Exercise therapy and lower extremity revascularization (LER) independently improve peak walking performance in symptomatic patients with peripheral artery disease (PAD), according to results from a study in JACC: Basic to Translational Science.
Researchers sought to determine the effectiveness of aerobic exercise therapy and LER for patients with symptomatic PAD, focusing on the qualitative trends of benefit over time. After conducting a database search through 2020, the study authors included randomized controlled trials (RCTs) of patients who were treated with aerobic exercise therapy vs nonintervention control, LER vs nonintervention control, LER vs exercise therapy, or any combination of LER with exercise therapy vs either intervention alone or nonintervention control.
Exercise performance measures included peak walking distance or time and claudication onset distance or time, as measured by treadmill, 6-minute walk test, or shuttle walk test. The analysis included 4193 participants from 38 primary studies (with 47 publications).
A total of 27 RCTs evaluated exercise therapy vs nonintervention control and found that exercise therapy was consistently superior through 18 months of follow-up regarding peak walking performance. In a review of 12 RCTs that compared LER vs nonintervention control, the researchers found that LER was consistently superior in peak walking performance, claudication onset, and subjective outcomes when measured between 6 and 18 months of follow-up.
Among 8 RCTs that evaluated LER vs exercise therapy, exercise therapy was favored for peak walking performance after 6 to 18 months of follow-up. In the 6 RCTs that evaluated the combination of LER and exercise therapy vs exercise therapy alone, the combination of therapies was favorable.
Six RCTs evaluated a combination of therapies vs LER alone and showed a benefit of the combination therapy with regard to peak walking performance through 18 months of follow-up.
“A unique finding of this review was that LER as a single treatment strategy may increase the need for subsequent LER procedures,” stated the researchers. “However, when LER and exercise therapy were combined, the opposite outcome occurred with the data, suggesting that when exercise therapy is part of the treatment strategy for LER, the risk for subsequent LER may be decreased.”
The study has limitations, noted the investigators. Conclusions are based on trials of unblinded participants and often unblinded assessors, and potential prerandomization selection bias may affect the results.
“In this structured review, the most effective therapies, with 6 to 18 months of follow-up, indicated that exercise therapy and LER each independently improve peak walking performance,” stated the investigators. “The combination of therapies provides greater benefit than either alone and may reduce the need for subsequent revascularization procedures.”
Disclosures: Some of the authors reported affiliations with pharmaceutical and biotechnology companies. Please see the original reference for a full list of authors’ disclosures.
Biswas MP, Capell WH, McDermott MM, et al. Exercise training and revascularization in the management of symptomatic peripheral artery disease. JACC Basic Transl Sci. 2021;6(2):174-188.