Peripheral Artery Disease

Peripheral Artery Disease 

Treatment options for patients with peripheral artery disease (PAD) are limited, so working with these patients can be frustrating. PCNA has put together these helpful tools for clinicians who see patients with PAD.

Get Your Patients Walking



Exercise Program

Research in vascular exercise has demonstrated remarkable improvement in symptoms of leg pain (claudication) without expensive or invasive interventions. Regular walking programs are extremely helpful for patients with PAD and intermittent claudication.

Download the instruction sheet (PDF) for getting patients stated with an exercise program>
exercise_program_for_indivduals_with_pad

Patient Perspective

Video Transcripts

Walking Program

Hello! I am Jane Nelson Worel, Nurse Practitioner and Director of Clinical Education at the Preventive Cardiovascular Nurses Association.

Our topic today is What You Can Do to Help Patients with PAD Feel Better Today. Because treatment options are limited, working with patients with peripheral artery disease, PAD, can be frustrating.

Symptoms such as leg pain or weakness when walking, known as claudication, limits the distance and duration the patient can walk without rest. This can make climbing stairs or activities of daily living difficult—and the pain may even persist when the individual is resting or lying down.

How can you help these patients feel better today?

Regular walking programs are extremely helpful for patients with PAD and intermittent claudication. 
Studies have demonstrated that participants in a walking program may be able to walk up to three or four times farther and have less leg pain within twelve weeks. This benefit can be a significant motivator for patients.

Walking may seem counter-intuitive to your patients, so it is important to provide guidance as to how to start, build and maintain their walking program.

A set of written instructions, such as those found on the PCNA web site at pcna.net/PAD, may help patients and their families/caregivers remember what you have discussed during the clinical visit. This is also a great way for patients to track progress. 

As you are discussing the walking program with your patient and perhaps their family/caregiver, it is important to assess their readiness to make changes and their perceived ability to change. You can assist by listening for potential barriers and helping the patient identify possible solutions.

Based on your patient, identify a starting place for their walking program. The goal is 30-45 minutes of total walking time (not counting rest breaks) and it may take several weeks to build to this level.
It is important to review the pain scale with your patient so that they can identify when to continue and when to stop walking. 

On a treadmill, the patient should set the speed and grade at a level that brings on claudication pain within 3 to 5 minutes. The patient should then walk at this rate until they experience claudication of moderate severity, rest until the pain improves, and then continue walking. 

Over time, the patient should be able to walk longer at the designated speed and grade. At this point, the speed and grade should be increased until the patient experiences the pain within 3 to 5 minutes once again. 

An example of your initial instructions to a patient might be, “Please begin your walking program with 5 to 7 minutes of walking 3 times per week. Remember to rest when your leg pain is an 8 to 9 on the pain scale.”

If your patient does not have access to a treadmill, a park or shopping mall that provides a level walking surface and comfortable spots to rest – such as a bench – will do. Apartment dwellers can also use the hallways of their buildings.

It is important to note that patients with PAD are at high risk for coronary artery disease. Make certain to provide your patients with instructions as to how to identify symptoms including chest pain or shortness of breath, and identify the steps they should take if they experience angina or heart attack-like symptoms. 

Managing risk factors associated with cardiovascular disease is important for those with PAD. Lowering cholesterol, quitting smoking and improving blood sugar and blood pressure control may improve claudication symptoms while reducing the risk of heart attack and stroke. 

In conclusion, you can help your patients with PAD feel better starting today. Thank you for taking time to join us, and please visit pcna.net/PAD for additional information and resources. 

Patient Perspectives

SUSAN: Welcome to today’s topic, How PAD Impacts Your Patients’ Lives. I am Susan from northern Colorado. In this video, we will cover the impacts of peripheral artery disease on patients, as well as their families and caregivers. 

Many of us take for granted that we can relatively easily move from point A to point B—whether we are traveling up or down stairs, grocery shopping, getting from the car into a friend’s house or even navigating through a shop or restaurant. For patients with PAD, even these tasks can seem insurmountable.

Let’s get the perspective of a patient. I’m here with Betty, and she’s had PAD for about a year. Betty, can you tell us about the types of symptoms you have experienced?

BETTY: You bet I can Susan. The first symptom I experienced was leg pain. When I was walking around places like the grocery store, my leg would start to hurt and even tingle. At first, I thought it might be because I was over-tired or had somehow pulled a muscle or something, since the pain went away when I stopped walking, but then it kept happening.

Then I figured it was just because I was getting older and that everyone had this type of pain. I didn’t know at first that it was PAD.

SUSAN: So Betty, did the symptoms impact your family in any way?

BETTY: At first, the symptoms weren’t as frequent and it didn’t make much of a difference. But as time went on and I wasn’t able to walk very far without any pain, my family definitely was impacted. I had to rely on help to even walk my dog!

I couldn’t walk up the stairs anywhere without pain, so I relied on my family to get things in and out of the basement when they were needed. We’d have to really consider our plans with friends in case there were stairs at their homes and decide if it was really worth the effort. In commercial buildings, I was always looking for an escalator or elevator if it was available—and often times, these are much further away than you expect and the additional walking would cause me pain, also.

And I often chose movie theater seats closer to the screen if it meant that I wouldn’t have to navigate any stairs. 

Parking also became more of a challenge—we were always looking for the closest spot for everyday errands and even special events. My family members and friends went out of their way to even drop me off and pick me up at the door of a store, and I’d sit—if possible—and wait for them to park the car and join me.

If I was having a particularly bad day, with pain after walking only a short distance, we’d sometimes miss out on planned activities such as concerts, festivals or other events. Even when I did get to go, I was always looking out for the next place to sit down—and sometimes tell my family or friends to simply go ahead without me.

SUSAN: Betty, were there any other impacts that you noticed?

BETTY: I sure did Susan, I noticed that I was giving up activities that I liked—golf, bowling, church and my service club—because of the walking that was involved. I really felt left out, and kind of angry that I had to make so many changes in my life. 

I also felt guilty because I know that some of my past choices, like years of smoking, have put me at risk for conditions like PAD. 

SUSAN: Betty, what advice would you give to someone who thinks they might have PAD symptoms?

BETTY: Susan, I would tell them to talk to your doctor or nurse like I did. When I was diagnosed with PAD, we decided on what to do together. For me, it worked to start with lifestyle changes to help get my underlying conditions under control. We’ll look at other treatment options if this isn’t enough.

Also, it has been helpful to talk with people about my experience—although it was tough at first because I was really embarrassed by my limitations. My clinic has a support group for patients—and I also talked with some friends at my service club about feeling left out of things. Everyone was very understanding and provided some great perspectives—and they made me feel better when I was having a bad day.

SUSAN: Well Betty, thank you so much for sharing your experience with us.  Understanding the impacts of PAD on patients, families and caregivers helps all of us provide the best possible care and continue to work towards the best patient outcomes.

For other topics in this series, additional information and resources, please visit pcna.net/PAD. Thank you for joining us.