Treating Peripheral Artery Disease with Supervised Exercise Therapy
Now covered by Medicare!
Peripheral artery disease is a narrowing of the blood vessels in the legs caused by atherosclerosis which is the buildup of plaque inside the artery walls. People with PAD have an increased risk of coronary artery disease, stroke and heart attack, and left untreated, PAD can lead to increased pain or even leg amputation.
Symptoms and Diagnosis of PAD
People with PAD often experience painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising. The cramping, called claudication, is the body’s way of warning that muscles aren’t receiving enough blood. Because resting muscles need less blood flow, pain associated with PAD usually goes away with rest.
“Unfortunately, a person with PAD who feels pain when walking may cut back on activities that cause discomfort,” says Monique Scott, Director overseeing the program at Providence Health. “This can result in further deconditioning, worsening cardiovascular risk factors, loss of leg strength and eventually disability.”
Symptoms of claudication from PAD are easily confused with symptoms from other diseases of the lower extremities such as osteoarthritis, neuropathy, sciatica, myopathy and spinal stenosis. Therefore, if a person is experiencing leg pain, it is important that they see their doctor to investigate to causes to make sure it can be treated if it is PAD. On the otherhand, some people with PAD have no symptoms at all.
The predominant method for diagnosing PAD is an Ankle Brachial Index (ABI) test which can be ordered by your primary care physician.
At Risk for PAD
The chance of having PAD increases significantly after age 50. Other risk factors include:
- Current or previous tobacco use
- High Blood Pressure
- Abnormal blood cholesterol levels
- African American ethnicity
- Heart disease, heart attack or stroke
Treatment for PAD
"One of the most significant threats of Peripheral Artery Disease is the loss of an extremity,” says Dr. Arthur Cooler of Providence Surgical Associates. “There are surgical and minimally invasive endovascular options that can help avoid the need for leg amputation, such as using balloons or stents to open the blood vessels that have been affected by plaque build up and blockages that, left untreated, can cause ulcers or gangrene to develop in the foot. Fortunately, patients with PAD can potentially avoid the need for surgery or intervention by participating early on in a recommended SET program.”
Supervised exercise therapy (SET) involves performing intermittent physical activity to a point of mild-to-moderate discomfort, a process that creates collateral circulation by strengthening the smaller arteries that routinely run through muscle tissue. When the threshold is reached, the body builds and creates new blood vessels which allows additional blood flow to parts of the lower leg where that flow was previously compromised. Therefore, by participating in a supervised program that guides the patient through the recommended levels of activity, patients can actually build new blood pathways, which means improving the blood supply system for active muscles, which means longer periods of diminished pain during activity and a better quality of life.
While a complete program will generally take 6 months, results are seen after 4 to 8 weeks.
To receive coverage for SET, Medicare beneficiaries with PAD must have a face-to-face visit with a physician and be referred for the program. The physician visit must also include education on cardiovascular disease and PAD risk reduction. For more information, visit: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10295.pdf