Objective
Data Sources
Review Methods
Results
Conclusion
Keywords
Introduction
- Aboyans V.
- Ricco J.-B.
- Bartelink M.-L.E.L.
- Björck M.
- Brodmann M.
- Cohnert T.
- et al.
- van den Houten M.M.L.
- Hageman D.
- Gommans L.N.M.
- Kleijnen J.
- Scheltinga M.R.M.
- Teijink J.A.W.
- Aboyans V.
- Ricco J.-B.
- Bartelink M.-L.E.L.
- Björck M.
- Brodmann M.
- Cohnert T.
- et al.
NICE. Peripheral arterial disease: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg147 [Accessed 22 June 2020].
Materials and methods
Eligibility criteria
Search
Outcomes
Risk of bias
Results
Search

Characteristics of included studies
Study design
First author (year) | Study design | Participants | Intervention | WAM used | Other interventions or control | Outcome measures |
---|---|---|---|---|---|---|
Normahani (2018) 34 | 12 mo RCT | n = 37, mean age 69.1, 81% M, symptomatic IC | WAM + SET (1 h/w). Clinic consultation at 3, 6, and 12 mo to discuss daily walking goals | Nike+ FuelBand | SET (1 h/w for 3 mo) | MWA + PFWA (constant-load treadmill test), QoL (VascuQol) |
Endicott (2019) 30 | 6 mo prospective study | n = 49, mean age 67.4, 98% M, veteran population, symptomatic IC | WAM based exercise prescription. Clinic consultation every 4 w to discuss step count and goals | FitBit One | N/A | DWA |
Duscha (2018) 28 | 12 w RCT | n = 20, mean age 69.4, 84.2% M, mean ABPI 0.62, symptomatic IC | WAM based HEP exercise prescription with electronic IC info and weekly telephone consultations | FitBit charge | Usual care | MWA + PFWA (Gardner graded treadmill test) and DWA |
McDermott (2018) 27 | 9 mo RCT (multicentre) | n = 200, mean age 70.3, 47.5% M, mean ABPI 0.66 | 4 SET sessions in 1st month then HEP + WAM with weekly telephone consultations | FitBit Zip | Usual care | 6 min walk test, DWA and QoL (SF-36 + PROMIS) |
Gardner (2011) 31 | 12 w RCT | n = 119, mean age 65, 48% M, mean ABPI 0.73, symptomatic IC | WAM used during HEP sessions 3×/w. Duration increased from 15 to 40 min/session. 15 min consultation every 2 w | StepWatch3 | (1) SET (3×/w for 3 mo) (2) Usual care | MWA + PFWA (Gardner graded treadmill test) and QoL (SF-36) |
Gardner (2014) 32 | 12 w RCT | n = 180, mean age 65, 53.3% M, mean ABPI 0.70, symptomatic IC | WAM with HEP sessions 3×/w. Feedback given on data at 1, 4, 8, and 12 w. Duration increased from 20 to 45 min. 15 min consultation every 2 w | StepWatch3 | (1) SET (3×/w for 3 mo). Duration increased from 20 to 45 min (2) Light resistance training (3×/w) | MWA + PFWA (Gardner graded treadmill test), 6 min walk test and cardiovascular metrics (ischaemic window, LAEI/SAEI, StO2, hsCRP) |
Nicolaï (2010) 29 | 12 mo RCT (multicentre) | n = 304, mean age 66.2, 63.1% M, mean ABPI 0.66, symptomatic IC | WAM + SET (60-–90 min/w). WAM score used during physiotherapy sessions to give feedback on walking effort outside SET | Pam Personal Activity Monitor | (1) SET (30 min 2–3×/w) + WA + told to walk to maximum pain 9×/d (2) WA + told to walk to maximum pain 9×/d | MWA + PFWA (Gardner graded treadmill test) and QoL (SF-36) |
Mays (2015) 33 | 14 w RCT | n = 25, mean age 65.4, 80% M, mean ABPI 0.81, symptomatic IC or previous endovascular therapy | 2 w SET (3×/w) then 12 w HEP (3×/w) with WAM and weekly telephone consultations | Piezoelectric activity monitor (OrthoCare Innovations) and Accusplit AE120XL | Usual care | MWA + PFWA (Gardner graded treadmill test) and QoL (SF-36) |
Tew (2015) 26 | 6 w RCT | n = 23, mean age 68.6, 69.5% M, mean ABPI 0.66, symptomatic IC | Structured IC education (PREMIS) + WAM based walking self regulation to build step count to >7500/d. Telephone consultation at 2 w | Yamax SW-200 Digiwalker | Usual care | MWA + PFWA (Gardner graded treadmill test), 6 min walk test and QoL (EuroQol EQ-5D-5L) |
Participants
Intervention
Devices used
Control
Outcomes
Risk of bias


Effect of interventions on outcomes
Walking ability
First author (year) | Outcome measure – unit | Follow up moment | WAM intervention | Usual care | Supervised exercise therapy | |||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | Follow up | Baseline | Follow up | p value | Baseline | Follow up | p value | |||
Normahani (2018) 34 | MWD – m | 3 mo | 80 (50–117) | 112 (91–210) | 68 (50–70) | 80 (50–91) | .78 | |||
6 mo | 178 (133–270) | 80 (50–91) | .009 | |||||||
12 mo | 147 (131–405) | 68 (51–104) | .011 | |||||||
CD – m | 3 mo | 40 (24–61) | 54 (41–88) | 36 (26–41) | 36 (26–41) | .32 | ||||
6 mo | 115 (60–162) | 45 (33–85) | .002 | |||||||
12 mo | 110 (57–198) | 45 (33–85) | .011 | |||||||
Duscha (2018) 28 | PWT – s | 12 w | 596±271 | 824±309 | 546±394 | 568±368 | Ns | |||
COT – s | 12 w | 320±226 | 525±252 | 252±256 | 231±196 | ≤.05 | ||||
McDermott (2018) 27 | 6MWT – m | 9 mo | 330.5±100.2 | 333.4±115.1 | 336.2±96.6 | 348.2±98.1 | Ns | |||
Gardner (2011) 31 | PWT – s | 12 w | 402±285 | 526±374 | 505±216 | 494±240 | ≤.050 | 325±169 | 540±281 | Ns |
COT – s | 12 w | 204±137 | 337±250 | 225±157 | 209±168 | ≤.050 | 196±144 | 361±264 | Ns | |
Gardner (2014) 32 | PWT – s | 12 w | 380±274 | 490±350 | 464±237 | 486±260 | ≤.050 | 356±222 | 547±299 | ≤.050 |
COT – s | 12 w | 195±171 | 300±242 | 205±167 | 222±180 | ≤.050 | 193±150 | 363±292 | Ns | |
6MWT – m | 12 w | 328±108 | 372±119 | 376±73 | 380±81 | ≤.050 | 326±94 | 341±87 | ≤.050 | |
Nicolaï (2010) 29 | MWD – m | 12 mo | 260 (165–370) | 600 (435–1 040) | 260 (160–370) | 400 (230–490) | <.001 | |||
FCD – m | 12 mo | 150 (95–245) | 460 (295–720) | 150 (100–220) | 320 (180–500) | <.001 | ||||
Mays (2015) 33 | PWT – min | 14 w | 10.1±1.8 | 12.4±1.9 | 8.2±1.7 | 8.2±1.9 | .037 | |||
COT – min | 14 w | 5.8±1.5 | 7.4±1.6 | 4.7±1.4 | 4.1±1.5 | .045 | ||||
Tew (2015) 26 | MWD – m | 6 w | 585±322 | 655±308 | 375±299 | 323±253 | ||||
CD – m | 6 w | 143±121 | 164±135 | 138±142 | 99 ±93 | |||||
6MWT – m | 6 w | 367.3±94.3 | 390.2±93.9 | 355.3±82.7 | 334.6±77.6 |
Daily walking activity
First author (year) | Outcome measure | Follow up moment | WAM intervention | Usual care | Supervised exercise therapy | |||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | Follow up | Baseline | Follow up | p | Baseline | Follow up | p | |||
Endicott (2019) 30 | Steps/d | 6 mo | 3 492 (2 661–4 322) | 4 502 (3 636–5 367) | ||||||
Duscha (2018) 28 | Steps/d | 12 w | 6 829 ± 3 370 | 7 121 ± 3 317 | 5 011 ± 1 822 | 5 048 ± 2 074 | Ns | |||
McDermott (2018) 27 | Exercise frequency | 3 mo | 1.7 ± 2.9 | 3.7 ± 2.5 | 1.5 ± 2.1 | 2.2 ± 3.0 | .005 | |||
6 mo | 4.3 ± 6.8 | 2.4 ± 3.5 | .045 | |||||||
9 mo | 3.5 ± 4.2 | 2.3 ± 2.9 | .09 | |||||||
Steps/d | 4.5 mo | 3 945 ± 2 689 | 3 744 ± 2 698 | |||||||
9 mo | 3 551 ± 293 | |||||||||
Gardner (2011) 31 | Max 60 min cadence strides/min | 12 w | 10.4 ± 5.2 | 12.9 ± 7.8 | 12.4 ± 4.9 | 11.1 ± 4.0 | ≤.050 | 9.2 ± 3.0 | 9.3 ± 3.3 | Ns |
Gardner (2014) 32 | Max 60 min cadence strides/min | 12 w | 9.8 ± 4.7 | 11.9 ± 6.6 | 12.3 ± 5.2 | 11.7 ± 4.8 | ≤.050 | 9.6 ± 3.8 | 10.3 ± 4.5 | Ns |
Tew (2015) 26 | Steps/d | 6 w | 5 915 ± 3 779 | 5 538 ± 2 864 | 4 765 ± 2 539 | 4 271 ± 2 261 |
Quality of life
First author (Year) | Outcome measure | Follow up moment | WAM intervention | Usual care | Supervised exercise therapy | |||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | Follow up | Baseline | Follow up | p | Baseline | Follow up | p | |||
Normahani (2018) 34 | VascuQOL | 3 mo | 4.7 (3.9–5.2) | 5.4 (5.2–5.7) | 4.5 (2.8–5.0) | 3.48 (2.4–5.2) | .004 | |||
6 mo | 5.6 (5.1–5.8) | 4.7 (3.0–5.5) | .031 | |||||||
12 mo | 5.8 (5.1–6.0) | 3.3 (2.6–4.2) | .065 | |||||||
McDermott (2018) 27 | SF-36 | 9 mo | 35.8 ± 9.4 | 36.5 ± 10.8 | 36.9 | 39.09.6 | .24 | |||
Pain interference | 9 mo | 56.4 ± 8.4 | 56.9 ± 9.0 | 56.7 ± 7.5 | 53.4 ± 8.8 | .002 | ||||
Role satisfaction | 9 mo | 48.5 ± 9.9 | 48.2 ± 9.7 | 48.8 ± 10.4 | 50.4 ± 10.3 | .20 | ||||
Mobility | 9 mo | 33.3 ± 5.3 | 33.0 ± 6.3 | 33.8 ± 5.3 | 33.1 ± 5.9 | .47 | ||||
Gardner (2011) 31 | SF-36 | 12 w | 40 ± 22 | 48 ± 23 | 55 ± 19 | 54 ± 18 | Ns | 37 ± 17 | 46 ± 21 | Ns |
Nicolaï (2010) 29 | SF-36 | 12 mo | 52.8 ± 14.3 | 65.1 ± 16.8 | 52.4 ± 15.0 | 59.0 ± 19.0 | .004 | |||
Mays (2015) 33 | SF-36 | 14 w | 42.3 ± 2.8 | 45.2 ± 2.0 | 38.9 ± 2.8 | 40.7 ± 2.0 | Ns | |||
Tew (2015) 26 | ICQ | 6 w | 32.7 ± 16.5 | 24.7 ± 9.7 | 44.8 ± 18.1 | 43.3 ± 18.9 | ||||
EQ-5D | 6 w | 0.7 ± 0.2 | 0.8 ± 0.1 | 0.5 ± 0.2 | 0.6 ± 0.2 |
Cardiovascular metrics
First author (year) | Outcome measure – unit | Follow up moment | WAM intervention | Usual care | Supervised exercise therapy | |||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | Follow up | Baseline | Follow up | p | Baseline | Follow up | p | |||
Duscha (2018) 28 | Peak VO2 – mL/kg/min | 12 w | 15.2±4.27 | 18.0±4.8 | 14.3±5.4 | 14.5±5.7 | ≤.050 | |||
Gardner (2011) 31 | Peak VO2 – mL/kg/min | 12 w | 11.8±3.8 | 12.4±3.8 | 13.7±3.7 | 12.8±3.5 | ≤.050 | 11.4±2.5 | 11.7±2.9 | Ns |
Gardner (2014) 32 | Ischaemic window – AUC/m | 12 w | –0.72±0.97 | –0.47±0.78 | –0.63±1.54 | –0.52±0.65 | Ns | –0.59±0.74 | –0.51±0.94 | Ns |
LAEI – mL/mmHg × 10 | 12 w | 14.0±6.4 | 16.2±8.7 | 13.1±4.0 | 13.5±4.4 | Ns | 12.2±5.5 | 12.9±7.2 | Ns | |
hs-CRP mg/L | 12 w | 7.68±19.72 | 5.86±11.60 | 5.91±5.96 | 5.32±3.87 | Ns | 5.70±6.39 | 5.38±5.78 | Ns | |
Time to min calf StO2 – s | 12 w | 195±247 | 341±259 | 245±283 | 272±236 | ≤.010 | 166±196 | 308±275 | Ns | |
Calf StO2 recovery half time – s | 12 w | 168±184 | 92±94 | 145±149 | 141±145 | ≤.010 | 165±147 | 94±76 | Ns | |
Mays (2015) 33 | Peak VO2 – mL/kg/min | 14 w | 17.5±1.3 | 18.7±1.3 | 15.0±1.3 | 15.7±1.3 | .66 |
Discussion
Limitations and future directions
- Le Faucheur A.
- de Müllenheim P.-Y.
- Mahé G.
- Zhao Z.
- Ali Etemad S.
- Arya A.
Apple. Apple announces three groundbreaking health studies. Available at: https://www.apple.com/newsroom/2019/09/apple-announces-three-groundbreaking-health-studies/ [Accessed 22 June 2020].
Conclusion
Conflicts of interest
Funding
Acknowledgements
Appendix A. Supplementary data
- Multimedia component 1
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