Endocrine · Oct 29, 2026

Characteristics of treatment responses to physical exercise and diet in diabetic peripheral artery disease patients: a systematic review

By Wang Q, Qian N, Liu Y et al.

PURPOSE: Peripheral artery disease (PAD) affects walking performance and increases risk of amputation. Diabetes mellitus (DM) not only contributes to disease progression but may also affect treatment effects. Though physical exercise is crucial in PAD management and diet optimization may reduce risk of atherosclerosis, their effects and variations in diabetic PAD patients remain unclear. The present systematic review aims to summarize features of treatment response to physical exercise and diet management in diabetic PAD patients, and provide crucial information on optimization of PAD management of these patients in clinical practice. METHODS: A systematic review was performed on human studies investigating effects of physical exercise and diet on development and improvement of diabetic PAD patients by searching PubMed, Embase, Scopus, Web of Science and CINAHL. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The certainty level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS: A total of 18 studies were included, 15 of which evaluated effects of exercise on diabetic PAD, and three evaluated correlation between diet and diabetic PAD. Supervised exercise therapy (SET) and home-based exercise were able to improve ankle-brachial index (ABI) and blood flow velocity in diabetic PAD. In contrast, walking performance such as the six minute walk distance (6MWD), maximal walking time and distance, peak walking time (PWT) and claudication onset time (COT) were not significantly improved or presented conflicting results. Administration of multiple exercises or alternative interventions such as shock wave therapy or low-frequency pulsed electromagnetic field therapy (LFPMT) may enhance improvement of ABI. Adherence to Mediterranean diet was associated with blood flow and intermittent claudication, as well as risk of development of PAD. GRADE analysis revealed very low to moderate grade evidence for findings on ABI, flow velocity and functions, mainly due to study types, number of studies available, small sample size, moderate risk of bias and conflicting results. Similarly, low grade evidence was also revealed for effects and association of diet on risk of PAD due to study type and number of studies available. CONCLUSION: Diabetic PAD patients may present reduced treatment response to physical exercise in walking performance and other functions, which may be improved by combination of multiple physical exercises or alternative interventions with or without combination of exercise. Mediterranean diet may be associated with beneficial effects, which requires further investigations. These findings were of very low to moderate level of certainty, and therefore, further validation is warranted in the future.

doi.org/10.1007/s12020-026-04836-9PubMed 42955565Interventions