OBJECTIVE: Resistance training (RT) improves walking ability in persons with peripheral artery disease. We conducted a meta-analysis of randomised controlled trials (RCTs) investigating the effect of RT on peripheral artery disease (as measured by walking ability). DESIGN: We included RCTs that investigated the effect of RT on treadmill and/or 6 min walk (6-MWT) distances. RT intensity was assessed according to the American College of Sports Medicine guidelines by 1 repetition maximum or rating of perceived exertion. Standardised mean (SMD) and mean differences (MD) were calculated using a random-effects inverse variance model. Heterogeneity and bias were assessed using RevMan V.5.3. Meta-regression and meta-analysis of variance were performed as moderator analyses. DATA SOURCES: Databases (Medline, Embase, Web of Science, CINAHL and Google Scholar) were searched until July 2018. RESULTS: Fifteen trials isolated RT; 7 trials compared RT with aerobic exercise. We analysed 826 patients (n = 363 completing RT), with a mean age of 67.1 +/- 3.8 years. Training ranged from low-high intensity, 2 to 7 times per week for 17 +/- 7 weeks, with a mix of upper, lower or whole body training. Overall RT significantly improved constant load treadmill claudication onset (COD) (SMD 0.66 (0.40 to 0.93), p < 0.00001) and total walking distance (WD) (SMD 0.51 (0.23 to 0.79), p = 0.0003), progressive treadmill COD (SMD 0.56 (0.00 to 1.13), p = 0.05) and total WD (SMD 0.45 (0.08 to 0.83), p = 0.02), and 6-MWT COD (MD 82.23 m (40.91 to 123.54), p < 0.0001). Intensity played a role in improvement, with high-intensity training yielding the greatest improvement (p = 0.02). CONCLUSIONS: RT clinically improved treadmill and flat ground walking ability in persons with peripheral artery disease. Higher intensity training was associated with better outcomes. Our study makes a case for clinicians to include high-intensity lower body RT in the treatment of peripheral artery disease. TRIAL REGISTRATION NUMBER: CRD42017081184.
Reproduced with permission from the BMJ Publishing Group.

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