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Biswas MP, Capell WH, McDermott MM, Jacobs DL, Beckman JA, Bonaca MP, Hiatt WR. Exercise Training and Revascularization in the Management of Symptomatic Peripheral Artery Disease. JACC Basic Transl Sci 2021; 6:174-188. [PMID: 33665516 PMCID: PMC7907537 DOI: 10.1016/j.jacbts.2020.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023]
Abstract
In the management of symptomatic peripheral artery disease, aerobic exercise therapy and lower extremity revascularization are the mainstays of therapy. In this structured review, the most effective therapies, with 6 to 18 months of follow-up, indicated that exercise therapy and lower extremity revascularization each independently improve peak walking performance. The combination of therapies was superior to either therapy alone and may decrease the need for subsequent revascularization. Further research is needed to evaluate the long-term durability of these interventions, their impacts on subsequent invasive procedures, and predictors of response.
Exercise therapy and lower extremity revascularization both improve walking performance in symptomatic patients with peripheral artery disease. The combination of therapies provides greater benefit than either alone and may reduce the need for subsequent revascularization procedures, but further trials with longer follow-up are needed for the outcome of subsequent revascularization.
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Key Words
- 6MW, 6-minute walk
- CMS, Centers for Medicare and Medicaid Services
- ET, exercise therapy
- HBE, home-based exercise
- LER, lower extremity revascularization
- MCID, minimum clinically important difference
- PAD, peripheral artery disease
- PRO, patient-reported outcome
- PWD, peak walking distance
- PWT, peak walking time
- SET, supervised exercise training
- SF-36, Medical Outcomes Short Form–36
- VascuQOL, Vascular Quality of Life
- WIQ, Walking Impairment Questionnaire
- evidence
- exercise therapy (supervised exercise training, home-based exercise programs)
- lower extremity revascularization
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Affiliation(s)
- Minakshi P Biswas
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
| | - Warren H Capell
- CPC Clinical Research, Aurora, Colorado, USA.,Division of Endocrinology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary M McDermott
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald L Jacobs
- Division of Vascular Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joshua A Beckman
- Division of Cardiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Marc P Bonaca
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
| | - William R Hiatt
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
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