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Comparative Effectiveness of Medical Therapy, Supervised Exercise, and Revascularization for Patients With
Sreekanth Vemulapalli1,2, Rowena J Dolor2,3,4, Vic Hasselblad4
1Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
Clinical Cardiology
|May 13, 2015
Summary
Supervised exercise significantly improved walking distance for intermittent claudication (IC) patients compared to usual care. However, evidence is insufficient to determine the superiority of exercise, medical therapy, or revascularization for improving quality of life.
Area of Science:
- Vascular Medicine
- Exercise Physiology
- Interventional Cardiology
Background:
- Limited data exist on comparing medical therapy, supervised exercise, and revascularization for intermittent claudication (IC).
- Improving walking ability and quality of life are key goals for IC patients.
Purpose of the Study:
- To compare the effectiveness of exercise training, medications, endovascular intervention, and surgical revascularization.
- To evaluate outcomes including functional capacity, quality of life, and mortality in IC patients.
Main Methods:
- Systematic literature search of PubMed, EMBASE, and Cochrane Database (1995-2012).
- Meta-analyses of direct comparisons, supplemented by mixed-treatment analyses.
- Inclusion of 35 studies with 7475 patients with IC.
Main Results:
- Supervised exercise training improved maximal walking distance (150m) and initial claudication distance (39m) versus usual care.
- All treatments improved quality of life (SF-36 physical functioning) compared to usual care, with no significant differences between treatments.
- Insufficient safety data; no significant difference in all-cause mortality between modalities.
Conclusions:
- Current evidence is insufficient to declare treatment superiority for quality of life or walking parameters in IC.
- Further high-quality studies with standardized endpoints are needed to determine comparative effectiveness.
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