An updated systematic review and meta-analysis of home-based exercise programs for individuals with intermittent claudication

Pymer, Sean; Ibeggazene, Saïd; Palmer, Jennifer A.; Tew, Garry A.; Ingle, Lee; Smith, George E.; Chetter, Ian; Harwood, Amy

doi:10.1016/j.jvs.2021.03.063

Cited by 45 publications

(49 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Various models of home-based exercise programmes have been evaluated. 29 , 30 However, evidence is heterogenous largely down to variations in the methods of delivery, components of the programme and variability in the exercise dose. A recent systematic review has demonstrated that while home-based programmes are inferior to SEPs, they are certainly better than providing no exercise or basic exercise advice.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review has demonstrated that while home-based programmes are inferior to SEPs, they are certainly better than providing no exercise or basic exercise advice. 30 Furthermore, including a form of active monitoring such as a pedometer or other device increases the benefit of a home-based programme. 30 Monitoring also means that patients are provided with regular feedback and that the exercise prescription can be structured and personalised.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Provision of exercise services in patients with peripheral artery disease in the United Kingdom

et al. 2021

Self Cite

View full text Add to dashboard Cite

Objectives Supervised exercise programmes (SEPs) are a vital treatment for people with intermittent claudication, leading improvements in walking distance and quality of life and are recommended in multiple national and international guidelines. We aimed to evaluate the use and structure of SEPs in the United Kingdom (UK). Design We conducted an anonymous online survey using the Jisc platform comprising of 40 questions. The survey was designed to address key areas such as access, provision, uptake and delivery of SEPs in the United Kingdom. Ethical approval was obtained from Coventry University (P108729). Methods The list of trusts providing vascular services was obtained from the National Vascular Registry (NVR) report. The survey was disseminated via social media, The Vascular Society of Great Britain and Ireland and the Society for Vascular Technology. Data were exported to a Microsoft Excel document and analysed using simple descriptive statistics. Results Of 93 vascular units identified, we received response from 48. Of these, 23 had access to an exercise programme (48%). The majority of SEPs were exclusively for PAD patients (77%), with 21% using integrated services. 67% of respondents were providing a circuit-based programme, and 5 out of 23 were meeting the dose recommendations in the UK National Institute for Health and Care Excellence (NICE) guidelines. Respondents felt that programmes were moderately to extremely important to patients, slightly to very important to clinicians and not at all important to slightly important to commissioning/funding bodies. Conclusion SEPs are a well-established first-line treatment for patients with IC and they are recommended by NICE guidelines. Despite this, many patients still do not have access to an exercise programme, and clinicians do not feel that they have support from commissioning/funding bodies to develop them. There is an urgent need for funding, development and delivery of SEPs in the United Kingdom.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Provision of exercise services in patients with peripheral artery disease in the United Kingdom

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…To improve the access and availability of exercise programmes for people with IC, studies have investigated the role of home-based exercise programmes (HBEP). Although HBEPs are well tolerated and have shown improvements in walking performance, 17 to our knowledge, no research has assessed their safety. Supervised exercise therapy has already been deemed safe for those with IC, with a low complication rate and with no need for prior cardiac screening.…”

Section: Introductionmentioning

confidence: 99%

“… 18 Unlike SET in a clinical setting or part of an exercise referral scheme, there is no direct supervision from a health or fitness professional when undertaking a HBEP, which may increase the risk of exercise-related complications and compromise safety. Some HBEPs involve remote exercise monitoring, such as with activity watches or telephone contact, which improves the effectiveness of HBEPs, 17 but does not necessarily monitor participant safety.…”

Section: Introductionmentioning

confidence: 99%

Safety of home-based exercise for people with intermittent claudication: A systematic review

et al. 2021

View full text Add to dashboard Cite

Intermittent claudication (IC) is a classic symptom of peripheral artery disease, with first line treatment being supervised exercise therapy (SET). Despite this, SET is frequently underutilised, and adherence is often poor. An alternative option are home-based exercise programmes (HBEP). Although HBEPs are well tolerated, to the authors’ knowledge, no research has assessed their safety. The aim of this review was to assess the safety of HBEPs in people living with IC. We performed an electronic search of the MEDLINE, CINAHL, and Cochrane Library databases. The main parameter of interest was complication rate, calculated as the number of related adverse events per patient-hours. Subanalysis was undertaken to determine differences in safety for studies that did and did not include pre-exercise cardiac screening, and for studies with exercise at low, moderate, and high levels of claudication pain. Our search strategy identified 8693 results, of which 27 studies were included for full review. Studies included 1642 participants completing 147,810 patient-hours of home-based exercise. Four related adverse events were reported, three of which were cardiac in origin, giving an all-cause complication rate of one event per 36,953 patient-hours. Three of these events occurred following exercise to high levels of claudication pain, and one occurred with pain-free exercise. All four events occurred in studies without cardiac screening. Based on the low number of related adverse events, HBEPs appear to be a safe method of exercise prescription for people with IC. Our results strengthen the rationale for providing alternative exercise options for this population. PROSPERO Registration No.: CRD42021254581

show abstract

“…Home-based exercise therapy is well-tolerated and has shown improvements in walking performance. 3 Current guidelines specifically include walking at least three times a week for at least one-half of an hour until calf aching occurs. One concern is instructing patients to push themselves to the point of severe calf pain might push themselves to the point of a heart attack.…”

mentioning

confidence: 99%

Safety of Home-based Exercise for People with Intermittent Claudication: A Systematic Review

Waddell¹,

Seed²,

Broom³

et al. 2022

Journal of Vascular Surgery

View full text Add to dashboard Cite

An updated systematic review and meta-analysis of home-based exercise programs for individuals with intermittent claudication

Cited by 45 publications

References 60 publications

Provision of exercise services in patients with peripheral artery disease in the United Kingdom

Provision of exercise services in patients with peripheral artery disease in the United Kingdom

Safety of home-based exercise for people with intermittent claudication: A systematic review

Safety of Home-based Exercise for People with Intermittent Claudication: A Systematic Review

Contact Info

Product

Resources

About