Exercise Interventions in Patients with Diabetes and Peripheral Artery Disease

Lower extremity peripheral artery disease (PAD) is defined by atherosclerotic obstruction of arteries supplying the lower extremities. PAD affects 8.5 million people in the United States and more than 200 million people worldwide. PAD will be increasingly common as the population survives longer with chronic disease. Diabetes mellitus is a major risk factor for PAD. People with PAD have significantly impaired walking endurance, increased rates of functional decline, and higher rates of disability compared to those without PAD. Functional impairment is even greater in people with PAD who have diabetes mellitus, compared to those without diabetes. Improving walking performance and preventing functional decline are major therapeutic goals for people with PAD and diabetes mellitus. Supervised treadmill exercise and home-based walking exercise programs that incorporate behavioral change methods have each been shown to significantly improve walking endurance in patients with PAD. This review summarizes current evidence regarding beneficial effects of specific exercise therapies for patients with PAD and diabetes mellitus. Practical information is provided for successful implementation of walking exercise programs for people with PAD and diabetes mellitus.