New Vascular Rehab Program Provides Hope for Patients with Peripheral Artery Disease

Anyone who has had a cardiac episode is familiar with cardiac rehab – a rehabilitation program to strengthen and improve their heart. But a new rehab option just launched at Texas Health that could make a big impact beyond the heart: vascular rehabilitation.

Unlike cardiac rehabilitation, which targets the heart, vascular rehabilitation is designed to meet the specific needs of patients who have been diagnosed with peripheral artery disease (PAD) or intermittent claudication (IC). It is estimated that one in every 20 Americans over the age of 50 has PAD.

“It is a condition where there are blockages in the leg arteries,” says Deborah Bricker, registered nurse and vice president of Heart & Vascular Services at Texas Health Resources. “It prevents the leg muscles from being fed arterial blood flow.”

Bricker explains that these blockages, similar to blockages in the heart, cause the muscles in our legs to not function well due to the lack of blood supply, which results in intense pain and cramping. This cramping usually occurs after a period of exercise and is relieved after rest.

Vascular rehabilitation aims to challenge those muscles by providing a specialized exercise program that is medically supervised by a professional staff, including cardiovascular nurses and exercise physiologists.

“There are very strict protocols for exercising to the point where you start having pain, then once you have pain, the exercise protocol pushes you just a little bit further so that you stress that muscle to demand more blood flow,” Bricker says. “This is similar to cardiac rehab in that it uses exercise to try to improve the health of that muscle. But in cardiac rehab you don’t really want to push to the point of pain; you want to push to the point where you’re not having pain. So it’s a little bit different in the fact that it targets peripheral muscles instead of the heart.”

Beginning Feb. 26, 2018, the vascular rehabilitation program will be available at ten Texas Health locations across the Metroplex.

“Cardiac rehab managers have done an outstanding job at structuring this appropriately and getting this standardized at each of the ten sites,” Bricker says. “There are clinical protocols that have all been done; clinical competencies; and education to the staff that will be providing this, so it’s been a wonderful success story.”

The program is conducted in a hospital outpatient setting by qualified personnel who are trained in exercise therapy for PAD, and includes up to 36 sessions during a 12-week period. A typical session is 30 to 60 minutes long and incorporates treadmill walking, stationary cycling, and other cardiovascular and strengthening exercises, depending on pain tolerance.

Signs and symptoms of PAD can include:

 - Painful and limited walking due to pain in the legs and calf muscles

 - Poor tolerance to activities of daily living in the standing position

 - Color changes in the skin of the feet, including paleness or blueness

 - Poor nail growth and decreased hair growth on toes and legs

 - Pain in the legs and/or feet that disturbs sleep

 

“Typically, people start complaining to their physician that they can’t walk very far without their legs, one leg, or a hip hurting,” Bricker explains. “And typically you start having pain with exercise or walking and then it goes away once you stop and rest. That’s the stereotypical symptom of PAD.”

Contributing factors of PAD include the presence of other health conditions such as diabetes, high blood pressure, or abnormal blood cholesterol levels. Heart disease or an incidence of heart attack or stroke are also contributing factors.

The American Heart Association and American College of Cardiology recommend vascular rehabilitation as the primary treatment for patients with PAD and IC before undergoing more intense or riskier treatment plans.

“We feel like this is a population that has been underdiagnosed, under-treated, or sometimes over-treated by immediately going to surgery or having an endovascular procedure,” Bricker says. “Going to a vascular rehab program really maximizes the medical therapy given to those patients who have this condition, before they go on to further surgery or eventually lose a limb, so it’s really a part of our preventative program that is the right thing to do for the patient.”

Although exercise has traditionally been prescribed by physicians to treat PAD or IC, Bricker explains that the program helps keep patients accountable so they can be successful.

“A lot of times patients do not do their due diligence and they end up having to have a procedure done in place of exercise therapy,” she says. “It’s been proven that if you have a coach who is coaching you through and making sure you do that exercise every single day, or at least three times a week, you’re going to be more compliant with that recommendation.”

Candidates have to be diagnosed with PAD or IC by a physician before being referred to the program. A vascular rehab representative will work with you and your physician’s office to get you started.

Bricker recently was featured on a Texas Health Out Loud podcast, discussing this new therapy. To listen to the podcast, go here.

 

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