Evaluating the Added Value of Combined Revascularization and Supervised Exercise Therapy in Symptomatic Peripheral Artery Disease: A Systematic Review and Meta-Analysis with a Focus on Functional and Patient-Reported Outcomes.
Caroline Marchand, Félix H Savoie-White, Jérôme Patry et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed whether revascularization combined with supervised exercise therapy (SET) improves outcomes over either treatment alone in patients with Fontaine stage II–III symptomatic peripheral artery disease. Seven randomized trials involving 712 patients were included. Combined treatment improved maximum walking distance (mean difference 106.35 m; 95% confidence interval, 46.54-166.17), pain-free walking distance, and SF-36 mental health scores. Differences were not significant for ankle-brachial index, SF-36 physical health scores, or subsequent intervention rates. The authors note high risk of bias and heterogeneity, and call for further high-quality trials.
Key findings
- Combined therapy improved maximum walking distance by 106.35 m (95% confidence interval, 46.54-166.17).
- Pain-free walking distance improved with combined therapy (mean difference 166.24 m; 95% confidence interval, 16.29-316.18).
- SF-36 mental health scores were higher with combined therapy (mean difference 4.11; 95% confidence interval, 3.45-4.77).
- No significant differences were found in ankle-brachial index, SF-36 physical health scores, or subsequent intervention rates.
Why it matters
Walking capacity and patient-reported wellbeing are important outcomes in symptomatic PAD. The pooled findings suggest that combining revascularization with supervised exercise may offer functional and mental health benefits beyond either treatment alone, while showing no clear advantage for several other measured outcomes. The evidence can inform discussion of treatment options but remains uncertain given the methodological concerns reported.
What to keep in mind
The review reports high risk of bias and heterogeneity in exercise interventions and outcome definitions; it also identifies a need for further high-quality randomized trials.