The Effect of Supervised Exercise, Home Based Exercise and Endovascular Revascularisation on Physical Activity in...

It is unclear whether supervised exercise therapy (SET), home based exercise therapy (HBET), and endovascular revascularisation (ER) for intermittent claudication (IC) have a meaningful impact on physical activity, despite extensive research on their effect on walking performance.

Multiple databases were searched systematically up to May 2018 for randomised controlled trials with objective measurements of physical activity in patients with IC. A Bayesian network meta-analysis was performed comparing the change in physical activity between baseline and follow up between treatments (SET, HBET, ER) and control (usual care). The standardised mean difference (SMD) with 95% credible interval (CI) was calculated as a summary statistic and converted into steps per day to aid interpretation.

Eight trials involving 656 patients with IC investigating the short-term effect of treatment on daily physical activity were included. Both SET (SMD 0.41, 95% CI 0.10-0.72: this corresponds to a difference of + 803 steps/day on a pedometer) and HBET (SMD 0.50, 95% CI 0.18-0.88: + 980 steps/day) displayed a benefit over control, based on evidence of moderate and low quality, respectively. The benefit of ER compared with control was SMD 0.36 (95% CI -0.22 to 0.99: + 705 steps/day), but only one trial supplied direct evidence, resulting in a low rating of the quality of evidence. Comparisons between treatments yielded no statistically significant differences. The results were robust to several sensitivity analyses.

SET improves daily physical activity levels in patients with IC over control. HBET may have a similar benefit, while invasive treatment failed to lead to a statistically significant improvement of physical activity compared with control. However, the underlying quality of evidence for comparisons with ER and HBET is low, impeding definite conclusions.