Claudication Cadence: Another Critical Variable For Fighting Peripheral Arterial Disease (PAD) With Exercise

In November, 2019, I published a book, “How to Train for Aging: The Ultimate Endurance Sport,” in which I described my struggle to run with peripheral arterial disease (PAD). At the track, I reported my first mile with an 18:20, yes, eighteen minutes and twenty seconds for one mile. A brisk walking pace. This was because I had to stop all the time to let blood into my right calf, or I couldn’t run – claudication!

What the hell, I thought. I ran the Boston Marathon in 2009, so I was once a runner (great book btw!)

Peripheral arterial disease prevents blood reaching my lower legs, inducing pain due to lack of blood in my feet and calves. This pain is called claudication, and it’s a right pain in the butt. But worse, it interferes with function, preventing a healthy running stride.

Since then, I’ve managed to keep PAD at bay, by building collaterals. This is done through exercise, lots of exercise, especially running. In order to promote new blood vessel growth, you have to let your body know you need them. It’s just like working out in the gym, as you gradually increase the weights, and your body adapts by growing more muscle, while strengthening bones and other connective tissues. It also grows your mind, your discipline and patience.

Education and pace are everything, in this game.

One-by-one, I’ve added the following modifications to my run, and each one is providing increasing relief from claudication and numb feet, and defective foot mechanics due to poor blood supply. This is coming with a gradual increase in my pace. The variables I’ve added, over the last few years, based on my medical and athletic training, are:

• An even lower impact running style than I had already – WHY? – To minimize pressure waves ascending my legs, to negate systolic pressure waves pushing blood toward my feet.
• Soft feet – WHY? – Relaxed muscles and connective tissues perfuse more effectively, as they present less resistance to regional arteriolar and capillary blood flow. They are also mechanically more responsive to the changing loads placed upon them. Tension is almost never a good thing!
• Minimalist shoes – WHY? – So my feet can feel, and thus talk to, the road. Modern running shoes are essentially orthotic devices, to be used at the your peril – they hide your heel strike, which will eventually kill your knees (bone-on-bone).
• Thick woolen socks (got this idea from my Ironman triathlete son, Nigel – eight times to Kona) – WHY? – To protect my feet, as minimalist shoes are tough on feet, and they are especially tough on the feet of people with connective tissue weaknesses, thus my abdominal aortic aneurysm (AAA).
• Running with the whole body, combined with lots of cross-training conditioning – WHY? – Strong, relaxed muscles, and a conditioned mind, can take considerable load off your feet and calves. I find that cycling and water running definitely contribute to my running progress.
• Toe flexion – WHY – To improve venous return and pump blood through your feet. It works, done right, though you have to carefully condition your anterior tibialis muscles.
• Regular stretching after workouts – WHY? – Because relaxed, lengthened muscles are less prone to injury, and they perfuse with blood more effectively.

And whence my latest trick?:

While walking my dog, Gizmo, the other day, I noticed a young lady was catching up with us, and so, being a scientist at heart, I wondered why. She was going about 25% faster than Gizzy and me. She was no taller than myself, and her stride length was similar. She also seemed to be walking in a relaxed manner, so I attempted to imitate her stride. The difference was simply her cadence. I counted hers, and she was making just over 60 strides (both feet, complete cycle) per minute. I then determined my base walking cadence. Just over 40.

Everyone complains how slow I walk, but I’m more about the journey than the destination.

I upped my cadence to 60, and claudication kicked in, in my right calf, within a 100 yards. I backed off, and the claudication diminished slowly. I realized that I could use my regular walks (5-10 miles/day), as collateral training, by easing my cadence up, in a controlled manner. I did this for a couple of days, and then applied it to a three-mile run, where I was struggling to maintain 15-minute pace, and this is what I got, by just upping my cadence during long walks, and during intermittent walking, while running, to get blood into my feet and calves.

Furthermore, I didn’t have to stop once to let blood into my right calf, and feet, I just eased back on the cadence, which did the trick. That probably accounts for the one sub-14!!!

You can fight peripheral arterial disease by using exercise to grow collaterals. Before you attempt to run, if you can, consider exploring the effects of walking cadence, and use it to tell your body, “Hey, I need more blood down here.”

And remember, “A life without risk, is no life at all.”

-kev aka FitOldDog

PS My training for the 2022 Arizona Ironman is picking up. Did a decent (for PAD) 9-mile run, yesterday, and a steady 60-mile ride today (Sunday, Aug. 7, 2022). What do I mean by steady. It’s a pace designed to encourage mitochondrial growth to improve the metabolic efficiency of my muscles. I work to hold a load of about 110-120 watts (this comes with experience, and previous coaching) – gave an average pace, over easy rollers, of 14.34 mph.