New rehabilitation program for peripheral arterial disease promises to help Canadians walk their way to better health

The University of Ottawa Heart Institute (UOHI) is leading Canada's first dedicated walking rehabilitation program for people with peripheral arterial disease (PAD), a painful and debilitating “hardening” of the arteries outside of the heart, most commonly in the legs. The first-of-its-kind initiative is helping patients not only improve their walking abilities and overall quality of life, but also reduce their risk of future cardiovascular incidents.

PAD patients often harbour a high number of cardiovascular risk factors such as diabetes, high blood pressure and smoking, and have a very high risk for future cardiovascular events such as heart attack, stroke and heart failure. If you or someone you know has PAD, then you are most likely all too familiar with the pain even the shortest walks can produce. Affecting nearly a million Canadians, PAD can progress from minor pain or fatigue in the legs with exercise, to severe pain at rest and even the risk of amputation if blood flow becomes severely restricted.

“PAD patients not only need more help in managing their cardiovascular risk factors, but also with their ability to walk, which can be severely compromised.”

- Dr. Thais Coutinho, Cardiologist and Division Head of Cardiac Prevention and Rehabilitation, UOHI

Despite this, their cardiovascular risk factors tend to be managed less effectively than in patients with coronary disease, predominantly because of the extent of the disease impact itself – because peripheral arteries are much larger than coronary arteries, the amount of plaque responsible for PAD is also usually significantly greater than would be found in people suffering from coronary artery disease, indicating a greater burden of disease.

“That’s why there is such a pressing need for this initiative,” says the program’s creator, Dr. Thais Coutinho, a cardiologist and the Division Head of Cardiac Prevention and Rehabilitation at the UOHI. “PAD patients not only need more help in managing their cardiovascular risk factors, but also with their ability to walk, which can be severely compromised.”

The exercise component of Dr. Coutinho’s rehabilitation program is specifically designed for each individual PAD patient. Taking into account a patient’s individual walking abilities and limitations, the program tailors their physical therapy to help train the leg muscles to work more efficiently when there is a lack of blood and oxygen. Over the course of 12 weeks, patients work with a multidisciplinary team for three hours a week to help them walk farther and/or faster before getting leg pain.

“Within only a few months in Dr. Coutinho’s program, I've seen tremendous improvements in the patients I work with,” says UOHI physiotherapist Sandra Black. “And it’s not just limited to their work on the treadmill and indoor track – they go home being able to do more around the house and when out with friends and family. This has a huge impact on a person’s quality of life. It’s very rewarding to see.”

“I used to experience excruciating pain just going from my car into the grocery store – it was so demoralizing” says Micheline Brazeau, one of the first patients to receive Dr. Coutinho’s PAD-specific rehabilitation therapy at the UOHI. “Today I can walk more often, farther and much longer. The program has changed my life.” Even though walking and risk management interventions have produced positive outcomes for PAD patients and are recommended by all guidelines, a lack of awareness of the condition and its impact has left room for improvement of prevention and care in Canada. By establishing Canada's first dedicated program for risk management and rehabilitation for patients with PAD, Dr. Coutinho and her team at the UOHI are improving awareness, treatment and hope for those currently suffering from the disease.

Video

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