significantly improve gait speed and measures of mobility and balance, as long as the walking exercise is performed at a pace that induces ischemic leg symptoms of the PAD,” Mary M. McDermott, MDJeremiah Stamler professor of medicine in the division of general internal medicine and geriatric medicine and preventive medicine at Northwestern University Feinberg School of Medicine told Healio. “In contrast, walking for exercise in or around the house at a pace that doesn’t cause these leg symptoms is not effective for people with PAD.

Mary M. McDermott

“Barriers are made up of discomfort associated with walking exercises,” McDermott told Healio. “However, it can be helpful for patients to understand that the leg discomfort or pain they experience during walking exercises is beneficial – it results in meaningful benefits. We also encourage people to walk with a friend or ‘buddy’ or to music or listening to a book on tape to reduce the pain they experience while walking.”

The LITE trial

For the LITE study, researchers compared a low-intensity home-based exercise intervention with a high-intensity home-based 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 study, previously presented at the 2020 American Heart Association Scientific Sessions, were published in JAMA, indicated that patients assigned to low-intensity walking exercises showed less improvement in the 6-minute walk test compared to those assigned to high-intensity walking exercises. In addition, researchers reported no difference in change in 6-minute walking distance between patients assigned to low-intensity walking compared to controls not assigned to exercise at all.

For this post-hoc analysis of the LITE study, researchers evaluated the effects of the intensive walking intervention that produced ischemic leg symptoms compared to low-intensity walking that did not cause ischemic leg symptoms at home, as well as a control group assigned to no exercise. The outcomes of interest were change in walking speed over 4 m and change in Short Physical Performance Battery (SPPB; scale from 0 to 12, with 12 being the best) at 6 and 12 months follow-up.

The SPPB is an objective assessment tool developed by the NIH National Institute on Aging for evaluating lower limb function in older adults.

Researchers reported that ischemic leg pain inducing gait improved the change in usual walking speed over 4 m at 6 months (mean change, 0.056 m/second; 95% CI, 0.019-0.094; p < 0.01) and 12 months of follow-up (mean change, 0.084 m/second; 95% CI, 0.049-0.12; p < .01) compared to walking intensity that did not cause leg pain.

The findings were similar when patients were evaluated for change in rapid gait speed over 4 m at 6 months of follow-up (p = .03).

The benefits of walking with ischemic leg pain compared to walking without pain on SPPB became significant at 12 months follow-up (mean change 0.821; 95% CI 0.309-1.334; p < .01). The effect was not significant at any time point in patients participating in pain-inducing leg exercises compared to controls.

“As people improve, they can usually walk a longer distance before experiencing these leg symptoms,” McDermott told Healio. “During the study, we encouraged them to walk at a pace that produced leg symptoms within 10 minutes of starting walking, even as people improved.

“PAD is common and often underdiagnosed,” McDermott told Healio. “Patients over the age of 50 who have difficulty walking longer distances — one to two blocks — and have a history of diabetes, smoking, high cholesterol, or hypertension should talk to their doctor about whether they have PAD. can be diagnosed non-invasively with the ankle-arm index, a ratio of BP in the lower and upper extremities.

PAD . National Action Plan

In May, the AHA and 24 collaborating organizations released the PAD National Action Plan, which, according to the release, acts as a roadmap for reducing the burden of PAD.

“PAD is a lifelong medical condition, but people with PAD can live active and long lives,” Joshua Beckman, MD, director of the division of vascular medicine, professor of medicine at Vanderbilt University in Nashville, Tennessee, and AHA volunteer expert and member of the PAD National Action Plan writing group, in the release. “If you notice that walking is getting harder, keeping up with others is difficult, or you have pain when you walk, talk to a doctor and describe when it happens and what it feels like.”

For more information:

Mary M. McDermott, MDcan be reached at mdm608@northwestern.edu.

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