Abstract 15110: Exercise Training for Management of Peripheral Arterial Disease: a Systematic Review and Meta-Analysis

Abstract

Objective: To quantify expected benefits of exercise training in people with peripheral arterial disease (PAD). Hypothesis: Walking as a training modality and training to mild pain were optimal for improving peak VO 2 and symptoms. Methods: We conducted a systematic search (PubMed, CINAHL, Cochrane controlled trials registry; 1966-May 31, 2014).We included randomized controlled trials (RCT’s) of exercise training versus usual medical care in persons with PAD, 42 of 60 (70%) RCT’s met selection criteria. Results: Exercise training produced significant peak VO 2 improvements with Mean Difference (MD) 0.62 ml/kg/min (95% CI 0.47 to 0.77; p<0.00001); 6 minute walk initial claudication MD 52.7m (95%CI 24.7 to 80.6m; p=0.0002); total walking distance MD 34.9m (95%CI 25.6 to 44.1m; p<0.00001); graded treadmill initial claudication MD 68.8m (95%CI 54.4 to 83.2m; p<0.00001); absolute claudication distance MD 41.0m (95%CI 28.8 to 53.2m; p<0.00001)); but not ABI (p=0.12) or FMD (p=0.96). Sub-analyses of maximum change in Peak VO 2 showed arm cranking to be the superior modality MD 1.91 ml.kg -1 .min -1 (95% CI 1.28 to 2.54, p<0.00001). Sub-analysis of peak VO 2 according to pain thresholds suggested that exercise training with no or mild pain may be superior MD 0.79 ml.kg -1 .min -1 (95% CI 0.45 to 1.14, p<0.00001) to moderate/maximum pain MD 0.49 ml.kg -1 .min -1 (95% CI 0.31 to 0.66, p<0.00001). Exercise training significantly improved Walking Impairment Questionnaire (WIQ) speed [MD 9.90 (95% CI 7.10 to 12.71, p<0.00001)]; WIQ distance [MD 7.04 (95% CI 3.98 to 10.10, p<0.00001)] and WIQ stair climbing [MD 4.99 (95% CI 3.03 to 6.69, p<0.00001)]. Perceived symptoms were not improved. SF-36 physical score was significantly improved compared to control [MD 1.27 (95% CI 0.41 to 2.13, p=0.004)], but not SF-36 mental score. Conclusions and Relevance: Various modes of exercise improve cardio-respiratory fitness, pain free and total flat ground walking distances and graded treadmill performance in PAD. Alternative modes of exercise are understudied in terms of quality of life, however walking to some level of claudication pain improves WIQ speed, distance and stair climbing scores in PAD as well as SF-36 physical component score.