Comparing Supervised Exercise Therapy to Invasive Measures in the Management of Symptomatic Peripheral Arterial Disease

Abstract

Peripheral arterial disease (PAD) is associated with considerable morbidity and mortality. Consensus rightly demands the incorporation of supervised exercise training (SET) into PAD treatment protocols. However, the exact role of SET particularly its relationship with intervention requires further clarification. While supervised exercise is undoubtedly an excellent tool in the conservative management of mild PAD its use in more advanced disease as an adjunct to open or endovascular intervention is not clearly defined. Indeed its use in isolation in this cohort is incompletely reported. The aim of this review is to clarify the exact role of SET in the management of symptomatic PAD and in particular to assess its role in comparison with or as an adjunct to invasive intervention. A systematic literature search revealed a total 11 randomised studies inclusive of 969 patients. All studies compared SET and intervention with monotherapy. Study results suggest that exercise is a complication-free treatment. Furthermore, it appears to offer significant improvements in patients walk distances with a combination of both SET and intervention offering a superior walking outcome to monotherapy in those requiring invasive measures.

Dynamic characteristics of T2*-weighted signal in calf muscles of peripheral artery disease during low-intensity exercise

“…Exercise impairment can worsen and patients can develop rest pain and eventually tissue necrosis, necessitating limb amputation. However, the outcome of conventional treatments such as exercise training and peripheral revascularization (angioplasty, stent, or bypass surgery) on oxygenation of leg skeletal muscle are mixed . As evaluated with MRI, percutaneous intervention is shown to improve the blood supply (measured with rest ankle branchial index, ABI) as well as adenosine triphosphate (ATP) metabolism (measured with P magnetic resonance spectroscopy) in PAD patients with symptomatic claudication, while the change of tissue perfusion (measured with first‐pass Gd‐enhanced MRI) was not significant .…”

Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee

“…A systematic review of 11 RCTs 1 ) assessed exercise therapy in conjunction with or in comparison with endovascular or open intervention. Exercise therapy was reported to be an effective method to improve walking distance in PAD, whether alone, or as an adjunct to endovascular procedures or surgery.…”

Treatment of Atherosclerotic Disease of the Femoral Artery: Randomized Controlled Trials and Meta-Analyses. Should You Be Sceptical?

“…There are a number of trials that include disease in the aortoiliac segment which have not been included in this table. However, Aherne T et al [7] have conducted a meta-analysis of 11 RCT's (969 patients) comparing SET with intervention, but with disease involving multiple levels. Their conclusion was that all trials should include SET and optimal medical therapy.…”