Higher-Intensity Exercise Improves Mobility in Peripheral Arterial Disease

High-intensity walking[1] resulted in substantial mobility benefits in people with peripheral arterial disease (PAD)[2], while low-intensity walking offered little to no benefit, according to the results of a new study published in the journal JAMA[3].

PAD is a serious, often painful condition[4] in which arteries leading to the legs and feet become narrowed or blocked by fatty deposits called plaque. It’s commonly seen in people with diabetes, and is widely viewed as a diabetes complication[5]. The reduced blood flow to the legs and feet that results from this condition can make it extremely difficult for even minor foot injuries to heal, potentially leading to foot ulcers (open sores) that may become infected and even lead to foot or leg amputations. Diabetic foot ulcers are the leading cause of lower limb amputations, accounting for over 80% of cases, according to the Mayo Clinic[6].


For the latest study, 305 participants with PAD were randomly assigned to one of three different study groups. One group was assigned to complete a high-intensity walking program, another was assigned to take part in a low-intensity walking program, and another served as a control group with no exercise program. Both of the exercise groups were instructed to walk five times a week for up to 50 minutes, and wore a device to track their exercise time and intensity. The low-intensity group was told to walk at a pace that didn’t cause any leg symptoms, while the high-intensity group was told to walk at a pace that gave them moderate to severe symptoms like cramping[7] and pain. As part of the study, an exercise coach talked on the phone with participants about their adherence to the exercise program once a week for the entire 12 months of the study. The control group also received weekly phone calls, but only to provide education and information about PAD.

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The main outcome researchers were interested in was any change in the results of a six-minute walking test — which, as the name suggests, measures how far someone can walk in six minutes. A total of 250 participants, or 82%, completed the entire study and were included in the results. For members of the control group, the average walking distance fell from 328.1 meters at the beginning of the study to 317.5 meters 12 months later — demonstrating worsening mobility. For members of the low-intensity exercise group, the average walking distance fell from 332.1 meters to 327.5 meters — a smaller drop in mobility than in the control group, but not significantly so. But members of the high-intensity exercise group saw their average walking distance increase from 338.1 meters to 371.2 meters, a significant improvement.

Throughout the study period, participants reported a total of 184 serious adverse events, which were slightly more common in the two exercise groups — occurring at a rate of 0.64 events per participant in the low-intensity exercise group, 0.65 in the high-intensity exercise group, and 0.46 in the control group. Only one serious adverse event in each of the exercise groups was deemed to be related to study participation.

“These results do not support the use of low-intensity home-based walking exercise for improving objectively measured walking performance in patients with PAD,” the researchers concluded. Instead, healthcare providers should direct people with PAD to higher-intensity exercise programs if they’re interested in increasing their mobility, despite the greater discomfort they’re likely to experience while exercising at this intensity.

Want to learn more about peripheral arterial disease? Read “Diabetic Leg Pain and Peripheral Arterial Disease”[9] and “How Much Do You Know About Peripheral Arterial Disease?”[10]

Living with type 2 diabetes? Check out our free type 2 e-course![11]

  1. walking: https://www.diabetesselfmanagement.com/nutrition-exercise/exercise/health-benefits-of-walking/
  2. peripheral arterial disease (PAD): https://www.diabetesselfmanagement.com/videos/peripheral-arterial-disease/
  3. JAMA: https://jamanetwork.com/journals/jama/article-abstract/2778112
  4. often painful condition: https://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/diabetic-leg-pain-and-peripheral-arterial-disease/
  5. diabetes complication: https://www.diabetesselfmanagement.com/education/diabetes-complications/
  6. Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/amputation-and-diabetes/art-20048262
  7. cramping: https://www.diabetesselfmanagement.com/blog/have-calf-cramps-strengthening-your-hip-muscles-may-help/
  8. sign up for our free newsletter: https://www.diabetesselfmanagement.com/newsletter/
  9. “Diabetic Leg Pain and Peripheral Arterial Disease”: https://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/diabetic-leg-pain-and-peripheral-arterial-disease/
  10. “How Much Do You Know About Peripheral Arterial Disease?”: https://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/how-much-do-you-know-about-peripheral-arterial-disease/
  11. Check out our free type 2 e-course!: https://www.diabetesselfmanagement.com/type-2-e-course/

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