Peripheral artery disease, peripheral artery disease support
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How To Walk Effectively To Improve Circulation 

· Heart of Innovation

You don’t want to miss this compelling episode of The Heart of Innovation, not only because it has the potential to save life and limb through a deep dive into how walking can help create a ‘natural bypass,’ but because a patient shares his story of how a second opinion changed
his life.

In segment three, Duke and his vascular specialist Dr.Yazan Khatib at First Coast Cardiovascular Institute in Jacksonville, Florida talk about how a leg amputation was thwarted. Duke has Peripheral Artery Disease (P.A.D.), which is a chronic circulation issue in mainly the legs. Duke had multiple interventions and bypasses to restore blood flow to his legs before finding Dr. Khatib. The catalyst for Duke seeking help from Dr. Khatib was the point where his previous doctor told him that it wasn’t worth his time and energy financially to delay what he believed was the inevitable, which was amputation. It was Duke’s Primary Care Physician who told him to get a second opinion before amputation. Four years later, Duke is still walking on two feet thanks to regular maintenance by Dr.Khatib and lifestyle modifications, especially walking.

Walking is the best medicine for P.A.D. That’s why during this episode, hosts Kym McNicholas and Dr. John Phillips spend the majority of time leading up to the Save My Piggies segment and afterwards talking to Interventional Radiologist Dr. Lorenzo Patrone, 2022 European Patient Champion and 2020 Global Vascular Doctor of the Year, about why walking is the best
medicine for P.A.D. and other circulation issues. Mass General Hospital Vascular Surgeon Dr. Anahita Dua also shares how to walk effectively to wake up and grow your collateral network to help improve circulation without intervention.

P.A.D. is defined by a narrowing of the arteries, mainlyin the legs, due to plaque build-up. When flow is restricted, muscles, organs, and tissue are starved of critical nutrients, including oxygen. This may cause symptoms, such as leg pain and cramping when walking (claudication). Even worse, it could prevent healing of sores on your feet, leading to ischemia, meaning tissue loss. Wounds need oxygen to heal. Your body does have a back-up system. It's the collateral network, known as your body's "natural bypass."

The collateral network consistsof smaller vessels available to handle extra demand. What makes them so special is they have the ability to expand and even grow if necessary to keep up with demand.

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Walking helps to accelerate this process.

When you walk or exercise, your heart startsto pump harder and faster to circulate blood to deliver oxygen to your muscles, organs, and tissues. If arteries can't handle the additional rush of blood flow, the collateral vessels re-structure to meet the increased demand.

Think about it like our freeway system. If there's anobstacle such as an accident on the freeway blocking the flow of traffic, more cars veer off on to side roads to continue moving forward towards their destination. Collateral vessels, like side roads, can vary in capacity, but unlike side roads collateral vessels can expand and grow with increased demand. The extent to which your collateral network can keep up with demand, depends on the individual and stage of disease.

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The collateral network's effectiveness may be limited inindividuals with advanced age PAD and those with smaller vessel disease below-the-knee. That's why it's important to get a full vascular assessment. During this assessment, discuss with your physician:

  • What is the extent to which you believe mybody will be able to re-route flow and slow the progression of disease
  • Based on my situation, what should be mydaily and weekly walking goals?
  • If walking is my initial treatment protocol,what symptoms are a warning for me to return prior to my scheduled follow-up
    for immediate re-assessment?
  • What are next steps if my Ankle-BrachialIndex (ABI) test improves by my next appointment?
  • What are next steps if my ABI test does notimprove by my next appointment?

For those without Critical Limb Threatening Ischemia(CLTI), standard protocols for treating P.A.D. suggest a three-month program that consists of medical and exercise therapy. During that time, physicians assess whether an antiplatelet drug and/or a vasodilator, coupled with brisk walking will help your body to increase flow not only through narrowed
arteries, but also through the collateral network.

If you are post-procedure, following an intervention orbypass, your physician will prescribe a walking regimen to help maintain the recently treated vessels open, as well as to continue to maintain and build your collateral network. If a covered stent is used or bypass is performed collateral vessels will be impacted in those areas, but walking will remain critical to
increase demand for blood flow to maintain those vessels open.

Some facilities offer a formal Supervised Exercise Therapy (SET) program to support
walking as medicine for P.A.D. patients. If your physician doesn’t have a formal walking program, go to to sign up for My Steps, which is a text-based program designed to meet each individual patient’s needs and goals to increase long-term accountability.

  • Read more about how to walk effectively togrow your natural bypass in the 20-page step-by-step PADdy's Post"Walking Special" handbook.
  • To find other P.A.D. Warriors walking to better health, join our community at or search “Peripheral Artery Disease” to download
    our app from the App Store or Google Play.
  • Listen to the full episode of The Heart of Innovation to hear straight from Dr.
    Patrone, Dr. Phillips, and Dr. Dua on how to walk effectively to grow your
    collateral network: