Supervised exercise therapy in intermittent claudication: a systematic review of clinical impact and limitations

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.

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Review of article: Jansen, S.C.P., Hoorweg, B.B.N., Hoeks, S.E., van den Houten, M.M.L., Scheltinga, M.R.M., Teijink, J.A.W, Rouwet, E.V. A systematic review and meta-analysis of the effects of supervised exercise therapy on modifiable cardiovascular risk factors in intermittent claudication. Journal of Vascular Surgery 2019;69(4), 1293-1308

Journal of Vascular Nursing ◽

10.1016/j.jvn.2019.09.002 ◽

2019 ◽

Vol 37 (3) ◽

pp. 221-222

Author(s):

Mary O. Whipple

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cardiovascular Risk ◽

Vascular Surgery ◽

Cardiovascular Risk Factors ◽

Intermittent Claudication ◽

Exercise Therapy ◽

Meta Analysis ◽

Supervised Exercise

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

Vascular ◽

10.1258/vasc.2011.ra0052 ◽

2012 ◽

Vol 20 (1) ◽

pp. 12-19 ◽

Cited By ~ 11

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.

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