The study
A systematic review published in Endocrine on 29 October 2026 by Wang and colleagues. It gathered studies of exercise or diet for people with diabetes and peripheral arterial disease (PAD), searching English-language literature up to 14 May 2025.
The review included 18 studies: 9 randomised trials, 3 non-randomised trials, 4 cohort studies, 1 case-control study and 1 cross-sectional study. Fifteen tested exercise (1,501 participants). Three looked at diet (1,718 participants), all observational.
The review wasn't registered in advance, and the authors described the studies one by one without combining them in a meta-analysis.
The exercise
Supervised treadmill walking: 9 studies.
Home-based programs: 4 studies.
Other formats: walking plus resistance training; combined aerobic, strength and balance training; interval training with pulsed electromagnetic field therapy; walking with functional electrical stimulation; and Buerger-Allen exercises.
Dose: mostly 30 to 60 minutes, three times a week, for about three months.
Reading the numbers
The authors rated certainty with GRADE. Moderate certainty means the true effect is probably close to what was found. Low means it could be substantially different. Very low means we can't be confident in the result at all.
What they found
Ankle-brachial index (ABI) improved with exercise, and one study reported better blood flow velocity. Certainty ranged from moderate to very low.
Walking outcomes mostly didn't improve. Six-minute walk distance didn't improve in one trial (Patel 2021). Maximum walking time didn't improve. Claudication onset time either didn't change or improved in men only (Gardner 2014). A 145-person trial (Collins 2011) found no difference in walking distance. Certainty for walking outcomes was low to very low.
Every randomised trial was rated as having “some concerns” for risk of bias.
The diet evidence came only from observational studies and was rated low certainty.
Funding and conflicts
The authors reported no funding and no conflicts of interest.
What it means for your practice
The ABI gains didn't come with clear walking gains. For patients with claudication, how far they can walk is usually the outcome that matters day to day, and that's where the evidence was weakest.
Several studies mixed people with and without diabetes, so the results don't apply cleanly to diabetes alone, and some included studies were small or weakly designed.
There's no pooled estimate, so the review can't say how large any effect is.
Supervised treadmill walking was the most tested format, at three sessions a week for around three months.
Bottom line
Across 18 studies of people with diabetes and PAD, exercise improved ABI, while walking distance and claudication time mostly didn't change, at low to very low certainty. It seems like the diabetes-specific evidence on exercise for PAD is still thin.