Supervised Resistance Training on Functional Capacity, Muscle Strength and Vascular Function in Peripheral Artery Disease: An Updated Systematic Review and Meta-Analysis.

Elizabeth E Blears,Jessica K Elias,Christian Tapking,Victoria G Rontoyanni,Craig Porter

doi:10.3390/jcm10102193

Abstract

Supervised resistance training appears to be a promising alternative exercise modality to supervised walking in patients with peripheral artery disease (PAD). This meta-analysis examined the efficacy of supervised RT for improving walking capacity, and whether adaptations occur at the vascular and/or skeletal muscle level in PAD patients. We searched Medline, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) in PAD patients testing the effects of supervised RT for ≥4 wk. on walking capacity, vascular function, and muscle strength. Pooled effect estimates were calculated and evaluated using conventional meta-analytic procedures. Six RCTs compared supervised RT to standard care. Overall, supervised RT prolonged claudication onset distance during a 6-min walk test (6-MWT) (101.7 m (59.6, 143.8), p < 0.001) and improved total walking distance during graded treadmill walking (SMD: 0.67 (0.33, 1.01), p < 0.001) and the 6-MWT (49.4 m (3.1, 95.6), p = 0.04). Five RCTS compared supervised RT and supervised intermittent walking, where the differences in functional capacity between the two exercise modalities appear to depend on the intensity of the exercise program. The insufficient evidence on the effects of RT on vascular function and muscle strength permitted only limited exploration. We conclude that RT is effective in prolonging walking performance in PAD patients. Whether RT exerts its influence on functional capacity by promoting blood flow and/or enhancing skeletal muscle strength remains unclear.

Highlights

Peripheral artery disease (PAD) is the third leading cause of cardiovascular morbidity, affecting more than 200 million people worldwide [1], and is the principal cause of nontraumatic lower limb amputation in the United States [2]
After screening 498 unique and potentially relevant records identified from electronic databases and reference lists, 94 full texts were assessed for eligibility, and 15 articles [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34], representing 9 randomized controlled trials (RCTs), met the inclusion criteria
Considering that PAD patients in the included RCTs could walk on average 140 m before they started experiencing leg pain during the 6 MWT, an increase of ~100 m in claudication onset time following resistance training (RT) that we demonstrated in our analysis is of great clinical importance

Summary

Introduction

Peripheral artery disease (PAD) is the third leading cause of cardiovascular morbidity, affecting more than 200 million people worldwide [1], and is the principal cause of nontraumatic lower limb amputation in the United States [2]. As a progressive atherosclerotic occlusive disease that primarily involves the lower limbs, PAD progressively reduces functional capacity [3] leading to mobility loss if left untreated [4]. Guideline-recommended therapies for PAD aim to lower cardiovascular risk, alleviate PAD symptomatology during claudication or critical limb ischemia, and to improve functional capacity [5]. Detection and diagnosis of PAD and adherence to guideline-recommended therapies including SET may even reduce the need for costly revascularization procedures and the risk for lower limb amputation. Since 2017, the Centers for Medicare & Medicaid Services cover SET for Medicare beneficiaries with symptomatic PAD [7]

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