Walking exercise | What is it good for? | Blood circulation

In light of my last post about walking exercise in which I wrote about walking basically in the negative light of not being the foundation for weight loss, I thought it would be helpful if I followed up with other posts about walking exercise, but this time in a more positive light.

walking exercise for PADThere are many benefits to walking as part of an exercising, moving lifestyle. In this post I am going to discuss some of the cardiovascular benefits of walking exercise, especially for people who may be at risk for poor blood circulation to the feet and legs.

Although – as I discussed in my last post – walking exercise is not all that great for weight loss, it does have a positive and direct role in supporting the cardiovascular system. This is the system of your heart and all the blood vessels through which your blood flows.

Walking not only helps blood flow to the heart, but throughout the body from “top to bottom,” up to the brain and down to the feet and legs.

Unlike many other medical problems, cardiovascular disease is one of those conditions you can actually do something about, both in terms of prevention in the first place, as well as to help improve, or mitigate, existing blood circulation problems. Many people are at a significant risk for developing cardiovascular disease at some point in their lives. As a matter of fact, evidence found in the blood vessels of ancient mummies suggests cardiovascular disease in some form is part of the human condition. I have posted about this here.

Recent analysis suggests U.S. adults have more than a 55 percent estimated risk of developing cardiovascular disease (CVD). Even among people with no major risk factors for this medical condition, the chance of developing cardiovascular disease is more than 30 percent.

This analysis found the “Lifetime risk estimates for total CVD were high (>30%) for all individuals, even those with optimal risk factors in middle age. However, maintenance of optimal risk factor levels in middle age was associated with substantially longer morbidity-free survival.” The term “morbidity-free survival” means living longer without having medical problems associated with cardiovascular disease.

What happens when blood flow is decreased to the feet and legs?

peripheral arterial disease (PAD)Decreased blood flow to the feet and legs is known as peripheral arterial disease (PAD). PAD is essentially cardiovascular disease of the feet and legs. It is often associated with poor circulation to the heart and brain leading to an increased risk of “cardiovascular events” such as heart attack or stroke.

Major risk factors for PAD are similar to those that promote decreased circulation elsewhere in the body. Cigarette smoking and diabetes top the list for promoting the greatest risk for PAD.

People with poor circulation to the feet and legs can develop “intermittent claudication.” This is a painful condition resulting from the muscles in the legs not getting enough blood flow. Although not life-threatening, it is somewhat analogous to a heart attack in the legs. When contracting muscles are starved of oxygen from inadequate blood circulation they cramp and hurt.

A walking exercise routine is an inexpensive, low-risk way to help improve blood flow to the feet compared to other approaches such as surgery and/or medication. Walking exercise has been shown to be of some value in helping PAD patients at least partly overcome poor blood flow to the feet and legs causing the symptoms of intermittent claudication.

As a matter of fact, it has been shown for people who get intermittent claudication a walking routine can be significantly effective in alleviating symptoms and increasing walking distances and walking times. It may also play a role in preventing worsening of the circulation problem, reducing cardiovascular disease in general, and improving quality of life.

It is not just walking exercise that is helpful. Other forms of exercise are like medicine for people with claudication. Strength training and various other upper or lower limb exercises done at least two times per week have generally been shown to significantly improve patients’ physical and mental status as well.

Walking exercise compared to surgery for decreased circulation to the feet and legs

There is some evidence that supervised walking exercise therapy can be comparable to a surgical procedure used to increase blood flow to the feet.

PAD patients who performed a program of supervised walking exercise on a treadmill for 30 minutes twice a week were found to have comparable benefits to an endovascular surgical procedure used to open up clogged blood vessels to the feet and legs. Patients in both groups were advised to walk at home as much as possible.

The walking patients who had pain in their legs from walking with poor circulation and the patients who had the surgery, both had equal outcomes in terms of their ability to function and their quality of life.

doctors doing surgeryOther data from the same researcher supports using both the endovascular procedure and walking exercise therapy as the best option for many patients.

If your doctor advises a surgical procedure to increase blood flow to your feet and legs, it is likely that using walking exercise alone will not be enough for your particular situation. If you are someone who would actually do the walking exercise therapy, and you are medically clear to do so, ask your doctor about this option. If he or she says “no,” I would not recommend you ignore this advice.

Medicine for PAD

The benefit of medicines for the pain of poor circulation is not all that great with or without intermittent claudication.

  • Antiplatelet treatment is indicated in virtually all patients with PAD. Aspirin therapy is usually considered a first line treatment and clopidogrel (Plavix) as an effective alternative.
  • Another example of a medicine used to help circulaltion to the feet and legs is pentoxyfylline.
  • Statin therapy is used to keep LDL levels down which may indirectly benefit PAD.
  • Elevated blood pressure is also associated with cardiovascular disease, so blood pressure medication is also often indicated.
  • In addition, it is advised that diabetic patients with PAD reduce their glycosylated hemoglobin to ≤ 7.0%.

Because PAD patients represent the group with the highest risk for cardiovascular problems, these patients need the most intensive treatment and elimination of risk factors for blood circulation problems. Many doctors believe these measures should be as comprehensive as those in patients with established coronary and cerebrovascular disease.

Podiatrists help you walk to support your best blood circulation to the feet and legs

Along with medical management, and possible surgery, many PAD patients have the most to gain from maintaining an active walking lifestyle. It is the podiatrist who has an important role to play in counseling these patients with the goal of maintaining blood flow to the feet and legs in an effort to prevent amputation.

Unless there is some medical reason why it should not be attempted, a supervised exercise therapy program should be the first treatment of choice for managing intermittent claudication and poor circulation to the feet in general. Some people may be better managed medically, some people surgically, and for people who are capable, they can use exercise therapy straight away.

Despite this information , in real world clinical practice, surgery to increase blood flow to the feet and legs is usually preferred. As with many medical interventions, the ones that are the “easiest” for the patient tend to be favored.

Regardless of whether someone needs to hope for the best with medical treatment, perform physical exercise, or undergo surgery to help their blood flow, each treatment can complement the other depending on what is best for a particular person. And most importantly walking exercise can, and should, be used regardless of other measures unless there is some medical problem preventing this therapy.

And last but not least – A brief mention of food for PAD

A discussion of food for PAD is well beyond the scope of this post, but a brief mention of food is appropriate in light of my last post about walking exercise not being the foundation for weight loss. Food likely also trumps exercise when it comes to cardiovascular disease prevention and management.  Sort of…given that food and movement are two sides of the same metabolic coin, and sleep is the outer edge, it is most likely that food and movement are both medicine that promote healthy blood flow. Eat well. Move freely. Sleep deeply.

Look for future posts about other benefits of walking exercise as medicine.

This information is not to be construed as medical advice. If you believe you have a circulation problem to your feet and legs, see a physician.




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About Robert Creighton

Dr. Creighton is a podiatrist and foot surgeon with over 26 years in podiatric practice treating thousands of patients afflicted with the physiological, physical, and psychological side effects and complications of diabetes and pre-diabetes metabolic syndrome. He believes these disorders present a pressing public health concern that need to be more actively addressed in a multidisciplinary way. Dr. Creighton graduated from what is now the Temple University School of Podiatric Medicine after receiving his undergraduate degree in Biology. He is certified by the American Board of Foot and Ankle Surgery, a member of the American Public Health Association, an American College of Sports Medicine certified personal trainer and a Member of the American Nutrition Association.


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