Combined Benefits Seen With Exercise Plus Revascularization in LE Peripheral Artery Disease

CT angiography of lower limb..artery occlusive disease
A combination exercise therapy and revascularization may result in improved clinical outcomes vs either strategy alone in lower extremity PAD.

Combination exercise therapy (ET) and lower extremity revascularization (LER) for the treatment of peripheral artery disease (PAD) improves walking performance better than either therapy alone, according to findings of a literature review published in the Journal of American College of Cardiology: Basic to Translational Science.

Researchers from the University of Colorado Anschutz Medical Campus searched publication databases through 2020 for publications on ET and LER in the treatment of PAD. A total of 47 articles were included in this analysis, inclusive of a median 100 participants aged 38 to 86 years (64% men).  Most of the studies had follow-ups ranging between 6 and 18 months, which is within this range commonly used for such therapies. Interventions included ET compared with control (n=27), LER compared with control (n=12), ET with LER (n=8), LER and ET compared with ET alone (n=6), and LER and ET compared with LER alone (n=6).

The review authors graded evidence using the A, B, C, D grading system. A grade of A indicated very strong evidence, in which 2 or more high-quality studies reported similar findings. A grade of B indicated similar findings from 1 or more high-quality and 1 or more low-quality studies. C indicated limited evidence (1 high-quality study and 1 or more low-quality studies), D weak evidence (1 low-quality study), and E inconclusive (conflicting findings).

Compared with controls, ET improved walking performance with a grade of A in less than 6 months, 6-12 months, and 12-18 months. ET deferred claudication onset with a grade of B at less than 6-12 to18 months and a grade of A at 6-12 months. LER increased walking performance and deferred claudication onset with a grade of B at 6-12, 12-18, and >18 months.

When ET was compared with LER, the former was shown to be somewhat superior in terms of walking performance and deferred claudication, with evidence graded as A level for the time frame of 6-12 months in terms of walking performance and 12-18 months for walking performance and deferred claudication.

Combination therapy was superior to ET alone in improving walking performance at 6-12 (B Grade), 12-18 (B Grade), and >18 (C Grade) months and at deferring claudication onset at 6 -12 (C Grade) and 12-18 (B Grade) months. The combination therapy compared with LER alone was superior at improving walking speed at less than 6 (B) and 6 to 12 (C grade) months and was better at deferring claudication onset at less than 6 months (C grade).

This review was limited by the quality of the underlying studies, which, for the most part, were short-term.

These data indicate that combination ET and LER therapy can provide better clinical outcomes than either strategy alone in patients with PAD.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Biswas MP, Capell WH, McDermott MM, et al. Exercise Training and Revascularization in the Management of Symptomatic Peripheral Artery Disease. J Am Coll Cardiol Basic Trans Science. 2021;6(2):174-188. doi:10.1016/j.jacbts.2020.08.012