Peripheral artery disease (PAD) has been referred to as the “last major pandemic of cardiovascular disease” as said by Alan Hirsch. It is estimated to affect 236.6 million people mostly from middle and low-income countries. PAD is a condition that ranges from asymptomatic stages to severe phases, which may ultimately lead to limb loss. These symptoms may still be present in different intensities, but the most frequent one is intermittent claudication (IC) which refers to leg pain when rested but that is relieved by walking.
Even though it appears to be not serious, IC severely reduces patients’ ability to walk, confines their physical movement, and ultimately impacts their quality of life. It was also reported that IC is directly linked to an increased risk of cardiovascular diseases and mortality due to its association with systemic atherosclerosis. The mortality rate in patients with IC has been estimated to be 10-15% and escalates up to 25% if the condition develops into critical limb ischemia (CLI) within one year.
Physical activity is well considered for its protective effect on patients with PAD especially for claudication because of its association with exercise capacity and mortality. Supervised exercise regimes are now considered the best therapy for PAD.
The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; crd42024499020) and was carried out based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and Cochrane bias. Inclusion criteria included only adult PAD patients with IC, who performed exercise at home, and whose walking capacity was assessed by the 6-minute walk test. This comprised only English-language randomized controlled trials (RCTs). Five databases such as Medline, Web of Science, Embase, Scopus, and the Cochrane Library were used up to August 2024.
Heterogeneity was checked by using the I² statistic and random-effect models to derive the pooled odds ratios. The results were further verified through the completion of the sensitivity analysis, and the innate quality of the evidence was confirmed using the grading of recommendations, assessment, development, and evaluations (GRADE).
From 334 articles, 177 remained after excluding duplicates from the database. Out of the articles that passed through the initial screening of titles and abstracts, 111 were removed for the following reasons: sample population non-IC PAD patients, or primary studies lacking clinical outcomes. Altogether 8 randomized controlled trials were included in the study, participants ranged from 22 to 148, and a mean age of 57 years and above. Three studies compared home-based exercise to supervised exercise, while other papers compared it to usual practice. The intervention duration ranged from 6 to 52 weeks.
Walking capacity was assessed by the 6-Minute Walk Test (6MWT) at baseline and, progressively, at some time points during the study or at the end of the study. Of the six studies that included pain-free walking distance (PFWD), two indicated no change in the result and four had a positive change.
Furthermore, meta-analysis indicated that home-based exercise is superior to control in improving mean PFWD (standardized mean differences (SMD) 0.67; p = 0.006) and maximal walking distance (MWD) (SMD 0.47; p = 0.03), but high heterogeneity of the studies was observed (I² = 82% for mean PFWD, I² = 83% for MWD). When comparing home exercise with supervised exercise PFWD had an SMD = -0.18, p = 0.65 and MWD an SMD = 0.23, p = 0.31 indicating no significant difference with the home-based exercise. One study performed a sensitivity analysis that demonstrated lowered heterogeneity to MWD.
In this meta-analysis, home-based exercise interventions were found to be as effective as supervised exercise programs for patients with PAD and IC, offering a feasible more cost-effective approach. The findings suggested improvement in the walking function as measured by PFWD and MWD but noted that the variability can be explained based on the study protocol, duration, and disease severity. Home-based exercise also significantly increased PFWD and MWD compared with control groups but not significantly better than supervised exercise. The level of compliance was good though slightly lower compared to the other elderly exercise programs. This study emphasizes the need for more research to set a protocol for implementation, integrate mobile health technologies, and increase compliance.
References: Xu Z, Chuo J, Zhao X. Effectiveness of home-based walking exercise for patients with peripheral artery disease and intermittent claudication: a systematic review and meta-analysis. BMJ Open. 2025;15:e086013. doi:10.1136/bmjopen-2024-086013
