Vickie Powell-Bass could barely walk half a block before the pain became overwhelming.
Fatty plaques had built up in the arteries that supply blood to her legs, a condition called peripheral artery disease (PAD) that affects as many as 12 million Americans. And up to 4 million suffer leg pain from the condition.
"I was embarrassed," says Powell-Bass, 60, of Chicago. "I didn't want people to see me barely walking. If I had to stop, I'd try to play it off."
Leg pain began to limit her ability to walk to the bus stop, or leave the house at all.
Without a car, "I would wait for someone to come and pick me up," Powell-Bass says.
Most patients with PAD get invasive treatment, in the form of a stent, which acts like a scaffold to prop open blocked blood vessels, says Alan Hirsch, director of vascular medicine at the University of Minnesota Medical School.
Powell-Bass' doctor didn't feel she was eligible for a stent, and she wasn't crazy about the idea of surgery.
But she agreed to enroll in an exercise study at the Northwestern University Feinberg School of Medicine in Chicago.
Participants in the six-month intervention were randomly assigned to walk in their community and attend support group meetings, or to attend health lectures. Those assigned to walk met once a week for 90 minutes, spending half their time learning how to manage their condition, and half that time walking around an indoor track. These participants also were assigned to walk on their own, at least five days a week, working up to 50 minutes at a time.
Powell-Bass says she can now walk at least 10 blocks. "I didn't believe it would work," she says. "But now I can do what I need to do without pain."
Most of the walkers in the program also improved their speed and endurance.
After six months, people assigned to the exercise program increased the distance they could walk in six minutes by 138 feet, according to a study of 194 adults released in July in the Journal of the American Medical Association. Those not assigned to exercise - who attended weekly health lectures instead - actually grew weaker, walking 30 feet less than when they started.
Patients assigned to exercise also increased the amount of time that they could walk on a treadmill, from eight minutes to 9½ minutes.
While those changes may seem small, they're enough for patients to notice real changes in their quality of life, says study author Mary McGrae McDermott, a professor at Northwestern.
Patients' improvements on the treadmill are about equal to the improvement seen in patients prescribed cilostazol, the main medication for PAD, Hirsch says.
Powell-Bass says the support group taught her ways to cope with pain and push through the end of a workout.
"It's better to walk and stop, than to stop walking," Powell-Bass says. "When I feel it, and it gets overbearing, then I stop for 30 seconds, stretch my legs and start again."
Now, she advises others, "Just do a block. Over the next couple of days, you may be able to walk a block and a half. I am living testimony: It gets better."
While these findings are encouraging, Hirsch notes that doctors don't yet know if others would enjoy the same benefits. While almost anyone can begin walking around the block, Hirsch notes that the support group was a key part of the study. Without that support and education, others who try to walk to relieve their leg pain may give up.
And while earlier studies of home-based walking for PAD have produced mixed results, McDermott says her study suggests that doctors should recommend it to their patients.
Walking in the community is less expensive than the alternatives, which include medication, surgery to place a stent in the blocked artery or even bypass surgery to reroute blood flow in the legs. Between 25% to 50% of stents stop working after two years, McDermott says. About 20% of bypass surgeries stop working after five years.
McDermott's study didn't compare these three options to see which was most effective.
Still, other studies have shown that supervised walking on a treadmill - overseen by a personal trainer - improves symptoms as much or more than surgery, says Emile Mohler, director of vascular medicine at the Perelman School of Medicine at the University of Pennsylvania.
Patients randomly assigned to a supervised treadmill program actually walked farther without pain than those patients who received a stent, according to a study published last year in Circulation by Mohler, Hirsch and others. Doctors arranged for personal trainers to supervise patients in order to maintain consistency across the study, and so they could offer patients a clear prescription, Mohler says.
Powell-Bass says walking has helped her lose weight and has given her a new appreciation for fitness after suffering health problems for decades. She was 19 when she developed hypertension, which runs in her family. She spent 15 years on kidney dialysis and has had two kidney transplants.
Exercise also offers additional benefits for the heart, lungs and mood, McDermott says. About one-third of people with PAD also have diabetes, she says.
In addition to walking in her neighborhood, Powell-Bass now goes to a gym, walks on treadmills and works with weights.
While walking may sound like a simple remedy, Hirsch says there are still barriers for some patients. Medicare doesn't cover the cost of a supervised walking program, which can be too expensive for many patients. Others may not live near a gym, or have transportation there. Medicare also doesn't pay for support groups or disease education classes.
"If you could do this on the phone, people could do it anywhere," Hirsch says.
Mohler is conducting a cost-effectiveness study of supervised walking. He predicts that it will prove to be a better bargain than surgery, which costs at least $2,000 for the stent, in addition to the cost of hospitalization, medications and doctors' fees.
Powell-Bass knows she needs to keep up her routine so the pain won't return.
"You can't say 'I've done it and it's over,'" Powell-Bass says. "It's never over."