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Resistance training as a treatment for older persons with peripheral artery disease: a systematic review and meta-analysis
  1. Belinda J Parmenter1,
  2. Yorgi Mavros2,
  3. Raphael Ritti Dias3,
  4. Stephanie King4,
  5. Maria Fiatarone Singh2,5
  1. 1Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, Sydney Medical School, University of Sydney, Lidcombe, New South Wales, Australia
  3. 3Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Nove de Julho, Sao Paulo, Brazil
  4. 4Sport, Health and Exercise Sciences, University of Hull, Hull, United Kingdom
  5. 5Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School and Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
  1. Correspondence to Dr Belinda J Parmenter, Exercise Physiology, University of New South Wales, Sydney, NSW 2052, Australia; b.parmenter{at}


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, 2–7 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, 0.93], p<0.00001) and total walking distance (WD) (SMD 0.51 [0.23, 0.79], p=0.0003), progressive treadmill COD (SMD 0.56 [0.00, 1.13], p=0.05) and total WD (SMD 0.45 [0.08, 0.83], p=0.02), and 6-MWT COD (MD 82.23 m [40.91, 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.

  • cardiovascular
  • strength
  • meta-analysis
  • artery
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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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