"No pain, no gain" approach improves walking ability with peripheral artery disease

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. 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.

At the study's start and at 6 and 12 months, participants completed three tests of leg function: walking speed over a four-meter distance (13 feet) at the usual pace, walking speed over a four-meter distance at the fastest pace, and the short physical performance battery (SPPB) consisting of four-meter walking velocity at usual pace, a standing balance test and the time for five repeated chair rises.

The key findings were:

At six months, participants whose walking pace induced leg pain or discomfort walked 11 feet per minute faster, and at 12 months, they walked more than 16 feet per minute faster than participants whose walking pace did not induce leg pain or discomfort. Compared to non-exercisers, participants in the group that walked for exercise at a pace inducing leg pain or discomfort walked nearly 13 feet per minute faster at six months, however, this increase was not statistically significant at 12 months.

At 12 months, people who walked for exercise with leg pain or discomfort scored almost 1 point higher on the sum of the three leg function tests (the short physical performance battery), out of a total of 13 points (0-12), compared to people who walked at a comfortable pace with no leg pain. For those walking for exercise at a comfortable pace, there was no improvement in walking speed at six months or 12 months compared to non-exercisers.

It is important to note that study participants walked at home, so the results may not apply to walking on a treadmill in the presence of a health professional, which is the standard of care and first-line therapy according to clinical practice guidelines.

Ref: Mary M. McDermott et. al, "No pain, no gain" approach improves walking ability with peripheral artery disease, AMERICAN HEART ASSOCIATION, Journal of the American Heart Association, DOI: 10.1161/JAHA.121.025063