Exercise Training for Management of Peripheral Arterial Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Peripheral arterial disease (PAD), a chronic condition with debilitating clinical sequelae, leads to reduced walking activity and increased mortality risk. Objective: We sought to quantify expected benefits elicited via exercise training in people with PAD and aimed to clarify which prescriptions were optimal. Data sources: We conducted a systematic search (Pub- Med, CINAHL, Cochrane controlled trials registry; 1966-31 July 2013). Study selection: We included randomized controlled trials (RCTs) of exercise training versus usual medical care in persons with PAD. Studies were assessed by two reviewers, 41 of 57 (72 %) of RCTs met selection criteria. Data extraction and synthesis: Data extraction sheets were used to record data and two reviewers cross-checked data. Included study authors were asked for missing data. Main outcomes and measures: Primary outcome: change in aerobic capacity (peak VO₂). Secondary outcomes: anklebrachial index (ABI), flow-mediated dilatation, 6-minute walk claudication distances (initial and absolute) and graded treadmill (initial and absolute) distances. The primary hypothesis was that peak VO₂ would increase with exercise training. Using sub-analyses, we also aimed to clarify what types of exercise prescription would provide patients with most benefit; hypotheses were developed a priori.