Supervised exercise therapy versus non‐supervised exercise therapy for intermittent claudication
Abstract
Background
Although exercise therapy is considered to be of significant benefit to people with leg pain (intermittent claudication), almost half of those affected do not undertake any exercise therapy.
Objectives
To evaluate the effects of supervised versus non‐supervised exercise therapy on the maximal walking time or distance for people with intermittent claudication.
Search methods
The Cochrane Peripheral Vascular Diseases Group searched their Specialized Register (last searched November 2005) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched Issue 4, 2005).
In addition, we handsearched the reference lists of relevant articles for additional trials. There was no restriction on language of publication.
Selection criteria
Randomized and controlled clinical trials comparing supervised exercise programs with non‐supervised exercise programs for people with intermittent claudication.
Data collection and analysis
Two authors (BB and EMW) independently selected trials and extracted data. One author (BB) assessed trial quality and this was confirmed by a second author (MP). For all continuous outcomes we extracted the number of participants, the mean differences, and the standard deviation. If data were available, the standardized mean difference was calculated using a fixed‐effect model.
Main results
We identified twenty‐seven trials, of which 19 had to be excluded because the control group received no exercise therapy at all. The remaining eight trials involved a total of 319 male and female participants with intermittent claudication. The follow up ranged from 12 weeks to 12 months. In general, the supervised exercise regimens consisted of three exercise sessions per week. All trials used a treadmill walking test as one of the outcome measures. The overall quality of the included trials was good, though the trials were all small with respect to the number of participants, ranging from 20 to 59.
Supervised exercise therapy showed statistically significant and clinically relevant differences in improvement of maximal treadmill walking distance compared with non‐supervised exercise therapy regimens, with an overall effect size of 0.58 (95% confidence interval 0.31 to 0.85) at three months. This translates to a difference of approximately 150 meters increase in walking distance in favor of the supervised group.
Authors' conclusions
Supervised exercise therapy is suggested to have clinically relevant benefits compared with non‐supervised regimens, which is the main prescribed exercise therapy for people with intermittent claudication. However, the clinical relevance has not been demonstrated definitely and will require additional studies with a focus on the improvements in quality of life.
PICOs
Plain language summary
Supervised exercise versus unsupervised exercise for people with leg pain while walking (intermittent claudication)
Some people experience a type of leg pain in the calf of one or both legs that occurs when walking and is relieved only by rest. This is called intermittent claudication, and it is the main symptom of peripheral arterial disease. Peripheral arterial disease is characterized by a reduced flow of blood in the leg due to hardening of the arteries, or blood vessels. Exercise is considered to be of significant benefit to people with this type of leg pain. People need to walk at least three times a week either by themselves or they can participate in a formal, supervised exercise program that involves walking on a treadmill. This review found that people in a supervised program improved their walking ability more than those following an unsupervised walking program. After three months, the people who followed the supervised, treadmill program could walk 150 meters more than the people who did unsupervised exercise. Before that, they were walking around 300 meters, 200 meters pain free, so this improvement is likely to help with independence. These conclusions are drawn from eight trials in which the participants with intermittent claudication had been assigned to either supervised or unsupervised exercise. Altogether there were 319 participants, ranging in age from 40 to 86 years with a mean age of 67 years. The overall quality of the included trials was good, although each had only a small number of participants. The trials lasted from three to twelve months. Keeping to an exercise program is important because of the decrease in leg pain and the likelihood of improving general physical condition, but it is not yet clear that it also improves compliance or quality of life.
