Supervised exercise for peripheral arterial disease

The NHS describes the main symptom as a painful ache in the legs when walking that usually disappears after a few minutes of rest, called intermittent claudication. Other signs include hair loss on the legs, numbness, brittle toenails, ulcers that do not heal, skin colour changes and, in men, erectile dysfunction.

The pain occurs because narrowed arteries cannot deliver enough blood to working leg muscles. Rest allows the supply to catch up, which is why symptoms ease.

The NHS says peripheral arterial disease is largely treated through lifestyle changes and medicine, and puts regular exercise and stopping smoking among the main interventions. Regular walking encourages the leg muscles to use oxygen more efficiently and promotes small supplementary blood vessels, so people can usually walk further before the pain limits them.

Exercise does not clear the narrowed arteries themselves. It helps the legs and the heart cope better and lowers the wider risk of heart attack and stroke that comes with arterial disease.

The NHS describes a programme of 2 hours of supervised exercise a week for 3 months. Classes are run by physiotherapists or exercise professionals, usually in a hospital, leisure or community setting, and typically combine walking with other leg and general fitness exercises.

Availability varies across the UK, so ask your GP or vascular team whether a programme exists locally. If none is available, ask for written advice on a structured home walking plan.

The NHS advises a stop-start approach: walk until the pain becomes intolerable, rest until it eases, then walk again, building up to at least 30 minutes of walking in total, repeated across several sessions a week. It adds that you should aim to exercise daily for the rest of your life after the programme.

Discomfort during walking is expected and not harmful, but chest pain, severe breathlessness, dizziness or a foot that becomes cold, pale or painful at rest are different and need medical advice.

• Wear well-fitting shoes and check your feet daily for sores.

• Walk on level ground at first, then add gentle slopes.

• Record the time you can walk before pain starts to see progress.

The NHS lists statins to reduce LDL cholesterol, blood pressure medicines such as ACE inhibitors or ARBs, and blood clot prevention with aspirin, clopidogrel or rivaroxaban. Naftidrofuryl oxalate may be offered for leg pain on exercise and is typically taken for around 3 to 6 months to see if it works.

Where symptoms are severe or the blockage is limb-threatening, angioplasty, a day procedure that widens a narrowed artery with a tiny balloon, or a bypass graft, which uses a blood vessel from elsewhere in the body, may be considered. The NHS says bypass results are generally longer-lasting but the operation is more invasive.

The NHS lists stopping smoking, a healthy diet, losing weight if overweight and moderate alcohol among key recommendations. Smoking is the single most important modifiable factor, because it speeds artery narrowing and makes treatment less effective. NHS stop-smoking services and pharmacists can help.

Foot care matters too, especially for people with diabetes. Report any wound that is slow to heal.

The NHS says critical limb ischaemia needs urgent attention: contact a GP immediately if symptoms develop, and call 111 or use 111 online if that is not possible. Warning signs include pain in the leg or foot at rest, sores that do not heal and skin changes such as a cold, pale or dark foot.

Sudden severe leg pain with a cold, pale, numb foot is an emergency and needs 999.