“Sit-Walking” for Peripheral Arterial Disease (PAD)

Enriched Life Home Care Services is pleased to present an educational article from Dr. James Hundley, VP for Research of GO2, LLC. Dr. Hundley is a board-certified orthopaedic surgeon with over forty years of medical experience and has provided valuable information in this article about Peripheral Arterial Disease.

Is it possible to walk while sitting?  Of course not!  Furthermore, why would you?

Physicians recommend walking as an effective treatment for PAD (Peripheral Arterial Disease).  Unfortunately, walking enough to make a difference is not possible for some and not feasible for others.  In addition, if you have PAD, walking can cause “claudication1” (calf and leg pain while walking) that makes you sit down and rest before continuing.

Before we talk about “sit-walking”, let’s describe how walking can help the circulation in your legs.  Fresh blood containing oxygen and nutrients goes into your legs through your arteries.  It then continues through your capillaries (tiny, thin-walled vessels) where the oxygen and nutrients are delivered to the tissues and the waste products of muscle activity are picked up.  Then it continues through the veins back up to and through the heart to be refreshed through the lungs and other organs before going back into the legs and elsewhere.  Walking helps with the blood circulation by energizing the “calf pump” which increases the blood flow out of the legs and then helps bring more in.  That raises the question, “What is the calf pump?”

Please bear with me for a little science. 

A) When you’re sitting, blood is pumped downhill into your legs under high pressure.  The amount of the blood flow reaching the lower part of the legs and feet relates to the pressure and the size of the arteries and the distance it must travel.  You cannot change the distance and you don’t want to have too much blood pressure.  Fortunately, walking can cause concurrent enlargement of the inner diameter of the arteries (Imagine making a water hose larger.) so more blood can be pumped through them at the same pressure.  Exercise is known to cause this enlargement (called “vasodilation”) and the reason is thought to be through the release of chemicals (including nitric oxide, famous for its role in the treatment of erectile dysfunction) into the blood stream inside the arteries.

B) We know from our own studies that vigorous exercise is not required for the leg arteries to dilate (enlarge).  Whether walking or sitting the act of working your ankles up and down causes the calf muscles to tighten and relax.  The tightening squeezes the deep veins2 that run among the calf muscles pushing out the blood.  Valves in the veins3 direct the blood back up toward the heart.  This phenomenon is a body mechanism called the “calf pump” or “second heart”.  In our research, about a minute after the increase in blood flow velocity occurs in the veins there is a large increase in the blood flow velocity in the arteries.  These studies were done in subjects sitting down working their feet up and down on a low-resistance treadle, a device that makes it nearly effortless to do so.

C) As mentioned above, one of the factors affecting blood flow is the length of the vessel.  The longer the vessel (the tube) the more resistance there is for blood (fluid) to get to its end.  In normal blood vessels, this is not a problem.  Unfortunately, those with PAD (including those with and without diabetes) have clogging of the inside of their arteries and ultimately the blood cannot flow freely to where it needs to go.  This can result in pain with walking due to oxygen deprivation of the leg muscles (claudication) and sores and poor healing in the feet and toes due to inadequate circulation to the skin and deeper tissues.

Now let’s discuss “sit-walking” and how to make it easy.  First try working your ankles up and down for as long as you can.  Most people tire in the front of their legs fairly quickly.  That’s because the muscles in the front of the legs are relatively small and can’t last very long.  They’re mainly there to lift your feet when walking so you don’t stumble over your toes.  You need help to work your calf pump while sitting.

CV2-TreadlingImage

There are several devices out there but we prefer a momentum-assisted device that both helps lift the front of your feet to assist the calf pump and then recruits you to keep on going.  Many people can use this non-electrical device to work their ankles while sitting and reading or watching television, etc., for hours without even thinking about it.  In fact, it has been calculated that “treadling” (working your feet up and down on a treadle) for fifteen minutes can approximate the number of calf pumps you would get from walking for one and one-half miles.

So, what do we recommend?  Walk as much as you can.  That’s the best physical activity you can perform to help yourself.  It’s good for general conditioning, bone health, and your circulation.  If you can’t walk enough, work your ankles up and down as much as you can.  If you have trouble doing this on your own, find a device to help you do so.

For additional information, please take a moment to view the following videos:

http://youtu.be/T0HA2riysQI

 

1Claudication is a medical term for leg pain while walking.  We are discussing “vascular claudication” in this article but leg pain from other disorders such as “spinal stenosis” can closely mimic vascular claudication.  Before assuming that you have one or the other, you should get an opinion from your physician.

2You’ve probably heard of DVT, an abbreviation for “Deep Vein Thrombosis”.  It is also known as “blood clots” in the legs and can cause a serious problem called a pulmonary embolus (blood clot going from the legs into the lungs).  Physicians encourage their patients to work their ankles up and down to help prevent DVT by helping keep the blood from being sluggish.

3Sometimes the valves in the legs are absent or don’t function properly resulting in varicose veins.

Dr. Hundley, VP for Research of GO2, LLC (www.goodbloodflow.com), is a board-certified orthopaedic surgeon with over forty years of medical experience.  Since becoming involved with treadling to improve circulation he has taken a special interest in vascular disease and has performed research demonstrating that the calf pump can favorably affect both arterial and venous blood flow, leg edema (swelling), and pain in the legs of those with edematous legs.