For PAD Pain, Dual Approach Appears Best

For people dealing with pain and reduced mobility from peripheral arterial disease, or PAD, an approach that combines a vessel-opening procedure and exercise appears to be better than exercise alone, according to research presented at the American Heart Association Scientific Sessions 2013. Up to one-third of people with diabetes over the age of 50 have PAD.

PAD is a condition in which arteries leading to the legs and feet (or, in some cases, the arms) become clogged with fatty deposits called plaque, reducing blood flow to these areas. Symptoms include cramping, tiredness, pain, slow wound healing, or a feeling of heaviness in the legs and feet. Current treatment recommendations call for exercise first, followed by a vessel-opening procedure if that is not successful.


In the Endovascular Revascularization and Supervised Exercise (ERASE) Trial, researchers looked at 212 people in the Netherlands dealing with leg pain caused by PAD. Their average age was 66, nearly two-thirds were men, over 90% were smokers, and roughly 60% had diabetes. Half of the participants were randomly assigned to receive supervised exercise, while the other half were assigned to undergo angioplasty or stenting procedures to open blocked blood vessels, followed by a supervised exercise program. All participants were given physical evaluations, including a treadmill test to determine walking duration and associated pain, along with quality-of-life assessments at the beginning of the study and after 1, 6, and 12 months.

After one year, people receiving the combined treatment program could walk about 308 yards (roughly three blocks) further, and with less pain, than those in the exercise-only group. They were also able to walk roughly a quarter mile further without pain than those in the exercise-only group.

“Although guidelines recommend supervised exercise as initial therapy in patients with intermittent claudication, our data suggest that a combined therapy of the vessel-opening procedure followed by a supervised exercise program might be the best option,” noted study author Farzin Fakhry, MSc, PhD.

According to Paul Thompson, MD, who was not involved in the research, the results suggest that endovascular revascularization plus supervised exercise — not exercise alone — should be used as the initial treatment for PAD.

Because the study has not yet been peer-reviewed, its findings should be considered preliminary. Additionally, longer-term studies are needed to see if the benefits of supervised exercise therapy are maintained beyond a year.

For more information, read the article “AHA: Procedure Plus Exercise ERASEs PAD” or see the press release from the American Heart Association. And to learn more about PAD and diabetes, read the article “When Your Legs Ache.”