Abstract 19190: Effectiveness of Supervised Exercise Therapy for the Treatment of Intermittent Claudication in Real-world Clinical Practice

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ellen Rouwet ◽  
Karin Weststrate ◽  
Lidia Bons ◽  
Hence Verhagen ◽  
Sanne Hoeks
Keyword(s):  
Clinical Practice ◽  
Effective Treatment ◽  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Real World ◽  
Surgical Intervention ◽  
Walking Distance ◽  
National Guidelines ◽  
Luminal Diameter ◽  
Supervised Exercise

Introduction: Guidelines recommend supervised exercise therapy (SET) as a first-line treatment for patients with intermittent claudication. In trials, SET has indeed been shown to be equally effective as endovascular revascularization in improving walking performance and quality of life. However, SET is an underutilized treatment and the effectiveness of a SET-first approach outside a trial setting is unknown. Hypothesis: We assessed the hypothesis that SET is an effective treatment for intermittent claudication in real-world clinical practice. Methods: In a single-center prospective cohort study, 204 patients with newly diagnosed intermittent claudication were referred to a physiotherapist for SET between August 2009 and December 2013. All patients underwent lower extremity CTA or MRA imaging. Significant stenosis was defined as ≥50% reduction in luminal diameter. Community-based SET was provided according to national guidelines. Freedom from endovascular or open surgical intervention at the last outpatient visit was considered as the primary outcome. Kaplan Meier estimate was used to determine freedom from intervention at 1 year. Results: Mean age was 70±10 years with 59% men and the common risk factors (77% hypertension, 31% diabetes, 46% smoking, 10% obesity) and comorbidities (32% and 23% history of ischemic heart or cerebrovascular disease, resp.). Median maximum walking distance on treadmill testing at baseline visit was 320 m (IQR 150-510 m). The majority (88%) of patients had significant femoropopliteal and/or crural disease. Only 4% had isolated aortoiliac and/or common femoral artery stenoses. Of the 204 referred patients, 84% followed the SET program. After 1 year follow up, 88% of patients were still free from endovascular or surgical intervention. Conclusions: In a real-world clinical setting, a SET-first approach is an effective treatment for intermittent claudication, preventing invasive treatment in most patients.

Supervised exercise therapy for intermittent claudication: current status and future perspectives

Vascular ◽  
2012 ◽  
Vol 20 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Gert-Jan Lauret ◽  
Daniëlle C W van Dalen ◽  
Edith M Willigendael ◽  
Erik J M Hendriks ◽  
Rob A de Bie ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Randomized Clinical Trials ◽  
Walking Distance ◽  
Current Status ◽  
Current Evidence ◽  
Vascular Intervention ◽  
Supervised Exercise ◽  
Co Morbidity ◽  
Health Related

Intermittent claudication (IC) has a high prevalence in the older population and is closely associated with cardiovascular and cerebrovascular disease. High mortality rates are reported due to ongoing atherosclerotic disease. Because of these serious health risks, treatment of IC should address reduction of cardiovascular events (and related morbidity/mortality) and improvement of the poor health-related quality of life (QoL) and functional capacity. In several randomized clinical trials and systematic reviews, supervised exercise therapy (SET) is compared with non-supervised exercise, usual care, placebo, walking advice or vascular interventions. The current evidence supports SET as the primary treatment for IC. SET improves maximum walking distance and health-related QoL with a marginal risk of co-morbidity or mortality. This is also illustrated in contemporary international guidelines. Community-based SET appears to be at least as efficacious as programs provided in a clinical setting. In the Netherlands, a national integrated care network (ClaudicatioNet) providing specialized care for patients with IC is currently being implemented. Besides providing a standardized form of SET, the specialized physical therapists stimulate medication compliance and perform lifestyle coaching. Future research should focus on the influence of co-morbidities on prognosis and effect of SET outcome and the potential beneficial effects of SET combined with a vascular intervention.

scholarly journals Predictors of Walking Distance After Supervised Exercise Therapy in Patients with Intermittent Claudication

2009 ◽  
Vol 50 (4) ◽  
pp. 962
Author(s):  
L.M. Kruidenier ◽  
S.P.A. Nicolaï ◽  
J.A. Ten Bosch ◽  
R.A. de Bie ◽  
M.H. Prins ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Walking Distance ◽  
Supervised Exercise

scholarly journals Predictors of Walking Distance After Supervised Exercise Therapy in Patients with Intermittent Claudication

2009 ◽  
Vol 38 (4) ◽  
pp. 449-455 ◽  
Author(s):  
L.M. Kruidenier ◽  
S.P.A. Nicolaï ◽  
J.A. Ten Bosch ◽  
R.A. de Bie ◽  
M.H. Prins ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Walking Distance ◽  
Supervised Exercise

scholarly journals Effect of diabetes mellitus on walking distance parameters after supervised exercise therapy for intermittent claudication: A systematic review

2016 ◽  
Vol 22 (1) ◽  
pp. 21-27 ◽  
Author(s):  
David Hageman ◽  
Lindy NM Gommans ◽  
Marc RM Scheltinga ◽  
Joep AW Teijink
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Walking Distance ◽  
Inclusion Criteria ◽  
Potential Influence ◽  
Supervised Exercise ◽  
Exercise Response

Some believe that certain patients with intermittent claudication may be unsuitable for supervised exercise therapy (SET), based on the presence of comorbidities and the possibly increased risks. We conducted a systematic review (MEDLINE, EMBASE and CENTRAL) to summarize evidence on the potential influence of diabetes mellitus (DM) on the response to SET. Randomized and nonrandomized studies that investigated the effect of DM on walking distance after SET in patients with IC were included. Considered outcome measures were maximal, pain-free and functional walking distance (MWD, PFWD and FWD). Three articles met the inclusion criteria ( n = 845). In one study, MWD was 111 meters (128%) longer in the non-DM group compared to the DM group after 3 months of follow-up ( p = 0.056). In a second study, the non-DM group demonstrated a significant increase in PFWD (114 meters, p ⩽ 0.05) after 3 months of follow-up, whereas there was no statistically significant increase for the DM group (54 meters). On the contrary, the largest study of this review did not demonstrate any adverse effect of DM on MWD and FWD after SET. In conclusion, the data evaluating the effects of DM on SET were inadequate to determine if DM impairs the exercise response. While trends in the data do not suggest an impairment, they are not conclusive. Practitioners should consider this limitation when making clinical decisions.

scholarly journals Supervised exercise therapy and revascularization: Single-center experience of intermittent claudication management

2019 ◽  
Vol 24 (3) ◽  
pp. 208-215 ◽  
Author(s):  
Elke Bouwens ◽  
Sanne Klaphake ◽  
Karin J Weststrate ◽  
Joep AW Teijink ◽  
Hence JM Verhagen ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Walking Distance ◽  
Line Treatment ◽  
Single Center ◽  
First Line ◽  
Additional Intervention ◽  
Supervised Exercise ◽  
First Line Treatment

Guidelines recommend supervised exercise therapy (SET) as first-line treatment for intermittent claudication. However, the use of revascularization is widespread. We addressed the effectiveness of preventing (additional) invasive revascularization after primary SET or revascularization based on lesion and patient characteristics. In this single-center, retrospective, cohort study, 474 patients with intermittent claudication were included. Patients with occlusive disease of the aortoiliac tract and/or common femoral artery (inflow) were primarily considered for revascularization, while patients with more distal disease (outflow) were primarily considered for SET. In total, 232 patients were referred for SET and 242 patients received revascularization. The primary outcome was freedom from (additional) intervention, analyzed by Kaplan–Meier estimates. Secondary outcomes were survival, critical ischemia, freedom from target lesion revascularization (TLR), and an increase in maximum walking distance. In the SET-first strategy, 71% of patients had significant outflow lesions. Freedom from intervention was 0.90 ± 0.02 at 1-year and 0.82 ± 0.03 at 2-year follow-up. In the primary revascularization group, 90% of patients had inflow lesions. Freedom from additional intervention was 0.78 ± 0.03 at 1-year and only 0.65 ± 0.04 at 2-year follow-up, despite freedom from TLR of 0.91 ± 0.02 and 0.85 ± 0.03 at 1- and 2-year follow-up, respectively. In conclusion, SET was effective in preventing invasive treatment for patients with mainly outflow lesions. In contrast, secondary intervention rates following our strategy of primary revascularization for inflow lesions were unexpectedly high. These findings further support the guideline recommendations of SET as first-line treatment for all patients with intermittent claudication irrespective of level of disease.

scholarly journals Implementation of a supervised exercise therapy programme

2019 ◽  
Vol 101 (1) ◽  
pp. 7-13 ◽  
Author(s):  
E Murgitroyd ◽  
SCA Fraser ◽  
A Hebson ◽  
DR Lewis
Keyword(s):  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Cost Effective ◽  
Exercise Programme ◽  
Walking Distance ◽  
Healthcare Intervention ◽  
Female Ratio ◽  
Personal Cost ◽  
Supervised Exercise ◽  
Male To Female

Introduction Guidelines for peripheral vascular disease state that supervised exercise therapy (SET) programmes improve walking distance and quality of life in patients with intermittent claudication. This paper outlines the steps needed to implement a successful SET programme and discusses some of the challenges. Methods Edinburgh Leisure was approached to coordinate an exercise programme aimed at rehabilitation, run by level 4 members of the Register of Exercise Professionals. It is estimated to be cost effective at 500 referrals compared with physiotherapy referral. Success is measured by walking distance, reduction of symptoms and weight loss. Edinburgh Leisure also measures success with feedback and membership numbers at its health centres. Results Between 4 March 2014 and 25 January 2016, 155 patients were referred to the SET programme with a median age of 68 years (range: 39–95 years) and a male-to-female ratio of 1.2:1. Of these, 117 patients attended and 29 have completed the programme. The mean walking distance increased from 298.5m (range: 150–385m) to 360m (range: 195–482m), an improvement of 20%. Increasing class numbers and venues, and introducing evening classes to make the programme accessible to more patients has addressed initial patient engagement issues. Conclusions Collaboration with motivated local authorities can help implement a successful healthcare intervention. Early analysis is necessary to improve the system and engage as many patients as possible. The SET programme discussed has shown similar results to those of previous studies but is available at no personal cost to regional patients with intermittent claudication.

scholarly journals Treatment for intermittent claudication and the effects on walking distance and quality of life

Vascular ◽  
2012 ◽  
Vol 20 (1) ◽  
pp. 20-35 ◽  
Author(s):  
L M Kruidenier ◽  
W Viechtbauer ◽  
S P Nicolaï ◽  
H Büller ◽  
M H Prins ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Walking Distance ◽  
Analysis Model ◽  
Physical Quality ◽  
Supervised Exercise

The objective of the study was to provide an overview of the most common treatments for intermittent claudication and to determine the effectiveness in improving walking distance and quality of life based on a combination of direct and indirect evidence. We included trials that compared: angioplasty, surgery, exercise therapy or no treatment for intermittent claudication. Outcome measurements were walking distance (maximum, pain-free) and quality of life (physical, mental). We used a network meta-analysis model for the combination of direct and indirect evidence. We included 42 studies, presenting 3106 participants. The network meta-analysis showed that supervised exercise therapy (Δ = 1.62, P < 0.01), angioplasty (Δ = 1.89, P < 0.01) and surgery (Δ = 2.72, P = 0.02) increased walking distance significantly more than no treatment. Furthermore, supervised exercise therapy (Δ = 0.60, P < 0.01), angioplasty (Δ = 0.91, P = 0.01) and surgery (Δ = 1.07, P < 0.01) increased physical quality of life more than no treatment. However, in the sensitivity analysis, only supervised exercise therapy had additional value over no symptomatic treatment (Δ = 0.66, P < 0.01). In conclusion, this network meta-analysis indicates that supervised exercise therapy is more effective in both increasing walking distance and physical quality of life, compared with no treatment. Angioplasty and surgery also increase walking distance, compared with no treatment, but results for physical quality of life are less convincing.

Integrative therapy in patients with intermittent claudication

VASA ◽  
2015 ◽  
Vol 44 (2) ◽  
pp. 85-91
Author(s):  
Erich Minar
Keyword(s):  
Intermittent Claudication ◽  
Modern Technology ◽  
Walking Distance ◽  
Interventional Treatment ◽  
Therapeutic Concept ◽  
Integrative Therapy ◽  
Risk Factor Modification ◽  
Supervised Exercise ◽  
Main Challenge ◽  
Exercise Programmes

The generally accepted first-line treatment in patients with intermittent claudication is risk factor modification, medical treatment and exercise training. In an era of reduced resources, the benefit of any further invasive intervention must be weighted against best conservative therapy for patients with claudication. According to some recent trials an integrative therapeutic concept combining best conservative treatment - including (supervised) exercise therapy - with endovascular therapy gives the best midterm results concerning walking distance and health-related quality of life. The improved mid- and long-term patency rate with use of modern technology further supports this concept. The conservative and interventional treatment strategy are more complimentary than competitive. The current main challenge is to overcome the economic barriers concerning the availability of exercise programmes.

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