Intermittent Claudication: Importance of Supervised Exercise Programme

Abstract

Introduction: To provide an update review of the current literature regarding supervised exercise therapy as a conditional part of the treatment for patients with IC. Methods: A thorough review and analysis was conducted on Pubmed database with the following query: ("Intermittent claudication"[Mesh]) AND ("exercise therapy"[Mesh] OR "supervised exercise therapy"). One hundred and thirty articles were selected. The research was limited to articles written in English and published as of 2010. Articles that were considered relevant by the author and referenced in the initial database were also included. Primary endpoints were maximum walking distances or maximum walking times while secondary endpoints were pain-free walking distance and quality of life. Results: Increase in maximum walking distance (MWD) ranged from 120 meters to 180 meters in patients that underwent exercise therapy compared to control groups that did not receive exercise therapy. Pain-free walking distance (PFWD) increased from 82 meters to 128 meters in patients that received exercise therapy compared to the no exercise group. Supervised exercise therapy (SET) showed statistically significant improvement in MWD and PFWD compared with non-supervised exercise therapy regimens, with an increase ranging from 180 meters to 240 meters and 150 meters to 200 meters respectively. Additionally, SET was demonstrated to be more effective in improving quality of life (QoL) parameters when compared to unsupervised programs. When evaluating the effect of different exercise modalities, the results showed no clear differences for MWD distance and PFWD at the end of training when compared to supervised exercise therapy with a standardized mean difference of -0.11 (95% CI ‐0.33 to 0.11; P = 0.32) and ‐0.06 (95% CI ‐0.30 to 0.17; P = 0.59)]. Moreover, supervised exercise therapy was compared to endovascular revascularization (ER) in patients with aortoiliac or femoropopliteal disease. The results showed that MWD, PFWD and QoL increased significantly in both groups with no statistically significant differences between them (P<0.001). SET demonstrated a superior improvement in pain-free walking time by a mean of 2.1 minutes (95% CI, 0.0 to 4.2 minutes, p=0.04) when compared to the ER group. Results demonstrated that the combination of endovascular revascularization with supervised exercise had a significantly greater improvement in MWD compared to patients that only received SET with a mean difference between both groups of 285 meters (99% CI: 60-505 meters). In addition, ER plus SET was superior in terms of gain in QoL outcomes. Conclusions: Supervised exercise therapy is an effective treatment for intermittent claudication and should be offered to all patients as first-line treatment since it significantly improves maximum walking distance, maximum walking time, pain-free walking distance, quality of life parameters and reduced the risk for future major cardiovascular events. Despite the robust evidence supporting supervised exercise programs as first-line treatment for intermittent claudication, the availability of these programs is far from optimal and actions should be taken so that they can become available to all patients suffering with intermittent claudication.