For patients with advanced peripheral arterial disease (PAD), walking from one room to another can be a slow, painful journey. That’s because fatty plaques in their leg arteries obstruct blood flow, causing leg cramps. This type of cramping that is triggered by exercise and relieved by rest is called claudication.
Claudication can be treated with medication or stenting, but the most effective pain relief is gained through exercise therapy.
In June of this year, after 15 years of lobbying by multiple physician groups, the Centers for Medicare & Medicaid Services agreed to cover supervised exercise therapy for PAD. The ability to be reimbursed for exercise therapy opens the door to a better quality of life for millions of people with this form of cardiovascular disease.
“We have known for years that patients with claudication pain get the same benefits from a physician-supervised exercise program as from a procedure—and sometimes better. We are thrilled with CMS’s decision,” says Cleveland Clinic vascular surgeon Lee Kirksey, MD.
Why Exercise Works
Exercise therapy for PAD is similar to cardiac rehabilitation. Patients walk on a treadmill to the point of feeling moderate leg pain, rest until the pain resolves, and then begin walking again.
“Stressing the muscles causes them to use oxygen more efficiently. It also makes new blood vessels grow around the blockages, creating healthy routes for blood flow,” Dr. Kirkseyexplains.
Newcomers to PAD exercise therapy walk slowly and stop often. In no time at all, they discover that the more they walk, the longer they are able to walk before the leg cramps kick in.
What a Supervised Exercise Program Entails
CMS will cover up to 36 physician-supervised exercise sessions over a 12-week period. Sessions must be 30 to 60 minutes in length, conducted in a hospital outpatient setting or physician’s office, and supervised by a medical professional, which can include a physician, physician assistant, nurse practitioner or clinical nurse specialist trained in life-support techniques.
Because patients with PAD often have coronary artery disease, a physician-supervised program ensures their safety.
Supervision increases the likelihood that a patient will perform the exercise, complete the program and derive the expected benefits.
“Claudication is so uncomfortable that most people find it too challenging to push themselves enough to benefit without supervision. Others become concerned about causing themselves possible harm and simply won’t do it,” says Dr. Kirksey.
“In general, patients who try to exercise independently don’t get the same benefits as those in a supervised program. Many, in fact, find their symptoms stay the same or get worse, and they end up requiring surgery.”
Living Life to the Fullest
Research has repeatedly shown that a supervised exercise program can increase both pain-free walking distance and total walking distance. It can help PAD patients avoid revascularization. It can also help patients who undergo revascularization maintain the benefits they have acquired.
“Patients who undergo revascularization can become deconditioned over time if they don’t do enough walking,” says Dr. Kirksey.
After completing the course, most patients feel well and confident enough to continue exercising at home or with a community-based program.
Whether or not exercise helps someone with PAD avoid revascularization or stay strong and mobile after surgery, recovering the ability to walk makes an enormous difference in quality of life.
“They find they have renewed ability to go about their daily life with less pain and more enjoyment,” says Dr. Kirksey.