title: Exercise training for health-related quality of life in peripheral artery disease: a systematic review and meta-analysis.
abstract: We sought to quantify whether health-related quality of life (HRQoL) is improved through exercise training in people with peripheral artery disease (PAD) and to clarify which prescriptions were optimal for improving HRQoL when compared to usual care. We conducted a systematic search (PubMed, CINAHL, Cochrane Central Register of Controlled Trials; 1966 - 31 August 2014). We only included randomized controlled trials (RCTs) of exercise training versus usual medical care in persons with PAD that included the Walking Impairment Questionnaire (WIQ) and Short-Form Health Survey component summary scores as outcomes. Of 15 RCTs, 1257 participants were studied: 543 participated in supervised exercise, with only 61 undertaking resistance training and 316 unsupervised exercise. When compared to controls, participants who completed any form of exercise training significantly improved their WIQ speed [mean difference (MD) 9.60 (95% CI 6.98 to 12.23, p<0.00001)]; WIQ distance [MD 7.41 (95% CI 4.49 to 10.33, p<0.00001)] and WIQ stair-climbing [MD 5.07 (95% CI 3.16 to 6.99, p<0.00001)]. Walking also significantly improved the Short-Form Physical Component Summary (SF-PCS) score when compared to controls [MD 1.24 (95% CI 0.48 to 2.01, p=0.001)], but not the Mental Component Summary (SF-MCS) score [MD -0.55 (95% CI -1.27 to 0.18, p=0.14)]. Exercise training improves the SF-PCS dimension, as well as perceived walking distance, speed and stair-climbing as measured by the WIQ, but not the SF-MCS score. Future studies should aim to blind assessors of such subjective measures, and study alternative modes and prescriptions of exercise alternative to walking.
authors.affiliation: Department of Exercise Physiology, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Parmenter
authors.affiliation: School of Science & Technology, University of New England, Armidale, NSW, Australia.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Dieberg
authors.affiliation: School of Science & Technology, University of New England, Armidale, NSW, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Phipps
authors.affiliation: School of Science & Technology, University of New England, Armidale, NSW, Australia nsmart2@une.edu.au.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Smart
mesh_terms: D016009:Chi-Square Distribution; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods; D017079:Exercise Tolerance; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D055070:Resistance Training; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: claudication; exercise training; peripheral artery disease; quality of life; walking impairment