8 – 15 This results in impaired walking performance, 4, 16 accelerated functional decline, 17 – 19 and a diminished quality of life. Patients with symptomatic PAD avoid exertion 6, 7 and tend to have muscle weakness, and altered gait and lower limb biomechanics. 1 – 4 However, a fairly large proportion of patients present with atypical claudication and experience exertional pain not meeting all of the Rose Claudication Questionnaire criteria. 1, 2 The hallmark symptom of PAD is typical intermittent claudication, defined as reproducible exertion-induced cramping or pain in the lower extremities, which is rapidly relieved with rest. 1, 2 PAD is characterized by atherosclerotic lumen narrowing or occlusion of the lower limb arteries, leading to an imbalance between oxygen supply and demand downstream, especially in activated muscle during exertion. Lower-extremity peripheral artery disease (PAD) affects more than 200 million people worldwide. When the training modalities were considered, walking at a vigorous intensity showed the greatest improvement in MWD. These results indicate that vigorous was less effective than light-to-moderate intensity in improving walking performance, whereas it was more effective in improving V̇O 2peak. A larger increase in V̇O 2peak was observed following vigorous (3.0 mL O 2 When training modalities were considered, walking at a vigorous intensity (272 m, p < 0.00001) showed the largest improvement in MWD compared to other exercise modalities. Light-to-moderate was superior to vigorous exercise intensity in improving MWD (223 m, p < 0.00001 153 m, p < 0.00001 respectively) and PFWD (130 m, p < 0.00001 83 m, p < 0.00001 respectively). ![]() Secondary subanalyses examined the training modality (walking or other modalities) and the approach (high-intensity interval or moderate-intensity training). The main outcomes were walking performance (pain-free and maximal walking distance) and cardiorespiratory fitness (V̇O 2peak). We searched the Embase, MEDLINE, Cochrane, Web of Science, and Google Scholar databases up to April 2021 and included randomized controlled trials reporting training therapies targeting exercise intensity (heart rate, oxygen consumption, or perceived exertion). We investigated how nonpain-based exercise therapy intensity (light-to-moderate or vigorous) affects improvements in walking performance and cardiorespiratory fitness of patients with symptomatic lower-extremity peripheral artery disease (PAD).
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