A systematic review of the role of heat therapy for patients with intermittent claudication due to peripheral artery disease

Abstract

Intermittent claudication (IC) is associated with impairments in quality of life and walking ability. Heat therapy is an emerging cardiovascular therapy, which may improve walking in patients with IC. We undertook a systematic review to establish current evidence for heat therapy for patients with IC. We searched five databases (Ovid Medline / PubMed, Embase, Scopus / Web of Science, Cochrane Library and Health Technology Assessment Databases). A total of 6751 records were screened with 76 full-text articles assessed for eligibility. We included three randomised control trials and three acute interventions. For chronic interventions, three different heat therapy interventions were used. The 6-minute walk distance significantly improved following whole-body immersion ( p = 0.03; ES 0.94, 95% CI: 0.06–1.82), but not after Waon therapy or a water-perfused garment. Ankle–brachial pressure indices were significantly improved following whole-body immersion ( p = 0.01; ES 1.10, 95% CI: 0.20–1.99) but not after other therapies. No form of heat therapy demonstrated statistical improvements in quality of life or brachial blood pressure. Acute interventions were characterised by large increases in limb blood flow and core temperature, and transient reductions in blood pressure post-heating. At present there are only three randomised controlled trials assessing heat therapy for patients with IC. Moreover, each of those randomised controlled trials utilised different heat therapies. There is also very limited study of the acute physiological responses to different heat therapy interventions in these populations. Future research should establish appropriate heat therapy protocols and implement more randomised trials to understand its effectiveness. PROSPERO: CRD42020187941

Efficacy of Hydrotherapy on Arterial Blood Pressure in patients with peripheral artery disease: A systematic review and meta-analysis

“…Results of a quiet recent systematic review [30] were not aligned with the current review results as it suggested signi cant differences in the 6MWT, the possible reason is that they did pooled the studies together and one or two studies could not be sure about the results, they did not measure the difference between the PAD and control groups, and they reported that their results could not give clear conclusions for patients with PAD due to small number of studies and large heterogeneity between the types of the interventions in the intervention and control groups.…”

“…A recent systematic review assessed the effect of heat therapy on arterial shear rate, blood ow rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), six-minute walk test (6MWT) and ABI in patients with PAD and intermittent claudication. There was no comparison between the intervention and control groups and there was no pooled data in different outcomes in this systematic review [30]. The recent review showed that the 6MWT distance was improved only in whole body immersion in patient with PAD, but a recent randomized controlled trial (RCT) showed non-signi cant difference in the 6MWT distance between the supervised exercise and the heat therapy procedures [9].…”