In people with peripheral arterial disease, structured home exercise improves walking distance and activity levels

Golledge J, Singh TP, Alahakoon C, et al. Meta-analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease. Br J Surg. 2019;106:319-31.

Review question

In people with peripheral arterial disease, does structured home exercise improve walking distance and physical activity?

Background

Peripheral artery disease is a narrowing of the arteries in the legs, head, or organs caused by a buildup of plaque. The buildup of plaque reduces blood flow, which can have serious consequences.  Some people with peripheral artery disease in their legs have no symptoms. Others have muscle pain or cramping, usually in their lower legs, when they walk or exercise (called intermittent claudication). If the pain is severe, it can be difficult to walk or do other physical activities. This review looks at whether home structured exercise can improve the ability to walk or do other physical activities.

How the review was done

The researchers did a systematic review of studies available up to September 2018. They found 11 randomized controlled trials that included 807 people, with an average age over 60 years.

The key features of the studies were:

• people had peripheral arterial disease in their legs;
• studies compared structured exercise programs, where at least half of the sessions were done at places chosen by the participants (but not in a hospital or other health care facility) with no exercise program;
• the home exercise programs usually included walking, a suggestion to exercise 3 to 5 times per week, and face-to-face or telephone discussions with exercise experts, psychologists, or counsellors to motivate people to walk more;
• in general, people in the no-exercise group received basic education or advice or participated in discussions about topics unrelated to exercise.

What the researchers found

Over a period of 6 months or less, structured home exercise programs increased

• the maximum distance walked by about 32 cm or 12.6 inches (based on a treadmill test);
• the distance walked before people had leg pain (claudication) by 45 cm or 18 inches (based on a treadmill test);
• the distance walked in a 6-minute walking test by 28 cm or 11 inches; and
• physical activity levels (usually based on fitness trackers or pedometers).

Conclusion

In people with peripheral arterial disease in their legs, structured home exercise improved walking distance and physical activity levels by small to moderate amounts over the short term compared with no structured home exercise.