Exercise for intermittent claudication

Abstract

Background Exercise programmes are a relatively inexpensive, low-risk option compared with other, more invasive therapies for treatment of leg pain on walking (intermittent claudication (IC)). This is the fourth update of a review first published in 1998. Objectives Our goal was to determine whether an exercise programme was effective in alleviating symptoms and increasing walking treadmill distances and walking times in people with intermittent claudication. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events, and improving quality of life. Search methods For this update, the Cochrane Vascular Information Specialist searched the Specialised Register (last searched 15 November 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10) via the Cochrane Register of Studies Online, along with trials registries. Selection criteria Randomised controlled trials of an exercise regimen versus control or versus medical therapy for people with IC due to peripheral arterial disease (PAD). We included any exercise programme or regimen used for treatment of IC, such as walking, skipping, and running. Inclusion of trials was not affected by duration, frequency, or intensity of the exercise programme. Outcome measures collected included treadmill walking distance (time to onset of pain or pain-free walking distance and maximum walking time or maximum walking distance), ankle brachial index (ABI), quality of life, morbidity, or amputation; if none of these was reported, we did not include the trial in this review. Data collection and analysis For this update (2017), RAL and AH selected trials and extracted data independently. We assessed study quality by using the Cochrane 'Risk of bias' tool. We analysed continuous data by determining mean differences (MDs) and 95% confidence intervals (CIs), and dichotomous data by determining risk ratios (RRs) and 95% CIs. We pooled data using a fixed-effect model unless we identified significant heterogeneity, in which case we used a random-effects model. We used the GRADE approach to assess the overall quality of evidence supporting the outcomes assessed in this review.

Development of a two-stage limb ischemia model to better simulate human peripheral artery disease

“…This report describes the development of a novel model of HLI which results in more severe and prolonged ischemia than the traditional model. Mice subjected to the 2-stage HLI had functional and ambulatory impairment and a positive response to exercise training as has been reported for PAD patients 51 .…”

Peripheral Arterial Disease: A Case Report From the Henry Ford Hospital

“…These findings are consistent with an earlier meta-analysis that reported improvements of 179% and 122% for walking distance to the onset of pain and to maximal pain, respectively (15). It is noted that exercise training has not been shown to affect the ABI (14).…”

Peripheral arterial disease: Scoping review of patient‐centred outcomes

“…For those with PAD, SET has improved 3‐ and 6‐month maximum or pain‐free walking distance compared with placebo, usual care, iloprost, or vitamin E, paralleled by a 3‐month increase in ABI mainly for patients with ABI levels >0.5 . SET, smoking cessation, and antiplatelet therapy are important standard care interventions for those with PAD.…”

“…The authors reviewed 221 abstracts and/or full‐text studies qualifying for inclusion and summarised evidence, supporting significant improvements reported for each patient‐centred outcome measured in response to one or more interventions studied. Study quality and risk of bias, graded elsewhere, were not addressed in this work, which aimed to describe the frequency of studies improving patient‐centred outcomes, not evaluating evidence strength or quality. Probability of type I error of ≤.05 was the criterion for a statistically significant effect of an intervention on a patient‐centred outcome.…”