No pain, no gain approach improves walking ability with peripheral artery disease: Journal of the American Heart Association Report

Walking for exercise at a pace that induced pain or discomfort improved walking ability among people with peripheral artery disease, or PAD, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

About 150,000 nontraumatic amputations occur annually, according to the 2021 American Heart Association policy statement: Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to Our Feet. Between 8 and 10 million people in the United States have PAD. The condition disproportionately affects Black people, American Indian people and those of low socioeconomic status.

The condition occurs when the arteries that transport blood from the heart throughout the body narrow, reducing blood and oxygen flow. It usually affects the legs and feet causing symptoms while walking, such as cramping, weakness, fatigue, aching and pain or discomfort that subside within 10 minutes of rest. Previous research found that walking for exercise, particularly on a treadmill while supervised by a staff member, improves walking ability and walking distance among people with PAD. What remained unclear were the potential effects of walking at a pace that induced symptoms such as leg pain on speed, strength and balance.

This study examined the effects of home-based walking for exercise among 264 people with PAD who were participating in a randomized clinical trial, called the Low-Intensity Exercise Intervention in PAD (LITE), which included 305 people overall. From September 2015 to December 2019, participants enrolled in the LITE study at four U.S. medical centers (Northwestern University, Tulane University, University of Minnesota and University of Pittsburgh). Their average age was 69 years, 48% were women and 61% were Black adults.

Researchers randomly assigned participants to one of three groups for 12 months. The first group (38%) walked at home at a comfortable pace; the second group (41%) walked at home at a pace that induced leg symptoms; while the third group (21%) did not walk for exercise. Both walking exercise groups wore an ActiGraph, a device that monitored the intensity of their walking and the time walked.

Personalized thresholds for the ActiGraph intensity that corresponded to walking for exercise at a pace that induced leg symptoms (high intensity) and that corresponded to walking for exercise at a comfortable pace without leg symptoms (low intensity) were defined for each individual randomized to an exercise intervention. Participants randomized to exercise wore their ActiGraph device during walking exercise activity and uploaded data on exercise frequency, intensity and duration to the study website.

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