Lifestyle Changes:

Exercise is the most important lifestyle measure for treating, and preventing, PAD.

Exercise to Help the Heart. The benefits of regular moderate exercise for the heart are undisputed. People who maintain an active lifestyle have a 45% lower risk of developing heart disease than do sedentary people. And, according to the American Heart Association, patients with PAD who are physically active have death rates that are a third of those who are less physically active.

Exercise Training to Improve Blood Flow in the Legs. Exercise training improves blood flow in the legs and, in some cases, can work as well as medications and surgical procedures in increasing pain-free walking distance. To maintain benefits, exercise must be regular and consistent. A regular walking program, either outside or on a treadmill, is the best type of exercise for patients with PAD and can significantly slow the rate of functional decline.

For patients with intermittent claudication who find that their leg cramps make it difficult to walk or participate in lower-extremity exercise, upper-body aerobic exercise can still provide benefits. By increasing oxygen and blood flow through the body, arm aerobics may help reduce leg pain and improve a patientâ ' s ability to walk.

Quit Smoking

Patients who smoke should quit. Smoking is one of the primary risk factors for PAD and a major cause of complications. Quitting smoking may not make leg pain go away, at least not in the short term, but it certainly may keep blockages from getting worse. Continued smoking is associated with the majority of patients who progress from milder forms of PAD to critical limb ischemia involving severe pain, skin ulcers, and possible amputation. Smoking cessation also reduces the risk to the heart.

Eating Habits

The goals of a heart-healthy diet are to:

• Reduce overall cholesterol levels and low-density lipoproteins (LDL), which are harmful to the heart
• Increase high-density lipoproteins (HDL), which are beneficial for the heart
• Reduce other harmful lipids (fatty molecules) such as triglycerides and lipoprotein(a)

Any diet should also help keep blood pressure and weight under control. General guidelines for a heart-healthy diet include:

• Choose fiber-rich food (whole grains, legumes, nuts) as the main source of carbohydrates, along with a high intake of fresh fruits and vegetables.

Dietary fiber is the part of food that is not affected by the body's digestive process. Only a small amount of fiber is metabolized in the stomach and intestine. The rest is passed through the gastrointestinal tract and makes up a part of the stool. There are two types of dietary fiber, soluble and insoluble. Soluble fiber retains water and turns to gel during digestion. It also slows digestion and nutrient absorption from the stomach and intestine. Soluble fiber is found in foods such as oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. Insoluble fiber appears to speed the passage of foods through the stomach and intestines and adds bulk to the stool. It is found in foods such as wheat bran, vegetables, and whole grains. Fiber is very important to a healthy diet and can be a helpful aid in weight management. One of the best sources of fiber comes from legumes, the group of food containing dried peas and beans.

• Avoid saturated fats (found mostly in animal products) and trans fatty acids (found in hydrogenated fats and many commercial baked products and fast-foods). Choose unsaturated fats (particularly omega-3 fatty acids found in vegetable and fish oils).

• When selecting proteins, choose soy protein, poultry, and fish over meat.
• Weight control, quitting smoking, and exercise are essential companions of any diet program.

[For more information, see In-Depth Report #43: Heart-healthy diet.]

Vitamins

In general, no vitamins have been proven to reduce the risk for PAD or heart disease. Low levels of vitamin D have been linked to an increased risk of PAD; many older Americans are deficient in this vitamin. Deficiencies in the B vitamins folate and B12 have been linked with elevated levels of homocysteine, an amino acid that has been associated with a higher risk for heart disease and PAD. However, while vitamin supplementation lowers homocysteine levels, it has no effect on heart disease outcomes. Vitamin E has also not been shown to help with symptoms.

Herbs and Supplements

Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Always check with your health care provider before using any herbal remedies or dietary supplements.

Gingko biloba is an herbal remedy reported to have blood-thinning properties. However, studies have shown it does not provide any benefit for patients with PAD or intermittent claudication. Although the risks for gingko appear to be low, there is an increased risk for bleeding at high doses and harmful interaction with high doses of anti-clotting medications. This is particularly important because patients with PAD often use these types of medications. Commercial gingko preparations have also been reported to contain colchicine, a chemical that can be harmful in pregnant women and people with kidney or liver problems.