No pain no gain?

Inger-Lise AamotAs we grow older, the risk of different diseases increases. For instance, as we reach middle age, most of us have some degree of atherosclerosis (plaques build up in the arteries). As the plaque burden increases, the lumen in the arteries narrows and blood flow becomes limited to organs and muscles. This can cause serious trouble and lead to heart attack or stroke, but another not uncommon condition is intermittent claudication (IC). This is a condition where the arteries cannot deliver enough oxygenated blood to the muscles, typically in the legs, with symptoms like pain and cramping in the leg muscles during walking. This lead to a functional limitation, reducing the walking distance and quality of life. It is estimated that about 20% of the population worldwide is affected by peripheral arterial disease, and one third of these people have IC. Major risk factors for IC are smoking and physical inactivity. Therefore, to improve functional status and quality of life, people with IC are encouraged to “stop smoking and keep walking”.

Exercise is medicine in numerous different conditions, also in mild-to-moderate stages of IC. The #1 recommendation of exercise in this population is supervised exercise performed as walking, to moderate-severe pain. However, uptake to exercise programs is very low and adherence is low as well. Not surprisingly really, as we can imagine that only the most motivated people will expose themselves willingly to pain. So how can we make the “exercise pill” taste a little better?


In the last years, several studies have assessed the effect of different modes of exercise on walking distance in IC. It has been found that both arm cranking and strength training have substantial effect on walking distance (both pain free and total distance). Improvements in walking performance may be explained by exercise-induced central cardiorespiratory adaptations, improved lower limb oxygen delivery and utilization, and changes in walk economy. Tompra and colleagues  concluded in a systematic review of the literature that exercise performed for upper or lower limbs in people with IC induced the same improvements in walking distance. Based on their findings, the authors recommended that alternative exercise programs should be considered to make exercise more attractive in this population. So “Stop smoking and keep walking” is not a bad idea, however, maybe we just should start to say “Stop smoking and just keep moving”?

Inger-Lise Aamot

Post doc CERG/ Head of the Norwegian National Advisory Unit on Exercise Training as Medicine for Cardiopulmonary Conditions.


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About CERG

The Cardiac Exercise Research Group (CERG) at the Norwegian University of Science and Technology (NTNU) seeks to identify the key mechanisms underlying the beneficial effects of physical on cardiac health in the context of disease prevention and treatment. Named the K.G. Jebsen Center for Exercise in Medicine under Professor Ulrik Wisløff's leadership in 2011, CERG uses both top-down and bottom-up approaches to combat lifestyle-related disease.

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