The effects of upper extremity and lower extremity aerobic exercise training in patients with peripheral arterial disease: A systematic review

Objective: Aerobic exercise for both the upper extremity (UAE) and lower extremity (LAE) is recommended to increase functional capacity and walking performance in patients with peripheral arterial disease (PAD). However, the effects of the UAE and LAE on patients with PAD remain uncertain. This study aimed to investigate the effects of UAE and LAE on cardiorespiratory parameters, walking distance, quality of life (QoL), physical activity, functional capacity, and hemodynamic variables in patients with PAD compared with a control group. Methods: Six databases were searched from inception to October 2024. Studies included after comprehensive screening were evaluated by two independent and blinded researchers. All disagreements were resolved through consultation with a third researcher. The study protocol was recorded in the PROSPERO database with registration number CRD42024594415. Results: Ten randomized controlled trials with a total of 655 participants were included in this current review. It is revealed that maximal walking distance, pain-free walking distance, peak oxygen consumption, functional capacity, and QoL improved equally effectively in UAE and LAE patients with PAD, with a strong level of evidence. In addition, UAE and LAE improved disease-specific functional status, although the evidence of this improvement is conflicting. Conclusions: According to the current systematic review, UAE, which improved similarly to LAE compared with the control group in maximal walking distance, pain-free walking distance, cardiorespiratory parameters, functional capacity, and QoL parameters, might be an alternative therapeutic exercise for patients with PAD, who have a low level of exercise adherence and find difficulty in maintaining exercise programs because of intermittent claudication during LAE.