Inequity in exercise-based interventions for adults with intermittent claudication due to peripheral arterial disease: a systematic review

Abstract

Purpose: To determine the equity in access to trials of exercise interventions for adults with intermittent claudication due to peripheral arterial disease. Methods: Systematic electronic database searches of MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Clinical Trials, PEDRO, Opengrey, ISRCTN and ClinincalTrials.gov for randomised controlled trials of exercise interventions for adults with intermittent claudication were conducted. Data extraction was informed by Cochrane’s PROGRESS-Plus framework. Results: Searches identified 6412 records. Following the screening of 262 full texts, 49 trials including 3695 participants were included. All trials excluded potential participants on at least one equity factor. This comprised place of residence, language, sex, personal characteristics (e.g., age and disability), features of relationships (e.g., familial risk factors) and time-dependent factors, (e.g., time since revascularisation). Overall, 1839 of 7567 potential participants (24.3%) were excluded based on equity factors. Disability was the most frequently reported factor for exclusions. Conclusion: Trialists endeavour to enrol a representative sample in exercise trials whilst preserving the safety profile of the intervention. This review highlights that these efforts can inadvertently lead to inequities in access as all trials excluded potential participants on at least one equity factor. Future exercise trials should optimise participation to maximise generalisability of findings. PROSPERO registration no. CRD42020189965.Implications for rehabilitation Equity factors influence health opportunities and outcomes. All trials of exercise for people with intermittent claudication excluded adults on at least one equity factor. Disability was the predominant factor for exclusions from trials. Trials should optimise participation to maximise generalisability of results as these findings are used to inform treatment and service design.