Supervised Exercise Therapy and Revascularization for Intermittent Claudication: Network Meta-Analysis of Randomized...

Area of Science:

• Vascular Medicine
• Interventional Cardiology
• Rehabilitation Medicine

Background:

• Intermittent claudication (IC) significantly impacts patient mobility, quality of life (QoL), and cardiovascular health.
• Previous research has not comprehensively compared all treatment combinations or synthesized QoL outcomes for IC.

Purpose of the Study:

• To conduct a network meta-analysis comparing all therapeutic modalities for intermittent claudication (IC).
• To identify the optimal first-line treatment strategy for IC, including best medical therapy (BMT) alone, percutaneous angioplasty (PTA), supervised exercise therapy (SET), and PTA combined with SET.

Main Methods:

• A systematic review identified 37 randomized trials for inclusion in the network meta-analysis.
• The analysis included 2,983 patients comparing BMT, SET, PTA, and PTA plus SET.

Main Results:

• Percutaneous angioplasty (PTA) combined with supervised exercise therapy (SET) demonstrated superior outcomes compared to best medical therapy (BMT) alone.
• PTA plus SET resulted in a significant gain in maximum walking distance (290 m) and improved quality of life (Cohen's D = 1.8).

Conclusions:

• Percutaneous angioplasty (PTA) combined with supervised exercise therapy (SET) emerges as the optimal first-line treatment for intermittent claudication (IC).
• This combined approach significantly enhances maximum walking distance and patient quality of life.