Integration of People With Peripheral Artery Disease Into Cardiac Rehabilitation Exercise Programs: A Scoping Review

PURPOSE: Supervised exercise therapy is a class IA recommendation for the management of people with peripheral artery disease (PAD). However, access to exercise programs is limited for most patients. Cardiac rehabilitation (CR) programs are widely available and have the potential to facilitate broader access to exercise therapy. The quality of evidence supporting the efficacy of CR in people with PAD is unclear. This review aimed to summarize the characteristics and quality of studies that have integrated people with PAD into CR. REVIEW METHODS: Electronic databases (Scopus, PubMed, Web of Science, CINAHL, CENTRAL) were searched from inception up to March 20, 2024. Eligible studies included any that integrated people with PAD into exercise-based CR. Reviews, gray literature, case reports, and surveys were excluded. This review was registered with Open Science Framework on February 24, 2023 ( https://osf.io/n7qm3 ). Of 12 966 articles identified, 21 studies were included comprising 4095 participants with PAD. There were only 2 randomized-controlled trials. Most participants (68%) were included in CR due to cardiac disease with a comorbidity of PAD. Only 5 studies fully adhered to current PAD exercise recommendations. While there were limited high-quality data, CR was associated with improvements in walking capacity, quality of life, and long-term mortality and morbidity rates. However, there were limited PAD-specific assessments and inconsistent outcome measures. SUMMARY: The number of randomized-controlled trials is low, and further high-quality studies are needed to assess the efficacy of CR in people with PAD. Future trials should aim to follow PAD-specific exercise recommendations and assess PAD-specific outcomes.