By Kym McNicholas, Host of The Heart of Innovation
“Here, our patients are really more like athletes. And like an athlete who’s in training, you have to really continue to work through the pain. And that’s the core principle of supervised exercise therapy.”
These words from Dr. Gaurav Sharma capture the counterintuitive truth that’s changing lives for patients with peripheral artery disease (PAD) at Kaiser Permanente Northern California. Their innovative RESET:PAD program (Remote Engagement Supervised Exercise Therapy: Peripheral Arterial Disease) just earned them the Walking is Therapy Research Team of the Year award from the Global PAD Association—and for good reason.
Why Walking Through Pain Builds Your Body’s Natural Bypasses
When a viewer commented on our YouTube livestream during our recent episode of The Heart of Innovation, they posted a question that cuts to the heart of PAD treatment: “Is walking through claudication pain like pushing through that burning feeling for one more rep at the gym?”
Absolutely.
Dr. Sharma explained exactly how this works: “When you do the walking therapy, you’re stimulating changes in the muscle and other tissues of the leg that make the muscle more efficient at using the energy it’s getting. You’re also sending the signal to your body that increases those progenitor stem cells that are there to rebuild and repair the blood vessels that have been blocked up.”
In other words, that uncomfortable burning in your legs isn’t damaging—it’s the catalyst for your body to build natural detours around blockages. It’s your body’s version of rerouting traffic when the main highway is closed.
This understanding flips traditional advice on its head. For years, patients have been told to “walk until it hurts, then stop and rest.” But that approach misses the critical biological moment when healing actually begins.
The Staggering Numbers That Prove Procedures Alone Aren’t Enough
The body’s ability to create these natural bypasses is why exercise therapy often outperforms surgery for many PAD patients. Throughout my years covering PAD, I’ve interviewed countless patients who underwent stenting or bypass surgery, only to find themselves back in the hospital within months. Dr. Sharma confirmed this pattern with sobering statistics:
“Let’s say we don’t put someone in exercise therapy and we just go in and do a stent or another procedure off the bat. The number of people who then go on to need another procedure after that period at one year is actually more than double.”
Specifically, about 10% of patients in supervised exercise therapy programs might need a procedure within a year. For patients who go straight to stenting without exercise therapy? That jumps to 20-25%. As Dr. John Phillips noted during our conversation, “Once we cross this Rubicon for a procedure, you’re going to have another one.”
These numbers reveal the fundamental challenge in PAD treatment: surgical interventions address the blockage, but not the body’s ability to adapt to it. This is precisely why Kaiser Permanente’s approach is so significant—they’ve developed a systematic way to build the body’s natural resilience.
How Kaiser Found a Tech Solution to the “Just Go Walk” Problem
The medical community has long known exercise is the best medicine for claudication, but telling patients to “just go walk” rarely works. Most patients stop when the pain starts—exactly when they should be pushing through.
Kaiser’s research team tackled this challenge head-on. Rather than simply repeating the same ineffective advice, they reimagined the entire delivery system for exercise therapy through their RESET:PAD program.
The research program utilizes an app developed by CellEd that works with the pedometer in participants’ smartphones, sets personalized walking goals, and—most critically—connects patients with trained health coaches who understand exactly how to help patients push past the pain threshold.
“Part of this project and part of the innovation was really to take that trainer, that health coach, take the gym and bring it to the patients so that they have it here on their mobile phone in the palm of their hands,” Dr. Sharma told us. “They could really integrate it seamlessly into their busy day-to-day lives.”
These coaches use evidence-based techniques like cognitive behavioral therapy to help patients overcome the psychological barriers to walking through pain—transforming what feels like harmful pain into what one PAD patient in our previous episode called “productive pain.”
Building Long-Term Success Beyond the 12-Week Mark
This mobile coaching approach solves the initial challenge of getting patients to walk correctly, but Kaiser’s research team recognized another critical gap in traditional PAD care: sustainability.
Anyone who’s ever made a New Year’s resolution knows that starting an exercise program is one thing—maintaining it is another. This challenge becomes even more significant for PAD patients, who must consistently push through discomfort to continue building collateral vessels.
Kaiser’s solution within their research program? A dedicated sustainability phase built right into the treatment plan.
“Once people went through the intense 12-week period, we have a sustainability phase where they work with our internal health coaches on a regular basis for a minimum of six months,” Dr. Sharma explained. These additional touchpoints help patients solidify their walking habits, especially when life inevitably throws obstacles in their way.
What makes this research approach particularly powerful is how it acknowledges the reality of behavior change. Just as those collateral vessels take time to develop, new habits require ongoing support and reinforcement—especially when they involve embracing discomfort rather than avoiding it.
From PAD to Cancer Care: The Expanding Impact of Exercise as Medicine
The implications of Kaiser’s research extend far beyond PAD. By developing a scalable, technology-enabled approach to supervised exercise therapy, they’ve created a template that could transform treatment across multiple conditions if broadly implemented.
“We’re learning as a field that there probably is a much bigger application for exercise therapy than we really appreciated,” Dr. Sharma noted. His research team is already seeing potential applications in cancer care, where exercise therapy benefits patients undergoing chemotherapy or preparing for surgery. Similar approaches show promise in orthopedics, thoracic surgery, and aneurysm treatment.
This is the hallmark of truly groundbreaking medical research—it doesn’t just solve the immediate problem; it opens doors to possibilities no one had previously considered. By focusing on helping the body heal itself rather than just intervening when it fails, Kaiser’s approach represents a fundamental shift in how we think about disease management.
This broader vision explains why we honored Kaiser Permanente’s team with this year’s Walking is Therapy Research Team of the Year award. Their work exemplifies the future of preventive rather than reactive healthcare—a model that empowers patients rather than simply treating them.
Taking Control of Your PAD Journey Today
While Kaiser’s specific app-based program is currently part of their research initiative, the core principles can benefit PAD patients everywhere. First, you can ask your doctor about adopting the Cell-Ed Supervised Exercise Therapy virtual walking program or to align with a facility-based program. If you’re living with PAD or experiencing symptoms like leg pain when walking, you can also start applying these insights immediately:
Talk to your doctor about supervised exercise therapy programs available in your area, whether in-person or remote. Ask specifically about programs that teach you how to safely push through claudication pain rather than just avoiding it.
Call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS if you have questions about PAD or need help finding resources in your area. Our team can connect you with specialists who understand the importance of exercise therapy.
Join our Facebook group at www.padsupportgroup.org to connect with others who understand what you’re experiencing. Here, you’ll find countless stories from patients who’ve transformed their PAD through consistent walking.
Join the Global PAD Association’s Walking Program ‘30 Day to a 5k’ at PADwalkingGroup.org to track your PAD progress on your own if you don’t have access to a program like Kaiser’s. While not as comprehensive as the RESET:PAD system, it provides a starting point for monitoring your walking and progress.
Remember the fundamental truth we learned from Dr. Sharma and his research team: walking is medicine for PAD, but pushing through the pain is what creates real healing. As one viewer perfectly summarized during our YouTube livestream: “Kim is right. That one more step through claudication is like one more rep in the gym when you feel like you just can’t push the leg press another time.”
Your biological bypasses are waiting to be built—one painful but productive step at a time.
The Heart of Innovation airs weekly on KDOW and streams live on YouTube. This episode was made possible through support from the Global PAD Association, committed to reducing unnecessary amputations through education and advocacy.
