Balance, Muscle Strength, and Functional Decline in Peripheral Arterial Disease: A Systematic Review and...

Peripheral arterial disease (PAD) is associated with impaired physical performance beyond walking limitation, including reduced muscle strength, impaired balance, and increased risk of falls. We performed a systematic review and exploratory meta-analysis following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines to evaluate the association between PAD severity and functional outcomes. Twelve studies involving 2083 patients with PAD were included. Study-level associations between clinical characteristics (ankle-brachial index [ABI], claudication, smoking, and statin use) and functional outcomes (balance performance, Timed Up-and-Go Test, Short Physical Performance Battery, 6-minute walk distance, and handgrip strength) were examined using Spearman's correlation and random-effects meta-regression. Claudication was associated with poorer balance, greater fear of falling, and slower Timed Up-and-Go performance, while smoking correlated with lower handgrip strength and increased fear of falling. Higher ABI values were associated with better walking performance, and meta-regression demonstrated significant associations between lower ABI and slower gait speed and poorer lower-extremity function. These findings suggest that greater PAD severity is associated with impaired balance, muscle weakness, and reduced functional mobility. Early functional assessment and targeted rehabilitation strategies, including balance and strength training, may help reduce frailty and fall risk in patients with PAD.