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Newsletters February 2011 - Jefferson Cardiology Happenings

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Peripheral Artery Disease and Gender Differences

Recent research has demonstrated that women may be more limited than men by clogged leg arteries or peripheral artery disease (PAD). PAD is like heart disease of the legs. A buildup of cholesterol narrows the leg arteries and reduces effective blood flow. Most commonly, symptoms consist of pain, cramping or fatigue in leg muscles that comes on with walking and is relieved with rest.

In a recent published study, patients’ ability to walk for distances and time was evaluated. CT scanning was also used to measure calf muscle size and physical testing was done to measure knee strength. The subjects were ob-served over four years. Women were found to be more likely to be unable to continuously walk for 6 minutes and al-most twice as likely to report that they could no longer walk a quarter mile or climb one flight of stairs. They also demonstrated a greater decline in walk-ing speed.
Why is there this gender difference? Researchers speculated that men may have greater muscle size and may have more leg strength to continue to walk. Research is needed to determine if exercise to build up calf muscle may help women maintain their ability to walk.

Home Exercise for Peripheral Artery Disease

Peripheral artery disease, PAD, may affect 5% of U.S. adults over 50 and 12-20% over 65. This may limit these persons ability to climb a flight of stairs or walk to a mailbox. PAD is caused by a buildup of fatty material in leg arteries preventing effective blood flow from reaching leg muscles. The process is the same as may cause heart attacks or strokes. The presence of PAD increases the risk for heart attack and stroke. Without treatment, PAD can lead to pain with walking, infections and even ampu-tation.
Research has shown that supervised progressive exercise programs can increase leg circulation and reduce pain caused by walking. Often times, such programs are not covered by insurance and an alternative exercise program is needed.

A recent research study evaluated the benefits of a home exercise program and compared these benefits with those obtained at a supervised program at a medical center. Participants in this study were fitted with an ankle device used to determine walking speed, number of steps taken and incline. One hundred ninety patients were randomized to participate in either the home-based or medical center-based program. Over a 12-week period, walking distance for both groups was increased from 20 min-utes to 45 minutes per session three times per week. Instead of walking on a treadmill, the home-based exercise group was instructed to walk on level ground in their neighborhood.

After 12 weeks, the results of both exercise groups was very similar. Both groups extended their ability to walk and were able to reduce their pain while walking. This study certainly de-monstrated the benefit of a home-based exercise program.

Practical Facts About PAD

The first sign of PAD may be a painful cramp in the calf or thigh that comes on with walking and resolves with rest.  This symptom may cause people to cut down their walking which may worsen the condition.  As the disease progresses, other signs may develop.  Aching and burning in the feet and toes especially at night may occur.  Redness or color changes in the skin of the feet may also occur.  The skin of the feet may feel cool to the touch and sores may develop on the feet that won’t heal.

PAD is diagnosed by history, family history, risk factors, physical exam and testing.  A test called ankle brachial ratio may demonstrate reduced blood pressure and thereby reduced blood flow to the legs.  This is an initial screening test.  Other testing may include ultrasound and angiography by several different techniques. 

Home exercise may be very helpful.  This should include a warm-up for 5 minutes with slower walking and a similar cool down period at the conclusion of the walking period.  Walking may start with 20 minutes three times per week with subsequent increase to 5 days per week until reaching 45 minutes of total walking.  Improvement in symptoms may occur after 3 to 6 months of regular walking.

Risks for PAD can be reduced by exercise and a healthy lifestyle.  Avoiding cigarette smoking is critical as smokers have a 4 times greater risk than non-smokers.  Excess body fat is a risk factor.  Also, high blood pressure and high cholesterol need to be controlled.  Diabetes needs to be avoided by weight loss and vigorously treated if present.

Staff News

We would like to wish a very Happy Birthday to Joanne Bondi.  Joanne is our medical transcriptionist whose hard work and dedication is truly appreciated by all of us here at JCA!  Keep up the great work and truly enjoy your birthday!!!

Happy Valentine’s Day

Happy Valentine’s Day to you and your loved ones from all of us at Jefferson Cardiology. 

National Heart Month

February is national heart month.  Remember to eat healthy, continue to exercise, stop smoking and consume alcohol only in moderation.  Always remember that we will continue to offer a comprehensive array of services to meet our patients needs.  Thank you for your continued support and confidence in our practice.

A publication of Jefferson Cardiology Association
Alan D. Bramowitz, M.D. | Michael S. Nathanson, M.D. | Gennady Geskin, M.D.

Jefferson Hospital Medical Building
Suite 403, Coal Valley Road
P.O. Box 18285

Belle Vernon Office
1533 Broad Ave
Belle Vernon, Pa 15012