Arm or Leg? Both Aerobic Training Approaches Improve Walking in PAD: RCT Finds
UK: A randomized controlled trial published in the Journal of Vascular Surgery reports that both upper- and lower-limb aerobic exercise can significantly enhance walking performance in people with symptomatic peripheral arterial disease (PAD).
The study, led by Irena Zwierska from Sheffield Hallam University, sheds new light on alternative rehabilitation options for patients who often struggle with pain and mobility limitations.
The trial enrolled 104 individuals with stable PAD, with a median age of 69 years. Participants were randomly allocated to one of three groups: an upper-limb aerobic exercise programme (UL-Ex), a lower-limb aerobic programme (LL-Ex), or a non-exercising control group. Over 24 weeks, those in the training groups completed supervised aerobic sessions twice weekly, with the intensity tailored to match equivalent relative exertion across both modalities.
To track physiological changes and functional outcomes, the researchers conducted incremental arm-crank and leg-crank tests at baseline and at five subsequent intervals throughout the 24-week programme. Peak oxygen consumption (VO₂), claudication distance (CD), maximum walking distance (MWD), perceived exertion, blood lactate levels, and pain ratings were recorded using standardized protocols, including a shuttle-walk test to capture changes in mobility.
The study revealed the following findings:
- Both exercise groups showed significant improvements over the 24 weeks.
- Claudication distance increased by 51% in the upper-limb exercise group and 57% in the lower-limb exercise group by week 24.
- Maximum walking distance improved by 29% in the UL-Ex group and 31% in the LL-Ex group.
- These improvements highlighted the strong therapeutic benefit of regular aerobic exercise, whether performed using the arms or legs.
- Participants in both training groups demonstrated higher peak heart rates during the maximum walking distance test after training, indicating better cardiovascular endurance.
- They were also able to tolerate higher levels of claudication pain before stopping exercise, reflecting improved pain tolerance.
- Peak VO₂ during leg-crank testing increased significantly in both exercise groups compared with the control group, showing enhanced aerobic capacity.
- Arm-crank peak VO₂ improved only in the upper-limb training group, confirming cardiovascular gains specific to upper-body training.
The authors concluded that the observed gains stem from a mix of systemic cardiovascular adaptations and improved tolerance to exercise-induced pain. Importantly, they noted that upper-limb training—often overlooked in PAD rehabilitation—can be a valuable alternative for patients who find walking too painful during the early stages of therapy.
The study highlights that arm-cranking and other non–weight-bearing modalities are feasible, well-tolerated, and capable of delivering strong functional benefits. These findings hold promise for expanding tailored rehabilitation strategies for individuals with PAD who have become inactive due to discomfort during walking.
Reference:
Zwierska, I., Walker, R. D., Choksy, S. A., Male, J. S., Pockley, A. G., & Saxton, J. M. (2005). Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: A randomized controlled trial. Journal of Vascular Surgery, 42(6), 1122-1130. https://doi.org/10.1016/j.jvs.2005.08.021
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