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Durability of Exercise vs. Revascularization in Intermittent Claudication: An Updated Meta-Analysis of Randomized
Mislav Puljevic1,2, Petra Grubic-Rotkvic2, Mia Dubravcic-Dosen2
1School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.
Healthcare (Basel, Switzerland)
|January 28, 2026
Summary
Supervised exercise therapy (SET) is the preferred first-line treatment for intermittent claudication (IC) due to sustained quality-of-life improvements. Endovascular revascularization (ER) offers quicker relief but has long-term limitations.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Rehabilitation Medicine
Background:
- Intermittent claudication (IC) is a common symptom of lower-extremity peripheral artery disease (PAD).
- Supervised exercise therapy (SET) and endovascular revascularization (ER) are established treatments for IC.
- The comparative long-term effects of SET, ER, and combined ER+SET on health-related quality of life (HRQoL) require further clarification.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) comparing SET, ER, and ER+SET for IC.
- To evaluate the primary outcome of health-related quality of life (HRQoL) at various time points.
- To compare effects on walking distance and adverse events.
Main Methods:
- Systematic review and meta-analysis of RCTs published in PubMed, Embase, and CENTRAL up to December 2024.
- Inclusion criteria: RCTs in patients with IC (excluding critical limb ischemia) reporting validated HRQoL outcomes at ≥3 months.
- Data extraction and risk of bias assessment (Cochrane RoB 2.0) by two independent reviewers; random-effects meta-analyses used.
Main Results:
- Five RCTs (n=728) were included. Both SET and ER improved HRQoL and walking distance compared to optimal medical therapy.
- At 12 months, no significant difference in HRQoL was found between SET and ER (SMD 0.02).
- ER+SET was superior to SET alone (SMD 0.35). SET showed sustained HRQoL improvements beyond 24 months, while ER benefits attenuated with higher reintervention rates (20-30% by 2 years).
Conclusions:
- SET should remain the first-line therapy for intermittent claudication, offering durable HRQoL benefits with minimal harm.
- ER provides faster symptom relief but is limited by restenosis and repeat procedures, especially in femoropopliteal disease.
- Moderate-certainty evidence supports SET as the preferred initial treatment for improving patient-centered outcomes in IC.
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