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Intermittent claudication Physical activity and


WHAT IS INTERMITTENT CLAUDICATION? The term claudication comes from the Latin word ‘to limp’ and it is the major symptom of peripheral artery disease, which is characterised as a pain in the buttocks, thigh or lower leg muscles that starts when exercising and is relieved by rest. The disease process is nearly always due to a build up of fatty plaque that is deposited in the arteries of the legs, which restricts blood flow. Therefore when exercise reaches a certain level the demand for oxygenated blood outstrips the supply, which leads to fatigue and leg pain.


There are several risks factors that increase your chances of developing intermittent claudication and they include: n Age


n Family history n Obesity


n Cigarette Smoking n Diabetes n High cholesterol n Sedentary lifestyle.


n Hypertension


HOW CAN EXERCISE HELP? Recent research has shown that by participating in a regular walking programme you can increase your walking distance by as much as 179% before you suffer from symptoms of claudication. So it is likely that if you exercise on a regular basis you will find it easier to perform everyday activities such as housework, gardening and shopping without leg pain. There are some individuals who may only tolerate walking for very short bouts but other exercise may be undertaken such as cycling, rowing and arm cycling. These exercises can also help improve walking distances before symptoms of claudication occur by as much as 57%.


THE BENEFITS OF EXERCISE There are several benefits that occur with performing regular aerobic training. Walking is believed to help improve the efficiency of the leg muscles allowing them to use the available oxygenated blood, the blood flow to the muscles may increase and walking technique may improve. Other improvements include: n Strength and stamina n Balance


n Walking speed and efficiency n Fitness


n Helps with weight loss n Helps lower cholesterol


n Helps lower blood pressure n Helps control diabetes.


SUITABLE TYPES OF EXERCISE You should not start an exercise programme without consulting your GP and ideally it should be supervised by a suitably trained exercise professional. There are many types of exercise programmes that are safe for you to participate in. The best types of exercise programmes are ones that involve weight-bearing exercises and are aerobic in nature such as walking. Walking can be performed on a treadmill or around a track. However treadmill walking has the advantage of being able to determine a set speed and incline. It can also provide feedback on time, distance walked and the amount of energy you have used. The speed you go on the treadmill should be set so that leg pain starts within 3-5 minutes. This should feel about 3 ie. moderate, on a 4-point pain scale (see box). Once the score of 3 is achieved you may rest until the pain subsides. The exercise-rest cycle is then repeated


several times with the long-term goal being to progress the time you can walk to 50 minutes and then eventually to 35-50 minutes of continuous walking.


Other types of aerobic exercises such as cycling, rowing and arm cycling can also be included into your programme. These exercises can be incorporated into a circuit and can be performed during the rest periods inbetween walking bouts. This will help increase your cardiovascular fitness even further, as well as your walking distances and may even reduce risk factors and promote weight loss.


SUBJECTIVE GRADING SCALE FOR LEG PAIN Grade 1 Definite discomfort or pain, but only of initial or modest levels (established, but minimal)


Grade 2 Moderate discomfort or pain from which the patient’s attention can be diverted, for example by conversation


Grade 3 Intense pain (short of grade 4) from which the patient’s attention cannot be diverted


Grade 4 Excruciating and unbearable pain.


REMEMBER n Always warm up for 10 minutes before starting your exercise programme


n Start slowly and gradually increase the number of walking bouts performed during each exercise session


n Try to perform your exercise programme at least three times per week and ideally five times per week


n Perform non-weight bearing exercises such as cycling, rowing and arm cycling in between walking bouts


n Always perform a cool down and do some stretches for 10 minutes after your exercise session.


WHEN NOT TO EXERCISE? If you suffer from any of the following symptoms do not to exercise and speak to your GP before recommencing your exercise programme: n Angina pain at rest or on exertion n Leg pain at rest n Leg wounds n Shortness of breath at rest or on mild exertion n General feelings of unwell n Unstable blood pressure n Unstable diabetes n If your health or exercise professional tells you not to exercise.


FOR MORE INFORMATION


n British Heart Foundation Helpline: 0300 330 3311 www.bhf.org.uk


The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. To the extent permissible by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negligence) as a consequence, whether directly or indirectly, of the use by any person of the contents of this article.


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