Washington: People suffering from the peripheral arterial disease should be given the option of pain-free exercise, suggests a new study, which has been published in the 'European Journal of Preventive Cardiology.'\r\n\r\nAround 200 million people worldwide have peripheral arterial disease (PAD), where arteries in the legs are clogged, restricting blood flow to the legs and raising the chances of stroke and heart attack. Smoking, diabetes, high blood pressure, and high cholesterol all increase the risk of PAD.\r\n\r\nAround 30 per cent of patients have pain and cramping in their legs when they walk, referred to as intermittent claudication.\r\n\r\nExercise is a cornerstone of PAD management, together with smoking cessation, healthy diet, and weight loss. It improves symptoms, mobility, and quality of life.\r\n\r\n"For many years the standard exercise prescription for patients with PAD has been to walk towards, and push past moderate to severe pain," said study author Edward Lin of the University of Toronto.\r\n\r\n"Research has shown that this approach improves walking distance and quality of life. Naturally, if you force patients to walk past their pain thresholds and continue to do so, they're going to get better at walking," Lin said.\r\n\r\n"It has been suggested that the pain component of conventional exercise programmes is a deterrent. More recent studies have shown that pain-free forms of exercise are equally effective, but patients are not always given the option," Lin said.\r\n\r\nThis study compiled the best evidence and compared completion and adherence rates between traditional versus alternative exercise programmes of at least four weeks duration.\r\n\r\nCompletion was defined as the proportion of participants who finished the programme, while adherence was the percentage of exercise sessions done.\r\n\r\nIn the study, traditional programmes consisted of walking until moderate to severe pain was induced, resting until the pain subsided, then repeating the process.\r\n\r\nAlternative exercises included walking without pain, arm ergometer (an exercise bike for the arms), resistance training, circuit training, lower limb aerobic exercise, and walking with poles.\r\n\r\nA total of 84 studies and 4,742 patients were included in the analysis, encompassing 64 traditional walking programmes and 58 alternative exercise programmes.\r\n\r\nCompletion rates were six per cent higher in programmes with alternative forms of exercise compared to painful walking (80.8 per cent versus 86.6 per cent).\r\n\r\nSimilarly, adherence was eight per cent greater in alternative programmes compared to painful walking (77.6 per cent versus 85.5 per cent).\r\n\r\n"Pain played a major role in the completion and adherence rates. Walking to pain is effective, but only if patients actually do it. Many clinicians and vascular surgeons still prescribe this type of exercise, but it's important to consider other types of activity, which have also been shown to work," he said.\r\n\r\n"If patients prefer not to walk to pain, they can be encouraged to do pain-free exercise they enjoy. This should increase the likelihood of maintaining long-term physical activity," Lin said.