Effect of exercise modalities on walking capacity in patients with intermittent claudication: A Network Meta-Analysis

Abstract

Despite extensive research on the effect of supervised exercise therapy (SET) on walking performance in patients with symptomatic peripheral arterial disease (PAD), it remains unclear which training modality provides the greatest improvement in walking capacity. Thus, a random-effect network meta-analysis was performed to compare the effect of different types of SET on walking capacity in individuals with symptomatic PAD. The following databases were searched from January 1966 to April 2021: SPORTDiscus, CINAHL, MEDLINE, AMED, Academic Search Complete, and Scopus. Trials must include at least one type of supervised exercise therapy for patients with symptomatic PAD, with a minimum of 5 exercise sessions, and an objective measure of walking capacity. Eighteen studies were included for a total sample of 1135 participants. Intervention duration ranged from 6 to 24 weeks and included aerobic exercise (treadmill walking, cycling, Nordic walking), resistance training (lower and/or upper body), a combination of both, and underwater exercises. Results showed that combined training improved walking capacity to a comparable extent to aerobic walking (+122.0 [24.2-219.8] m vs. +106.8 [34.2-179.4] m), but with a larger effect size (1.20 [0.50-1.90] vs 0.67 [0.22-1.11]). Similar results were observed for the distance performed during the 6-minute walking test, with combined training being the most promising modality (+57.3 [16.2; 98.5] m), followed by underwater training (+56.5 [22.4-90.5] m) and aerobic walking (+39.0 [12.8-65.1] m). While combined exercise seems to be the most promising training modality, aerobic walking, and underwater training also improved walking capacity for patients with symptomatic PAD.