Peripheral Artery Disease (PAD) refers to a reduction of blood flow in the arteries. Its main clinical symptom is intermittent claudication, which refers to cramp-like pains in the legs after walking for a while, thus stopping the patient from walking. In Spain, about 1.6 million active workers have signs of chronic ischaemia in legs. Although peripheral arterial insufficiency can affect anybody, diseases such as diabetes are an important risk factor to take into account.
A doctoral thesis carried out by Dr. Adelaida María Castro Sánchez in the Department of Physiotherapy at the University of Granada and directed by researchers Carmen Moreno Lorenzo, María Belén Feriche Fernández-Castanys and Mercedes Nieto García has shown the efficacy of the joint application of two physiotherapy methods on peripheral arterial insufficiency in type 2 diabetes patients.
Participants in this experimental study included patients from ages 30 to 65 who were diagnosed with type 2 diabetes and with PAD in stages I and II-a, according to the classification of the chronic ischaemia in legs in four clinical stages which was established by Leriche-Fontaine.
Massage and exercise
This research project, which was carried out in collaboration with the Andalusian Health Service, is based on the study of the application of a programme of sublesional kinetic therapy and bindegewebsmassage (subcutaneous reflex therapy) at the arterial haemodynamics level in the legs of type 2 diabetes patients.
On the one hand, sublesional kinetic therapy refers to an exercise programme which helps to develop a collateral circulation around the arterial segment affected by esthenosis in order to improve the natural process of compensation. On the other, bindewegebsmassage refers to carrying out a series of reflex strokes applied on certain areas which are far away from the affected areas. These areas do not usually show pain pathologies. This technique is based on the stimulation of an area located far away from the affected area, both being connected by a nerve circuit. “A stimulus produced in a subcutaneous conjunctive tissue has an effect on internal organs or tissues, improving blood circulation among other beneficial effects,” said researcher Castro Sánchez.
Complementary therapy
The joint application of the massage and the programme of physical exercise produces the best results in patients, raising arterial blood flow in legs and producing and decreasing arterial tension figures, “30 minutes being necessary, after the therapeutic application, to achieve the maximum vascular effect.” In addition, decreased figures of glycosylated haemoglobin show the benefits of the programme of exercises over the glycine metabolism. Moreover, both therapeutic methods improve the quality and reduce the score in the pain perception scale to effort, as well as raise the intermittent claudication threshold.
According to researcher Castro Sánchez, the interventions, complementary to pharmacology in PAD, are not profoundly developed in Spain. Based on the achieved results, the combination of both intervention methods is a complementary therapy for the treatment of PAD in first stages in type 2 diabetes patients “to slow down development of the disease, to raise course perimeter and to improve cardiovascular function and, consequently, the patient’s quality of life.
Reference: Adelaida María Castro Sánchez. Department of Nursing of the University of Granada. Telephone: +34 958 243 493. Mobile: +34 686 723 203. E-mail: adelaid@correo.ugr.es.