Systematic review of home-based exercise programmes for individuals with intermittent claudication.

Area of Science:

• Vascular Medicine
• Rehabilitation Science
• Exercise Physiology

Background:

• Intermittent claudication (IC) significantly impacts quality of life and mobility.
• Supervised exercise training (SET) is effective but often inaccessible for many IC patients.
• Home-based exercise programs (HEPs) offer a potential alternative for self-management of IC.

Purpose of the Study:

• To systematically review the evidence for structured home-based exercise programs (HEPs) in managing intermittent claudication (IC).
• To assess the effectiveness of HEPs compared to supervised exercise training (SET) and usual care.
• To identify gaps in the evidence regarding the long-term efficacy and cost-effectiveness of HEPs for IC.

Main Methods:

• Systematic literature search of Medline, PsycINFO, EMBASE, and Cochrane databases up to April 2013.
• Inclusion of 17 studies with 1,457 participants evaluating HEPs for intermittent claudication.
• Quality assessment of included trials using the GRADE system.

Main Results:

• Low-level evidence suggests HEPs can improve walking capacity and quality of life in IC patients compared to baseline or usual care.
• Improvements from HEPs may be less pronounced than those achieved with supervised exercise training.
• Significant heterogeneity across trials precluded meta-analysis, highlighting variability in study designs and outcomes.

Conclusions:

• Structured home-based exercise programs provide a viable option for promoting self-managed walking in intermittent claudication patients, especially when supervised programs are unavailable.
• Further robust clinical trials are necessary to establish the long-term clinical and cost-effectiveness of HEPs for intermittent claudication.
• Clinicians should consider recommending structured HEPs over simple advice for patients with intermittent claudication unable to access supervised exercise.