By Kym McNicholas, CEO of the Global PAD Association
Welcome to our first-ever “Collateral Nation: Walking Wednesdays” blog! I couldn’t be more excited to kick off this series with my amazing co-host Dr. Kevin Morgan—an 82-year-old pathologist, retired veterinarian, PAD warrior, and triathlete who’s been managing his condition for over a decade without surgery.
What is PAD and Why Walking Matters
Peripheral artery disease causes poor circulation in your legs because of narrowed or blocked arteries. When you have PAD, you get that cramping pain in your legs when walking—claudication—which honestly really sucks. But here’s the thing that might surprise you: don’t stop walking. Walk more. Walk through those cramps.
I know it sounds backwards. Why would you keep walking when it hurts? Because every step you take actually helps your body grow new blood vessels—natural bypasses that can save your legs.
“It’s particularly important if you do have peripheral artery disease, that poor circulation in your legs,” I explained during our show. “When you have poor circulation in your legs, you get claudication, you get cramps in the back of your legs when you walk, and that really sucks. So, it’s counterintuitive, but we’re going to tell you: don’t stop walking. Walk more. Walk through those cramps.”
With every step, your body is actually building natural bypasses around those blockages. Yes, your body can grow new blood vessels with consistent walking—it’s a remarkable ability we all have.
Meet Dr. Kevin Morgan: Living Proof That Walking Works
Kevin is the real deal. At 82, he still does triathlons even though his right popliteal artery (behind the knee) is 100% blocked.
“My right popliteal artery is 100% blocked, and there is no pulse on the top of my foot,” Kevin shared. “The dorsal pedal artery is getting no blood, but my feet are still working. It’s harder, but they’re running on collaterals that I’ve been building through training. And the best place to start that training is walking.”
Kevin was diagnosed with PAD in 2014 when his running performance tanked. “In 2014, my running went to hell. I started getting numb feet in marathons and calf pain.” By 2015, doctors confirmed severe PAD. When he asked his surgeon about stents, the doctor actually warned against it: “You risk losing that leg. It’s a dangerous procedure.” Instead, he suggested walking—advice that changed Kevin’s life.
What makes Kevin’s perspective so valuable is his unique combination of expertise. As a pathologist with a PhD in veterinary neuropathology, he understands disease mechanisms at a deep level. Plus, he’s studied body movement extensively through Feldenkrais, Pilates, yoga, and even Bruce Lee’s Jeet Kune Do fighting style. This blend of medical knowledge and movement expertise has shaped his approach to fighting PAD.
“My medical training and my pathology training have been critical for how I’ve dealt with PAD since 2014,” Kevin explained.
The Walking Program: A Step-by-Step Guide
Morning Preparation: The PAD100 Routine
Before you even get out of bed, there’s something you can do to jump-start your circulation. Kevin’s “PAD100” morning routine is a simple but powerful exercise to wake up your feet.
“I turned my feet into pumps,” Kevin explained. “I spread my toes and then I contract them. I contract them and then I pull back, which contracts all the muscles in the bottom of my feet. And that pumps the blood out of my feet. And then I lift and spread my toes. That helps the exit of the blood and tissue from my foot up toward my calf.”
You do this 100 times before getting out of bed. Our viewer Mike has made this part of his daily routine and raved about the results: “Once I get to 90 to 100, I can really feel it in the top of my feet and in the bottom of my feet… once I get up, it’s like I’m walking on air.”
During our live show, I tried the technique while on my treadmill and immediately felt relief from the hip pain I’d been having! This isn’t surprising since, as Kevin noted, “your feet and your hips are integrated. They’re an integrated system.”
For those who can’t get out of bed or struggle with mobility, Kevin offers hope: “Number one is you can imagine doing an exercise. Imagine walking. Imagine moving your feet around and wiggling your toes. Imagine it. And that actually helps.”
Mastering Your Walking Technique
Once your feet are awake, how you walk becomes critical. Think about it – when was the last time anyone taught you how to walk properly?
“When do you think we learn to walk? Pretty well when we’re about 18 months or two. We rush across to mom’s arms. And that’s how we learn to walk. As a general rule, we get no further training on walking,” Kevin pointed out.
Without proper training, we develop inefficient—sometimes harmful—walking patterns. “If you watch people walking, you’ll see they do some extremely odd things. Some are kind of leaning back. Others, their feet are sticking sideways like ducks. Some sway from side to side. But then if you watch a trained athlete walking, they have a very strong shoulder-hip counter-rotation. Their movements are very fluid.”
Kevin suggests having someone film you walking so you can see what you’re doing. “The best way to start that is just get a friend to film you walking towards them and away from them. And then you’ll see what you’re doing.”
He recommends Danny Dreyer’s book “Chi Walking” to learn proper technique. I can’t stress enough that how you walk matters as much as how much you walk. The right technique can make all the difference in managing claudication and building those life-saving collaterals.
Pushing Through Claudication: Finding the Right Balance
Now let’s address the contentious question that came up during our show: exactly how to handle claudication pain during walking.
I firmly believe—and research backs this up—that you need to push through some of that pain. As I said during our discussion: “A lot of people will stop at that 30 seconds. The moment they feel anything, they stop. And so the whole idea is you got to push through somewhat, not to the point you’re going to injure yourself, but you need to push through in order to walk further the next time.”
Kevin offered a different take that sparked healthy debate. He warned against pushing too far: “You have to take it to the edge of claudication, but not actually claudicate. So you don’t walk through the claudication because now you’re trying to get a muscle to do work it can’t do because it doesn’t have enough blood.”
But he also admitted that when he started in 2014, he had to push through pain frequently: “I would have to stop at about 250 yards on a run. My calf would lock up. I may have to wait as long as 20, 30 seconds for the calf to refill with blood and it would hurt like crap. I think to some extent you have to go to that point initially.”
Here’s what clinical evidence says: PAD patients should walk to moderate-to-severe claudication, push a bit further, then rest until the pain subsides before starting again. This cycle of pushing through claudication (not avoiding it) is exactly what triggers collateral vessel growth.
I’ve seen too many patients who wished they’d pushed more. “God, I wish my doctor would have told me to actually walk through some of that claudication. 'Cause every time I literally started feeling something, I would sit.” And many of them ended up with amputations.
Transitioning to Endurance Training
As Kevin explained, the approach to claudication changes as you develop your walking program. He likened PAD training to endurance sports: “If you push too hard and your calf locks up, then you have to stop. That’s not what you want. You want to take it right to the edge… If you go too fast, then the muscle will be deprived of blood completely, and then you don’t function.”
The goal is to gradually shift from the initial “pushing through” approach to a more sustainable endurance model. As Kevin put it, fighting PAD is “more like a marathon than a hundred-yard dash.” What I found really insightful was his comparison to lactate threshold in endurance training: “It’s basically endurance training. If you push too hard and your calf locks up, then you have to stop. That’s not what you want. You want to take it right to the edge.”
This progression from initial intensity to sustainable endurance is key to long-term success with PAD.
Training Options for Different Needs
Treadmill Training: Building Collaterals Indoors
For those using treadmills, Kevin has specific advice based on his experience. One viewer asked about improving collateral vessel growth while on a treadmill, including using different inclines.
Kevin has created a detailed video on this: “On my YouTube channel, I videoed a one-hour treadmill incline training that I did… I took segments at different incline levels and described how I get to the incline I want to work on.”
He recommends mixing up your training: “I think you have to do both intensity and endurance training. So for intensity, you can have a steep incline for a briefer period of time. But you also need regularly to do less of an incline for a longer time.”
Our viewer Mike shared his approach: “I do intervals of 10 minutes on a high incline and then intervals of 10 minutes on flat for an hour and a half.” This combination of intensity and endurance training can be very effective for building collaterals.
Treadmill Walking for PAD | Kevin Morgan
Alternative Exercises: Beyond Walking
Walking is king, but cross-training matters too. Kevin does cycling and swimming along with his walking. For people who struggle with walking due to severe PAD or amputations, pool exercises can be a game-changer.
“You need cross-training, for which I do cycling and swimming. Swimming is really good, especially certain exercises that are on a couple of my videos,” Kevin explained.
When I asked about exercises for bedridden patients, Kevin offered practical solutions: “If you are able to move your toes at all, there’s certainly stuff you can do… If you flex your toes, you curl your toes down, you can trap muscles in your calves that will help a venous return makes a huge difference. So bodies thrive on activity.”
For water exercises, Kevin emphasized the difference between walking on the pool bottom versus water running: “If you walk on the bottom in the pool, which I never do, it’s a very different kind of training to running off of the bottom, which is my main training approach is water running.” His YouTube channel includes detailed videos of these water exercises.
I’ve personally found great benefit from water exercises. “I ended up going on Amazon and getting a couple two-pound weights. And so when I’m now in the pool, I’ll do the water walking, but then I’ll also, I have a floater belt that I put around my waist and I actually go around the pool and I do little bicycles.”
Weight Training for PAD Patients
Douglas asked a great question about weight training for PAD patients: should they focus on heavy weights or light weights?
Kevin explained: “Once again, it comes down to intensity versus endurance. When I’m trying to build strength, I use heavier weights and shorter reps. When I’m doing endurance, I use light weights and more reps.”
The approach depends on your goals: “Are you trying to build muscle? Are you trying to build collaterals? Are you trying to build muscle, which you need. I mean, you need a strong body and strong muscles. In my opinion, for growing collaterals, the endurance approach is best. For getting strength so you don’t injure yourself, then intensity is better and therefore you use heavier weights.”
Equipment and Gear Recommendations
The Wool Sock Revolution
Here’s a simple tip that surprised me: your socks matter. Kevin strongly advised against tube socks and tight shoes that restrict blood flow.
“Whatever you do, don’t use compression socks. Don’t use tube socks. Don’t use shoes with a small toe box. You want to keep everything as open as you can so as blood and tissue fluids can get around,” Kevin warned.
“The thing about wool is it’s very elastic,” he explained. “And also the lanolin is good for your feet. Foot massages are really good.” Our viewer Douglas switched to all wool socks and told us: “I got rid of all my socks, and all I have now is wool socks. Building my tiny house and walking and staying on my feet all day, I have been able to tell a big difference in how my feet feel at the end of the day.”
Kevin recommends Smart Wool socks and shoes with a wide toe box so your toes can spread properly. “Being able to spread your toes is really important for pedal blood flow because there’s a number of arteries between your metatarsals. If you spread your toes, you spread those bones in your feet. That helps blood flow.”
Special Situations and Populations
After Stents and Bypasses: Keep Walking
A viewer named Paige asked what to do when stents block up again. Here’s what’s critical to understand: procedures like stents and bypasses are temporary fixes. They’re meant to:
Heal wounds that won’t heal due to poor circulation
Relieve severe pain that wakes you up at night
Help with lifestyle-limiting claudication where you can’t even make it to your mailbox
Give you enough pain relief to walk more
“The whole goal with having any interventional procedure to restore blood flow in a manual fashion, whether it’s wires or balloons or even a bypass, is to give you enough pain relief so that you can walk to grow your natural bypasses,” I explained during our discussion.
“These interventions are not permanent. The goal with them is to heal the wound, give you the pain relief so that you can get out and walk, walk, walk to grow your own natural bypasses. So when those go down, you can actually continue to walk.”
Kevin agreed and added: “If it looks like you’re heading for problems with the existing stents through clotting or build up on the wall, then you should be doing your training then. You should start your walking program then.”
If your symptoms don’t improve over 6-8 weeks of consistent walking after a stent blocks, then it’s time to talk to your doctor about another procedure. But remember, the goal is to build enough natural bypasses that you don’t need repeated interventions.
For Amputees: A Comprehensive Approach
We had a powerful discussion about PAD patients who’ve already had amputations. Our viewer Alan shared that he has a left leg amputation and half of his right foot amputated, limiting him to walking only 200 yards before pain stops him.
Kevin emphasized the need to work with what you have: “Somehow you have to let go of the past and work with what you have. So you have to discover what you have and then use it.”
For amputees, Kevin recommends focusing on whole-body fitness: “You need to get general, keep whole body strength. But boy, you have a challenge, but it’s exactly the same problem we have. Somehow you have to find a way to exercise and keep growing collaterals further up your leg.”
Pool exercises can be particularly beneficial for amputees. Kevin suggested: “If he can use the pool, if that’s possible, and work from the core. So working, I mean, when you swim kick, because I made a video about kicking in the pool, I find it helps my feet a lot because as you kick, it spreads your feet.”
For Alan specifically, who also has cardiomyopathy limiting his ability to do high-impact exercises, Kevin noted that endurance training would be more appropriate than intensity training. This approach aligns with his cardiovascular limitations while still promoting collateral vessel growth.
One challenge many amputees face is ill-fitting prosthetics. “Most people that we deal with, their prosthetics are never perfect,” I noted. “They just don’t seem to get them fitted right. And so they have trouble walking further and faster to a point where their other leg, the leg that’s actually remaining, is getting the endurance training that it needs in order to build those collateral network of vessels to save it.”
Kevin suggested that alternatives like wheelchair racing or other adaptive sports might help some amputees maintain cardiovascular fitness while building strength. The key is finding activities that are enjoyable and sustainable: “For me, it’s Ironman, but he needs to find things that he can sense progress and change and help others in similar situations.”
What struck me about our conversation with Alan is how many PAD amputees feel discouraged when they don’t see immediate progress. Kevin noted that for amputees especially, it’s essential to develop a personalized approach: “It’s a problem-solving issue. And we are at such early days with this. Man, amputations need to stop, that’s for sure. Because most of the time, I think they can be avoided with regular atherosclerosis.”
Prevention: Start Before You Need To
One of Kevin’s most powerful messages was about prevention. If you have any signs of atherosclerosis or family history, start working on your collateral vessels now.
“I think with this disease, if there’s any sign whatsoever of atherosclerosis or arteriosclerosis in you or family members, whatever, it’s important to think prophylactically, think ahead. And the exercise program should begin then because you need the collaterals later on when the vessels start to block.”
Kevin’s own story illustrates this point. He ran the Boston Marathon in 2009, years before his PAD diagnosis. That fitness foundation likely contributed to his ability to manage severe PAD now. His blood profile was concerning even in his 30s: “My fasting triglycerides were over 2000, whereas they should have been below 150 milligrams per deciliter. This was like a really a life threatening situation. And I was saved by my exercise and training.”
Join Our Walking Wednesdays!
Wherever you are in your PAD journey—newly diagnosed, living with claudication, post-procedure, or post-amputation—movement is medicine. Start where you are and build from there.
As Kevin summarized: “Remember, you’re probably going to have PAD for the rest of your life. So now you’re an endurance athlete fighting PAD. That’s the enemy, and you can beat it. I mean, I’m still going at 82. I did a local run not long ago. And so it’s, you would hardly call it running. I’m slow because I’ve got PAD and I’m 82. I mean, what do you expect? But you still do it.”
I’d love for you to join Kevin and me every Wednesday for our “Collateral Nation: Walking Wednesdays” sessions. We’ll walk together, answer your questions, and keep you motivated.
If you’re experiencing leg pain, numbness, or PAD concerns, call our Leg Saver Hotline at 1-833-PAD-LEGS. Join our walking support group at www.walkingsupportgroup.com and visit Kevin at inspirationalselfhelpbooks.org for his books and newsletter.
Kevin sends out a newsletter every Thursday morning, and if you reply to that email, he’ll get back to you personally with advice tailored to your situation. He’s offered this especially for amputees and others facing complex PAD challenges.
Want to join our live sessions? Email info@padhelp.org and we’ll get you set up!
Remember, it’s not about counting steps—it’s about setting aside 30-60 minutes daily to walk with purpose and build those life-saving natural bypasses. Your legs will thank you!
References:
Hamburg NM, Balady GJ. Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits. Circulation. 2011;123(1):87-97.
McDermott MM, Polonsky TS. Home-Based Exercise: A Therapeutic Option for Peripheral Artery Disease. Circulation. 2016;134(16):1127-1129.
Gardner AW, Afaq A. Management of Lower Extremity Peripheral Arterial Disease. J Cardiopulm Rehabil Prev. 2008;28(6):349-357.
Treat-Jacobson D, McDermott MM, Bronas UG, et al. Optimal Exercise Programs for Patients With Peripheral Artery Disease: A Scientific Statement From the American Heart Association. Circulation. 2019;139(4):e10-e33.
Fakhry F, Rouwet EV, den Hoed PT, Hunink MG, Spronk S. Long-term clinical effectiveness of supervised exercise therapy versus endovascular revascularization for intermittent claudication from a randomized clinical trial. Br J Surg. 2013;100(9):1164-1171.
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