Key result
Combined exercise training improved treadmill walking capacity with a larger effect size (1.20; 95% CI 0.50-1.90) compared to aerobic walking (0.67; 95% CI 0.22-1.11) in patients with symptomatic PAD.
Why the study?
It remained unclear which supervised exercise training modality provides the greatest improvement in walking capacity in patients with symptomatic peripheral arterial disease.
Which supervised exercise therapy modality provides the greatest improvement in walking capacity in patients with symptomatic peripheral arterial disease?
Meta-Analysis (n=1,135)
Which supervised exercise therapy modality provides the greatest improvement in walking capacity in patients with symptomatic peripheral arterial disease?
Standardized Mean Difference: 1.2 (95% CI 0.5–1.9)
Combined exercise and underwater training are promising modalities that improve walking capacity in patients with symptomatic PAD to an extent comparable to traditional aerobic walking.
Combined training matches aerobic walking for PAD walking gains; extends evidence by ranking multiple supervised modalities via network analysis.
INTRODUCTION: Despite extensive research on the effect of supervised exercise therapy on walking performance in patients with symptomatic peripheral arterial disease (PAD), it remains unclear which training modality provides the greatest improvement in walking capacity. The objective of this study was to compare the effect of different types of supervised exercise therapy on walking capacity in individuals with symptomatic PAD. METHODS: A random-effect network meta-analysis was performed. The following databases were searched from January 1966 to April 2021: SPORTDiscus, CINAHL, MEDLINE, AMED, Academic Search Complete and, Scopus. Trials had to include at least one type of supervised exercise therapy for patients with symptomatic PAD, with an intervention lasting ≥2 wk with ≥5 training sessions, and an objective measure of walking capacity. RESULTS: Eighteen studies were included for a total sample of 1135 participants. Interventions duration ranged from 6-24 wk and included aerobic exercise (treadmill walking, ergometer, and Nordic walking), resistance training (lower and/or upper body), a combination of both, and underwater exercise. Results showed that combined training improved treadmill walking capacity to a comparable extent to aerobic walking (+122.0 [24.2-219.8] m vs +106.8 [34.2-179.4] m), but with a larger effect size (1.20 [0.50-1.90] vs 0.67 [0.22-1.11]). Similar results were observed for the 6-min walk distance, with combined training being the most promising modality (+57.3 [16.2-98.5] m), followed by underwater training (+56.5 [22.4-90.5] m) and aerobic walking (+39.0 [12.8-65.1] m). CONCLUSION: While not statistically superior to aerobic walking, combined exercise seems to be the most promising training modality. Aerobic walking and underwater training also improved walking capacity for patients with symptomatic PAD.
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Tremblay et al. (2023) conducted a meta-analysis in Symptomatic peripheral arterial disease (n=1,135). Combined training (aerobic and resistance) vs. Aerobic walking was evaluated on Treadmill walking capacity (Effect size 1.20, 95% CI 0.50-1.90). Combined exercise training improved treadmill walking capacity with a larger effect size (1.20; 95% CI 0.50-1.90) compared to aerobic walking (0.67; 95% CI 0.22-1.11) in patients with symptomatic PAD.
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