Subscribe to DrG's Free Newsletter |
|
We DO NOT share our email list with anyone. DrG is very respectful of your right to privacy.
For a one-year hard copy subscription, sent through the U.S. mail, send $18 to Healthy Choices for Mind and Body, P.O. Box 19938, Sacramento, CA 95819. All email subscriptions and downloads from the website are free.
DrG's Healthy Choices for Mind and Body is a registered non-profit charitable organization established to promote a world in which all people practice healthy lifestyles. Your contributions are tax deductable.
DrG's Medisense Feature Article
18061-New_Data_Exercising
New
Data About Oldsters Exercising
by Ann Gerhardt, MD
June 2018
Print Version
Bottom
line at the Top:
The only way to maintain or improve circulation to the legs is to use
them. Just counting steps isn’t enough.
It takes sustained, moderately intense lower extremity activity to keep
arterial blood flowing freely. The recommendation of at least
30 minutes of exercise daily, even in ten-minute
increments, is still valid, but 10 minutes on your feet futzing around
the house doesn’t count.
A life of inactivity, particularly a high cholesterol, diabetic life of
inactivity, often destroys arterial circulation to the legs.
If they haven’t yet incurred amputation of a dead limb,
people with such a poor blood supply suffer from leg pain when walking
or otherwise exercising them. The pain mimics angina
pectoris, heart attack pain, in that both pains result from a body part
not getting enough oxygen from blood. The disease severity
determines how long a person can walk before experiencing
pain. Usually the pain resolves with rest.
Medicines don’t help much. Aspirin and others
prevent clotting, but don’t reverse arterial
narrowing. Some agents help oxygen-carrying red blood cells
to more easily slip through tiny vessels, but do nothing to dilate the
narrowed sections. Some medicines lower blood pressure by
dilating arteries, but only those that aren’t already solidly
stiff.
Doctors can open a critical narrowing with a balloon (angioplasty) and
keep it open with a tube (stent), but can do nothing to help diffusely
narrowed arteries.
The only
really effective
route to improved circulation in peripheral artery disease (PAD) is
sustained leg exercise.
The ‘demand’ for oxygen incurred during exercise
stimulates the body to make new vessels, which detour around blockages
and supply oxygen to working muscles. This takes time and
persistence: By walking until it hurts, resting until it
doesn’t and repeating again and again for a long time or
distance every day for months until it’s better, then years
to maintain it.
Simple advice, but people dislike doing something that hurts even if
it’s healthy, logical and will eventually reduce
pain. The challenge is motivation. Clinical
guidelines recommend supervised treadmill exercise, but frequent travel
to a medical center is difficult for many people and doesn’t
actually work as well as a home-based walking program with medical
visits every one to four weeks.
A recent study published in the Journal of the American Medical
Association tried to build on a home-based walking program by adding
coaching and an ankle activity monitor. The extra monitoring
didn’t work any better than did advice about a home walking
program and infrequent telephone updates.
Apparently ankle-monitor wearers reported more exercise than they
actually did, increased their steps without doing the recommended long
walk and by the end of nine months weren’t walking any more
than the non-banded control group.
This likely extrapolates to people without PAD who want to avoid it as
they age. Using a step monitor like a Fit-Bit might deceive
the wearer into believing that three miles walked over the course of a
day guarantees fitness. Unless those miles include sustained,
moderately intense activity (like a brisk walk or non-leisurely bike
ride) lasting at least 10 minutes at a time, the benefit to heart and
circulation is probably minimal.
The 10,000 step goal is a reasonable surrogate, because it’s
hard to move 10,000 steps in a day without at least one moderately long
walk.