As the CEO of the Global PAD Association, I’ve spoken with thousands of patients struggling with peripheral artery disease (PAD). The most common reaction I hear when doctors recommend walking as treatment? Disbelief.
“You want me to do MORE of the very thing that causes me unbearable pain?”
It seems counterintuitive, doesn’t it? Yet walking truly is the best medicine for PAD, a disease that’s more prevalent and deadlier than most cancers combined—including colon, breast, and prostate cancer.
Recently, I had the privilege of interviewing Dr. Chris Seenan, our Global PAD Association’s Walking Therapy Researcher of the Year, who provided invaluable insights into why walking works and how to make it effective for PAD patients.
Understanding PAD and Why It Hurts
Before diving into treatment, let’s understand what’s happening in your body. PAD occurs when arteries narrow due to atherosclerosis—the hardening and furrowing of blood vessels. This narrowing restricts blood flow to your legs and feet.
When you walk, your leg muscles demand more oxygen. With narrowed arteries, not enough blood can reach these working muscles. This oxygen deficit causes lactic acid to build up, resulting in that characteristic cramping pain called claudication.
As Dr. Seenan explained: “That pain you feel in the legs is a symptom, not the cause. It’s almost the output of the condition.”
The pain signals that your muscles aren’t getting enough blood flow. But here’s the crucial point: experiencing this pain doesn’t cause further damage to your vessels. In fact, it’s part of the healing process.
Why Walking Works When It Hurts
“Most doctors will tell you to avoid what makes you hurt,” I mentioned to Dr. Seenan during our interview. “But with PAD, they tell you to do more of it. Keep it hurting. Push through it.”
Dr. Seenan nodded, explaining that walking:
Slows the progression of arterial narrowing
Builds collateral circulation—natural bypasses around blockages
Improves overall cardiovascular health
Think of it like weight training. When you push through that last painful rep of bicep curls, you’re teaching your muscles to adapt and grow stronger. Similarly, when you walk through claudication pain, you’re signaling your body to develop new blood vessels to supply oxygen to those muscles.
Your body is remarkably adaptive. When regularly challenged by walking, it responds by growing a network of smaller blood vessels that bypass the blockages. These collateral vessels become your body’s natural bypass system.
Walking Recommendations: How Much Is Enough?
One of our attendees, Duncan, asked a question many patients have: “How much should I walk? I’ve been told to walk three times a day, but I don’t know how long, what speed, or what gradient.”
Dr. Seenan offered these evidence-based guidelines:
Frequency: 3-5 sessions per week (not necessarily 3 times daily)
Duration: 30-60 minutes per session
Intensity: Walk into pain—push yourself, but be reasonable
“We recommend walking into pain,” Dr. Seenan advised. “But we don’t have conclusive evidence that you absolutely have to walk into excruciating pain.”
The key is finding the balance. If the pain is so severe that it discourages you from walking altogether, that’s counterproductive. As Dr. Seenan put it: “It’s much better to be walking than to not walk.”
Measuring Progress: How To Know You’re Improving
Tracking progress motivates us. But how do you measure improvement with PAD?
Our Global PAD Association app helps track your walking distance before pain starts and how far you can go before needing to rest. It provides a concrete way to see progress.
Kathy, one of our long-time PAD warriors, shared her personal method: “I used to measure bricks in the wall and time it when I went out every lunchtime. I would see how long it took me to get to a brick in the wall before the pain started.”
She also emphasized that sometimes maintaining the same walking ability is progress, since PAD is naturally progressive. “If you can walk comfortably, don’t stop. That’s how you build capacity.”
Different Approaches for Different Needs
PAD affects everyone differently, and finding the right approach for your specific situation is crucial. Some participants shared alternative strategies that worked for them:
Interval Training: Kathy found success with interval training on a treadmill. “I would walk at my fast pace till I couldn’t walk anymore, then turn the speed down, keep walking. As soon as I recovered at the slower speed, I’d turn it up again. What I found was overall, I had a much better quality of walk.”
Walking Aids: Amy asked about using walking sticks or treadmill handrails, as they reduced her hip claudication. Dr. Seenan advised: “If you’re able to walk without pain using the treadmill or aids, that’s getting you walking. I would always encourage that more than pushing into debilitating pain and then not walking.”
Ankle Weights: These can help make muscles work harder, encouraging more blood flow and therefore growth of collaterals. This is particularly helpful for those who live in flat areas without natural inclines.
Creating a Walking Habit
Dr. Seenan summed up the approach beautifully: “Some is good. More is better. Make it a habit.”
He emphasized being kind to yourself: “If I’m doing some, that’s great. If I can do more, that’s excellent. What’s most important is that it becomes part of your lifestyle.”
Because PAD doesn’t go away and is progressive, making walking a consistent habit is essential for long-term management.
Finding Opportunities Everywhere
Kathy shared a brilliant perspective on fitting walking into everyday life: “I’m a real big believer in fidget activity. I never sit through a set of adverts. I get up every single set of adverts. Sometimes I’ll run up the stairs, do things up the stairs, come back down.”
Dr. Seenan smiled at this advice, noting it was “exactly the kind of model I wish I could adhere to.”
The key takeaway? Feel empowered. You have control, and there are many ways to incorporate movement into your day. Every small effort adds to that “bank” and helps your situation.
The Urgency for Younger Patients
A disturbing trend is emerging in the U.S.—Science Direct has reported an influx of patients between ages 18-27 presenting with advanced CLI (Critical Limb Ischemia) facing amputation.
This makes walking as medicine even more crucial for younger patients. As Kathy noted, “When you’re younger, you need to [keep PAD at bay] because when you get older, it’s much more difficult. You lose muscle mass and just keeping the capacity going is much harder. It’s like putting money in the bank that you’re going to draw out later when you need it.”
Special Considerations and Frequently Asked Questions
Is It Back Pain or PAD Pain? How to Tell the Difference
One of the most common questions we receive is how to distinguish between back pain and PAD pain. Here’s how to tell them apart:
PAD pain typically develops after walking a specific distance (which is fairly consistent for each person), gets worse the longer you walk, and relieves quickly with rest.
Back pain may be present immediately when starting to walk, doesn’t necessarily worsen in a predictable pattern with distance, and might not be immediately relieved by simply stopping.
This distinction is crucial for proper treatment, as each condition requires different approaches.
Managing Back Pain and PAD Together
Derek asked about the “perfect storm” of having both back pain and PAD. This common combination can feel overwhelming—back pain makes walking difficult, yet walking is essential for PAD.
Dr. Seenan recommends seeking specialized help for each condition: “For the back pain, have they been to see someone specifically for that issue and trying to get that managed as best they can. And then while dealing with that, also try to chip away with the leg pain at the same time.”
If you’re facing this challenge, consider:
Working with a physical therapist who understands both conditions
Developing a specific stretching routine for your back that won’t interfere with your PAD walking program
Using walking aids that reduce strain on both your back and legs
Starting with shorter walking sessions multiple times a day
Swimming or water therapy, which reduces pressure on joints while improving circulation
Remember that gentle walking is often recommended for back pain too, so finding the right balance can help both conditions simultaneously.
Cold Weather Challenges
Heinz raised concerns about walking in cold weather. Dr. Seenan explained that cold causes vasoconstriction—narrowing of blood vessels—which can worsen PAD symptoms.
“In cold weather, generally your body tends to do vasoconstriction. If you have PAD and increased narrowing of your vessels already, cold will make that even worse.”
Consider mall walking or indoor tracks during extreme cold, or invest in quality warm gear if you must walk outdoors.
Exercises When You Can’t Walk
For those temporarily unable to walk due to recovery, or who need seated options, there are several effective alternatives:
Seated Foot Cycle: These compact devices allow you to “pedal” with your feet while sitting in a chair. They’re excellent for maintaining circulation without putting weight on healing wounds or painful joints. A foot cycle can help build and maintain collateral circulation while recovering from procedures or amputations.
Hand Cycles: Since 3 in 5 heart attack sufferers also have PAD, don’t forget about your upper body circulation. Hand cycles can provide excellent cardiovascular exercise when leg exercise isn’t possible. This helps build collateral vessels not just in your legs, but potentially in your heart too.
Chair Exercises:
Pushing the “accelerator pedal” with your foot
Drawing the alphabet with your foot
Bending and straightening your knee
Using resistance bands
Heel raises if possible
Post-Amputation Rehabilitation
Marsha, preparing for a toe amputation, asked about rehabilitation. Dr. Seenan advised a personalized approach: “See what you’re like after the procedure—what you can manage, what you can’t, how your pain levels are.”
After amputation, focus on:
Following your medical team’s wound care instructions precisely
Using the seated foot cycle once cleared by your doctor
Gradually returning to weight-bearing activities
Maintaining overall cardiovascular fitness through upper body exercises
Working with a physical therapist who specializes in vascular conditions
The key is to maintain circulation and fitness without compromising healing. As Marsha noted, “I’ll be happy to say goodbye to this toe and get on with my life.” With proper rehabilitation, many patients find their mobility actually improves after recovery.
Medications and Walking
Rudy asked about medications like blood thinners and statins. Dr. Seenan confirmed these can be valuable complements to walking therapy:
Blood thinners help blood flow more easily through narrowed vessels
Statins help control cholesterol levels and reduce plaque buildup
Cilostazol (a vasodilator) can be beneficial for some patients
Some find benefit from natural supplements like ginger capsules, which have vasodilating properties
While medications are helpful, they work best when combined with a consistent walking program.
Getting Support
If you’re struggling with PAD or suspect you might have it, please don’t face this journey alone. Walking as medicine works, but it works even better with proper guidance and support.
Join our walking support group HERE.
Also, call our Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS. Our team can provide resources, answer questions, and connect you with specialists in your area.
For those serious about starting a walking program, it’s always a good idea to ask your physician if they know of and can refer you to a Supervised Exercise Therapy program in your area. If not, the Global PAD Association offers a structured walking program at no cost and is flexible to fit your schedule, and it’s specifically designed for PAD. We invite you to sign-up HERE to receive the download information for our walking app, which helps track your progress and provides motivation to keep going.
Remember: PAD may be progressive, but with the right approach to walking, you can build your body’s natural bypass system and take control of your circulatory health. As Dr. Seenan reminded us, “Every time you do one of these things, you’re adding to that bank and helping your situation.”
This content is designed for educational and informational purposes only. Do not act on any information provided here without EXPLICIT consent from your own healthcare team. Your healthcare team knows your situation best. So, it’s important to use this information only to help you have a more productive conversation with them about what your role is in improving your PAD prognosis. Never start a new workout routine or walking program without checking with your healthcare team on the right one for you.
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