A Cochrane review [Abstract] 1 included 32 studies with a total of 1 835 subjects with stable leg pain. The follow-up period ranged from 2 weeks to 2 years. The types of exercise varied from strength training to polestriding and upper or lower limb exercises; supervised sessions were generally held at least twice a week. 27 studies compared exercise with usual care or placebo, and 5 studies compared exercise to medication (pentoxifylline, iloprost, antiplatelet agents and vitamin E) or pneumatic calf compression. People with various medical conditions or other pre-existing limitations to their exercise capacity were generally excluded. Exercise improved pain-free walking distance (MD 82.11 m, 95% CI 71.73 to 92.48; 9 studies, n=391) and maximum walking distance (MD 120.36 m, 95% CI 50.79 to 189.92; 10 studies, n=500) compared with the no exercise group. Improvements were seen for up to 2 years. Exercise did not improve ABI, and the effect of exercise was inconclusive on mortality and amputation. Evidence was generally limited for exercise compared with antiplatelet therapy, pentoxifylline, iloprost, vitamin E and pneumatic foot and calf compression due to small numbers of studies and participants.
Another Cochrane review [Abstract] 2 included 21 studies with total of 1 400 male and female subjects with peripheral arterial disease. Follow-up ranged from 6 weeks to 2 years. In general, supervised exercise regimens consisted of 3 exercise sessions per week. Supervised exercise therapy (SET) showed statistically significant improvement in maximal treadmill walking distance or time (MWD/T) at 3 months compared with structured home-based exercise therapy (HBET)(SMD 0.37, 95% CI 0.12 to 0.62) and just walking advice (WA) groups (SMD 0.80, 95% CI 0.53 to 1.07). This translates to differences in increased MWD of approximately 120 and 210 meters in favor of SET groups. Data show improvements for up to 6 and 12 months.
Third Cochrane review [Abstract] 3 included 10 studies with a total of 527 subjects comparing supervised walking exercise and alternative modes of exercise. The alternative modes of exercise therapy included cycling, lower-extremity resistance training, upper-arm ergometry, Nordic walking, and combinations of exercise modes. Comparing alternative exercise modes versus walking showed no clear differences for mean walking distance at 12 weeks (SMD -0.01, 95% CI -0.29 to 0.27; 6 studies, n=274) or at the end of training (SMD -0.11, 95% CI -0.33 to 0.11; 9 studies, n=412). No clear differences were detected in pain‐free walking distance at 12 weeks (SMD -0.01, 95% CI -0.26 to 0.25; 5 studies, n=249) or at the end of training (SMD -0.06, 95% CI -0.30 to 0.17; 8 studies, n=382).
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