Combination Training was the most effective intervention for improving 6-minute walk test distance in patients with PAD compared to control (MD 65.98 m; 95% CI 22.67 to 109.29).
Meta-Analysis (n=3,710)
Do different exercise interventions improve 6-minute walk test distance and quality of life in patients with peripheral artery disease?
Combination training appears to be the most effective exercise strategy for improving 6-minute walk test distance and quality of life in patients with peripheral artery disease.
Mean Difference: 65.98 (95% CI 22.67–109.29)
Abstract Background Exercise therapy is a cornerstone of management for patients with peripheral artery disease (PAD). Although numerous exercise modalities exist, direct comparisons are scarce. The recent publication of several new randomised controlled trials (RCTs) necessitates an updated, comprehensive synthesis to clarify the optimal exercise strategy. Purpose To simultaneously evaluate the comparative effectiveness of diverse exercise therapies and establish a clear evidence-based hierarchy to inform best clinical practice for patients with PAD. Methods We conducted a systematic review and network meta-analysis (NMA) searching PubMed, Scopus, and ClinicalTrials.gov for relevant RCTs. Interventions were categorised into Supervised Exercise Programs (SEP), Home-Based Structured Exercise Programs (HSEP), Resistance Training, Alternative Exercise, Combination Training, and Control/Usual Care. The primary outcome was the change in distance on the 6-minute walk test (6MWT). Secondary outcomes included Maximum Walking Distance (MWD) and Quality of Life (QoL). We performed a random-effects NMA in RStudio using a frequentist approach to compare all interventions with 95% confidence intervals (CI). Results We included 46 RCTs involving 3,710 patients. After addressing initial heterogeneity and inconsistency, our model revealed that Combination Training was the most effective intervention for improving the primary outcome, 6MWT distance (MD: 65.98 m, 95% CI 22.67 to 109.29 vs control). For secondary outcomes, Alternative Exercise was the most effective for improving MWD (SMD: 0.87, 95% CI 0.50 to 1.25 vs control), while Combination Training could not be evaluated for this outcome due to a lack of studies. Combination Training was found to be the most effective for improving QoL (SMD: 0.95, 95% CI 0.26 to 1.63 vs control). Overall, the P-score analysis also confirmed that Combination Training was the most effective intervention, followed by Alternative Exercise and SEP. Conclusion Although most forms of structured exercise are beneficial, the Combination Training program is the most effective strategy for improving 6MWT and QoL in patients with PAD. However, the evidence base for some comparisons remains limited. Specifically, as Combination Training was not included in the MWD analysis, future trials should focus on direct head-to-head comparisons between Combination Training and Alternative Exercise to determine the definitive intervention for optimising both functional capacity and walking distance.Figure 1.NMA results.For image description, please refer to the figure legend and surrounding text.
Mayangsari et al. (Mon,) conducted a meta-analysis in Peripheral artery disease (PAD) (n=3,710). Combination Training vs. Control/Usual Care was evaluated on Change in distance on the 6-minute walk test (6MWT) (MD 65.98, 95% CI 22.67 to 109.29). Combination Training was the most effective intervention for improving 6-minute walk test distance in patients with PAD compared to control (MD 65.98 m; 95% CI 22.67 to 109.29).