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Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication.

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Area of Science:

  • Clinical Medicine
  • Exercise Physiology
  • Vascular Health

Background:

  • Supervised exercise therapy (SET) offers symptomatic benefits for intermittent claudication (IC) but is underutilized due to facility and funding limitations.
  • Home-based exercise therapy (HBET) and walking advice (WA) are alternative interventions for IC management.
  • This review is an update of previous research on exercise interventions for IC, first published in 2006.

Purpose of the Study:

  • To evaluate the effects of SET, HBET, and WA on maximal walking distance/time (MWD/T) in IC patients.
  • To assess the impact of SET, HBET, and WA on pain-free walking distance/time (PFWD/T), quality of life, and functional impairment.

Main Methods:

  • Systematic review and meta-analysis of parallel-group randomized controlled trials comparing SET, HBET, and WA for IC.
  • Searched Cochrane Vascular and Central Register of Controlled Trials databases, with no language restrictions.
  • Extracted data on walking distance, quality of life (SF-36), and functional impairment (Walking Impairment Questionnaire); standardized outcomes using standardized mean difference (SMD).

Main Results:

  • SET significantly improved MWD/T compared to HBET (SMD 0.37) and WA (SMD 0.80), with improvements sustained up to 12 months.
  • SET was more beneficial for PFWD/T and self-reported functional impairment compared to WA, and for PFWD/T compared to HBET.
  • No significant differences in MWD/T were found between HBET and WA; quality of life and functional impairment showed no clear differences between SET and HBET.

Conclusions:

  • SET provides significant benefits for treadmill-measured walking distance (MWD and PFWD) compared to HBET and WA.
  • The observed increases in walking distance with SET are likely clinically relevant for patients with IC.
  • Further research should focus on disease-specific quality of life, functional outcomes, and long-term follow-up for IC exercise interventions.