Supervised exercise therapy (SET) is a conservative non-operative treatment strategy for improving walking performance in patients with peripheral artery disease (PAD). Gait variability is altered in patients with PAD, but the effect of SET on gait variability is unknown. Forty-three claudicating patients with PAD underwent gait analysis before and immediately after a 6-month SET program. Nonlinear gait variability was assessed using sample entropy, and the largest Lyapunov exponent of the ankle, knee, and hip joint angle time series. Linear mean and variability of the range of motion time series for these three joint angles were also calculated. Two-factor repeated measure analysis of variance determined the effect of the intervention and joint location on linear and nonlinear dependent variables. After SET, walking regularity decreased, while the stability remained unaffected. Ankle nonlinear variability had increased values compared with the knee and hip joints. Linear measures did not change following SET, except for knee angle, in which the magnitude of variations increased after the intervention. A six-month SET program produced changes in gait variability toward the direction of healthy controls, which indicates that in general, SET improved walking performance in individuals with PAD.

This study investigated the impact of walking with ankle-foot-orthoses (AFOs) and without AFOs (non-AFO) on ground reaction forces (GRFs) in patients with peripheral artery disease (PAD). Additionally, this study examined the effect of AFO intervention vs. no AFO intervention on GRFs while walking with and without AFOs. Fifty patients with PAD were randomly assigned to either a three-month intervention (AFO) or a control (standard-of-care) group. After three months, subjects crossed over to the alternate group and were evaluated after three additional months. GRF data (anterior-posterior, medial-lateral, and vertical) were collected during walking with and without AFOs at baseline, three, and six months. Peak discrete GRF points, braking and propulsion impulses were compared across conditions, groups, and time points using linear mixed models. The peak brake and propulsion GRF were significantly reduced while walking with AFOs versus non-AFO (p < 0.01). Compared to non-AFO, walking with AFOs significantly reduced lateral GRF magnitude (p = 0.03) and significantly increased medial GRF (p = 0.02). The first and second maximum (p < 0.01) vertical GRF were significantly increased with AFOs versus non-AFOs. Walking with AFOs helped patients with PAD achieve greater peak propulsion and vertical GRFs compared to non-AFO, with GRF values trending toward those previously reported in healthy individuals.

Peripheral artery disease (PAD) involves atherosclerotic obstruction of the leg arteries and impairs function and structure of lower-limb tissues. Although traditionally regarded as a large-artery (macrovascular) disorder, PAD includes significant microvascular disease in the affected musculature, together leading to impaired leg perfusion. Monitoring muscle oxygenation during exercise provides an indirect index of limb perfusion and exercise capacity, and tracking its kinetics with near-infrared spectroscopy (NIRS; a portable, non-invasive technique measuring real-time tissue oxygen saturation) helps elucidate mechanisms underlying walking limitations in PAD. We systematically searched PubMed, Web of Science, and the Cochrane Library (1985–2025) for studies employing NIRS to monitor muscle oxygenation in PAD patients before, during, and after exercise. Of 628 articles screened, 11 met the inclusion criteria. NIRS demonstrated reliability and validity for monitoring muscle oxygenation in PAD. During walking, PAD patients showed a much steeper decline in muscle oxygenation and delayed recovery to baseline. Resting muscle oxygenation did not differ between patients with PAD and controls. These dynamics reveal the pathophysiological interplay in which proximal/macrovascular and distal/microvascular disease limit oxygen delivery and utilization in skeletal muscle. Accordingly, NIRS offers a sensitive, non-invasive tool to evaluate macro- and microvascular disease burden and monitor therapeutic response in PAD.