Poor arterial circulation in the legs (limping): physiotherapy

What is limp?

Do you have pain or discomfort in one or both legs when you walk, and you have to stop often?
If so, you may be suffering from intermittent claudication. This problem is caused by poor circulation in your legs, related to a narrowing or blockage of one or more arteries.
If one or more arteries are narrowed or blocked, your muscles are not getting enough blood and oxygen. This lack of oxygen acidifies your muscles. You will then feel pain that looks like a cramp.

An artery can gradually become blocked. We talk about arteriosclerosis, atherosclerosis or atheromatosis. Atherosclerosis is caused by deposits of fat (atherosclerotic plaques) and calcification of the walls of blood vessels. The blood circulates less well in the artery and the muscles receive too little oxygen.

You will find more information in the guide ‘Poor arterial circulation in the legs (limping)‘.

Risk factors

You are at greater risk of developing poor circulation in your legs if:

• you smoke ;
• people in your family suffer from cardiovascular disease;
• you are older;
• you suffer from diabetes ;
• you suffer fromarterial hypertension ;
• you have a rate of too high cholesterol ;
• you are overweight;
• you don’t exercise a lot and you often sit still.

What can you do to prevent a limp?

Try to limit the above risk factors. To do this, a healthy lifestyle is very important.

• Try tostop smoking, this is the most important measure!
• Get enough movement. Walk an hour a day if possible. If that’s not possible, every little bit counts.
• Watch your weight.
• Eat healthy and varied.
• Moderate your alcohol consumption.

Exercise program

Ask your doctor if you can follow an exercise program and gait training (see below), supervised by a physiotherapist preferably specialized.

What can you do with your physiotherapist?

Walking training is the best treatment for claudication:

• You follow this training preferably under the supervision of a physiotherapist specializing in the field of claudication. This physiotherapist has therefore undergone specialized training to support you in this training.
• Walking training supervised by a physiotherapist certified in limping is the best guarantee of obtaining good results.

How is the gait training going?

Gait training goes like this:

• It is about walking and doing endurance exercises with the legs (bike) and arms (crank, rower)¹. Muscle building (weight training) is also useful².

• The intensity of the training is determined by the physiotherapist according to your capacity to be able to make an effort³ and depending on your pain. It’s pretty intensive, so try to persevere. The physiotherapist will encourage you to do so.
• Important thing to know: The pain felt during training does not cause any harm to your muscles.
• After a few weeks, the supervision offered by the physiotherapist gradually decreases, and you will train more and more independently.
• Make gait training part of your daily routine.
• If you don’t exercise for a while, your walking distance will become shorter again.
• So try to walk and move every day.
• If you follow the physiotherapist’s instructions correctly:
• you will generally get good results after 3 months;
• you will notice after 6 months that your walking distance is already longer, without feeling any pain;
• your physical condition will improve;
• your complaints will decrease.
• The gait training program can take up to 1 year.

Thanks to an intensive gait training program combined with a healthy lifestyle, 7 out of 10 people with lameness do not need surgery. So don’t give up too quickly!

Want to know more?

• Physical activity – Eat Move – Health question
• Move at any age… After 50 too! – Eat Move – Health Question

• Stop smoking. It’s possible – Tabacstop
• Calculate your Body Mass Index (BMI)
• The food pyramid – Eat Move – Health Question
• Alcohol, the point on your consumption – Stop or else?

Are you looking for more specialized help?

• Smoking Assistance Center (CAF®) – FARES – Respiratory Affections Fund
• Tobacco specialists – FARES – Respiratory Affections Fund
• Find a registered dietitian – Professional Union of French-speaking dieticians
• Find a nutritionist doctor – Belgian Society of Nutritionist Doctors
• Alcohol aid – Le Pélican & Le center ALFA

Sources

Main sources

• Dutch practice guide ‘Symptomatic obliterating arterial disease’ (2014), updated in 2017 – KNGF – Koninklijk Nederlands Genootschap voor Fysiotherapie (summary in French)
• Dutch practice guide ”Symptomatisch perifeer arterieel vaatlijden‘(2014), updated in 2017 – KNGF – Koninklijk Nederlands Genootschap voor Fysiotherapie (original)
• Patiëntenfolder ClaudicatioCare

1. Zwierska I, Walker RD, Choksy SA, et al. Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: a randomized controlled trial. J Vasc Surg 2005; 42: 1122–30
2. Parmenter BJ, Mavros Y, Ritti Dias R, et al. Resistance training as a treatment for older persons with peripheral artery disease: a systematic review and meta-analysis. Br J Sports Med 2019.
3. Parmenter BJ, Dieberg G, Smart NA. Exercise training for management of peripheral arterial disease: a systematic review and meta-analysis. Sports Med 2015; 45: 231–44