Peripheral artery disease (PAD) impacts more than 200 million people worldwide [1]. As the prevalence of this disease increases, there is increasing recognition that females harbor at least equivalent, if not more, disease burden than men. However, men and females present with different levels of disease severity; females more often present with atypical leg symptoms, posing diagnostic challenges for treating physicians [2].

Intermittent claudication (IC) is a symptomatic manifestation of PAD that can impact a patient's health-related quality of life (QOL) substantially. Studies demonstrate the efficacy of optimal medical and lifestyle modifications for patients with claudication, such as antiplatelet therapy, statin therapy, tobacco cessation, and supervised exercise therapy (SET). Sex disparities in care for some components of medical and lifestyle modifications have been demonstrated in this patient population. For example, statins are less frequently prescribed to females, particularly those older than 75 years [3]. Reasons for, and implications of, these differences in evidence-based treatment for claudication are unclear [4]. Furthermore, some studies have found worse outcomes for females after revascularization as well [5].

SET is a core component of guideline-directed first-line therapy for the treatment of IC [6], [7], [8]. SET has demonstrated improvements in maximum walking distance, pain-free ambulation, and QOL. However, prior studies have noted that females are less likely to have access to treatment with exercise-based interventions and are less frequently represented in trials assessing the use of SET in the treatment of claudication [9]. Given sex-based differences in access to SET and the way it is studied, some studies suggest females may benefit less from SET than men [9]. Whether these differences are related to disease severity at time of presentation or intervention, or true differences in response to this therapy, is not clear. It is also unclear whether these discrepancies are seen for all SET outcome measures or only specific ones.

To better understand sex-based differences in exercise therapy, we performed a broad scoping review of the literature to identify differences in outcomes, including measures of walking performance and QOL in men compared with females undergoing any type of exercise therapy for IC.