For many of the 2 million to 3 million Americans with leg pain from narrowed arteries, exercise could be more effective than some surgeries, a University of Minnesota researcher says.
The primary treatment has been to implant a metal tube called a stent, an effective way to improve blood flow and almost immediately relieve leg pain that comes with exertion.
But a new study at 20 national sites lends support to a far cheaper and in some ways more effective approach to peripheral artery disease, said Dr. Alan T. Hirsch, chairman of a study. The study appeared last week in the American Heart Association journal Circulation.
Patients in a six-month program of medication plus supervised exercise -- one hour three times a week on a treadmill -- could walk longer without pain than either those with stents or those in a third group given medication and home exercises.
Stents were not ineffective. While both the exercise and stent patients reported higher quality of life after six months, those with stents reported the most improvement.
However, those with supervised exercise could walk 5.8 minutes until they had to stop because of pain, while those with a stent hit the pain threshold at 3.7 minutes. "Improving leg strength and limiting pain can really improve quality of life," Hirsch said. In addition, he noted, exercise benefits a patient's whole body.
A key national issue, however, is that Medicaid and private insurance typically pay for stents, but not the cheaper and more effective supervised exercise. Hirsch said he hopes that "this reimbursement nightmare" changes soon, as it has for other physical conditions such as low back pain, where exercise typically is the first treatment suggested to patients.
The researchers will report next year how the three groups are doing after 18 months.
"This appears to be another area of medicine where exercise is effective and safe, and almost certainly more cost effective," Hirsch said. Exercise "may take more time and dedication, but the result may be worth it."
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