Peripheral artery disease is associated with impaired functional capacity, reduced walking distance, and poorer quality of life, and structured exercise is a class I recommendation in current guidelines. Although lower-limb aerobic training represents the standard strategy, intermittent claudication limits adherence in a significant number of patients. In this context, upper-limb aerobic training has been proposed as an alternative. The objective of this systematic review was to compare the effects of upper- versus lower-limb aerobic exercise on functional capacity and other clinically relevant parameters in patients with peripheral artery disease.
Study Characteristics
A systematic review of randomized controlled trials was conducted by investigators from the Faculty of Physiotherapy and Rehabilitation at Hacettepe University, Ankara, Turkey. Studies evaluating upper- and/or lower-limb aerobic training programs in adults with peripheral artery disease were included. Primary endpoints were changes in maximal walking distance, pain-free walking distance, peak oxygen consumption, and functional capacity. Secondary endpoints included quality of life, physical activity level, hemodynamic variables, and inflammatory markers.
Ten randomized controlled trials were analyzed, including a total of 655 patients, 77 percent of whom were men, with a mean age between 64 and 77 years and a baseline ankle–brachial index ranging from 0.64 to 0.71. Exercise program duration ranged from six to twenty-four weeks, with a frequency of two to three sessions per week and session duration of forty to seventy minutes. Control groups received usual care, medical advice, and general physical activity recommendations, without supervised training. Concomitant use of cilostazol or other peripheral vasodilators was not reported systematically and therefore could not be analyzed as a potential confounder.
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Upper-limb aerobic training in peripheral artery disease: impact on walking distance and functional capacity
Regarding outcomes, both upper- and lower-limb aerobic training were associated with significant and comparable improvements in maximal walking distance and pain-free walking distance compared with control groups, with statistically significant evidence and no consistent differences between modalities.
Absolute increases in maximal walking distance ranged from fifty to two hundred meters, with similar magnitudes for both types of exercise. Peak oxygen consumption increased significantly compared with control in both groups, with absolute increases of two to four milliliters per kilogram per minute, equivalent to approximately a ten to twenty percent improvement, without clear superiority of one modality over the other. Functional capacity showed a concordant pattern. Modest reductions in systolic blood pressure and resting heart rate were also observed, with no relevant differences between modalities.
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Quality of life improved in both groups, particularly in the physical function and pain domains. No consistent improvements were observed in daily physical activity levels, nor were there significant changes in systemic inflammatory markers.
Conclusion: comparison between upper- and lower-limb training and their clinical benefits
In conclusion, this systematic review demonstrates that upper-limb aerobic training is not inferior to lower-limb training for improving walking distance, functional capacity, peak oxygen consumption, and quality of life in patients with peripheral artery disease. Given that intermittent claudication limits tolerance and adherence to lower-limb exercise, upper-limb training emerges as an effective therapeutic alternative, with the potential to enhance exercise continuity in a population at high cardiovascular risk.
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