Arm- and Leg Cycle Ergometry as Alternative Training Modalities of Supervised Exercise Therapy for Peripheral Artery Disease: A Scoping Review

While the current guidelines indicate a class-2a recommendation for alternate exercise modalities in patients with peripheral artery disease (PAD), practical guidance for clinical implementation remains limited. This is particularly critical for the high-risk populations, such as those with lower-limb amputations or wounds, and PAD patients not wanting to participate in walking activities. This scoping review aimed to synthesize the outcomes associated with supervised arm- and leg cycle-based exercises when treadmill walking is not feasible. This review followed the PRISMA-ScR guidelines. Searches were conducted in CINAHL, MEDLINE, Cochrane Library, PubMed, and the University of Ottawa Omni-database. Eligible studies included adults with PAD who completed supervised arm- or leg-cycle ergometry interventions. Fifteen studies (n=653) met the inclusion criteria. Across all modalities, pain-free walking distance, maximal walking distance, 6-minute walk distance, and peak oxygen consumption significantly increased, suggesting systemic cardiopulmonary improvements occurred independently of lower-limb ischemia. Notably, no studies included patients with moderate-to-severe PAD, lower-limb wounds, or amputations. Further, no studies incorporated systolic toe pressure for PAD stratification. Supervised arm- and leg-cycle ergometry appears to offer comparable benefits to supervised treadmill exercise and may be an effective alternative for patients who are unable to perform treadmill walking. However, a gap remains in the current literature due to the limited inclusion of high-risk populations, particularly those with moderate-to-severe PAD, major functional limitation, lower-limb amputations and tissue loss. Furthermore, incorporating a more comprehensive vascular stratification based on the ischemia grades of the Wound, Ischemia, foot Infection (WIfI) classification, which incorporates systolic toe pressure, may improve the interpretation of exercise interventions in patients with advanced PAD.