Exercise key in curbing artery disease

My dad was a golfer. He worked hard during the week and often fell asleep in front of the television, open novel on his chest, glasses pushed up on his head, a gentle snore emerging from his mouth. But come Sunday morning, he was up at 6 a.m., drinking coffee at the kitchen table with his best friend as they prepared to hit the golf course for 18 holes. They didn’t use golf carts in the those days. They enjoyed walking in the soft Southern California mornings.

But as my dad got older and years of barbequed steaks and whole milk caught up with him, walking got difficult. When he walked any distance at all, he developed painful cramps in his calf muscles that stopped him cold. He’d have to find a place to sit and rest as he waited for the pain to go away. By the time my parents retired to Palm Springs, a golf cart took up residence in their driveway.

Dad had a condition called intermittent claudication, a symptom that affects a third to a half of people with peripheral vascular disease. PVD is a common complication of atherosclerosis, or hardening of the arteries. The cramping and pain my dad felt in his calves would sometimes affect his feet as well. Deposits of cholesterol-laden plaque were narrowing his leg arteries so severely that whenever he exercised, his arteries could not deliver the oxygen-rich blood his working muscles demanded. And just like the heart, when enough oxygen can’t get to the working muscle, the muscles complain, and it hurts.

Intermittent claudication is often described in terms of the distance a sufferer can walk. In doctor circles, we might hear of a patient who has “two-block claudication,” describing how far he can walk before the pain sets in. Being able to negotiate “two blocks” barely gets a person from the parking lot into the grocery store,

Now, we always talk about the value of exercise – how it increases cardiovascular fitness and can decrease the symptoms and risks of heart disease.

In the case of claudication, exercise encourages the growth of smaller arteries that can deliver blood to places the severely clogged vessels can’t. But how do you exercise when walking causes excrutiating pain? (Not everyone has access to a swimming pool, and besides, my dad never learned to swim.)

Now a group of British researchers has discovered a way to help sufferers of PVD to exercise, increase their cardiovascular efficiency and reduce their pain. No swimming involved.

The researchers found that regular aerobic upper-body exercise eased the chronic leg pain of PVD. They recruited more than a hundred PVD sufferers between the ages of 50 and 85. These patients exercised by “arm-cranking,” stationary cycling using the arms instead of the legs.

The researchers measured pain tolerance with a series of walking tests at six-week intervals. They found that after 24 weeks, the patients were able to walk, on average, a third farther than they could before the exercise program began.

They also could walk 50 percent longer before they felt leg pain.

The arm-cranking improved overall cardiovascular fitness, and presumably that translated to improved blood supply to the complaining muscles. This is a good thing, because PVD can lead to more than pain when walking (which might lead some to say, “I’ll just quit walking then!”).

If the PVD gets bad enough, the pain can come at rest. The reduction in blood flow with severe PVD can lead to skin ulcers that won’t heal, gangrene and, ultimately, amputation.

So once again, we harp on the value of exercise.

Yes, there are medicines to take for PVD, but they work better with the lifestyle changes we always talk about. And those lifestyle changes, including the all-important exercise, may delay the need for some of those very expensive medications.