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Supervised exercise may help improve walking in patients with claudication
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Supervised exercise was more effective than unsupervised exercise at improving maximal walking and claudication distances in patients with intermittent claudication, according to results from a recent meta-analysis.
However, the researchers observed no difference in general quality of life or patient-reported community-based walking between those assigned supervised exercise and those assigned unsupervised exercise.
Sreekanth Vemulapalli, MD, and colleagues analyzed 24 randomized controlled trials and four observational studies comparing supervised vs. unsupervised exercise in 2,074 patients with intermittent claudication, a common manifestation of peripheral arterial disease.
Of the studies analyzed, 25 reported maximal walking measures, 25 reported claudication measures and 13 reported quality of life. The researchers converted data on continuous outcome measures into effect sizes interpreted according to Hedge g, in which 0 indicates no effect, 0.2 means small effect, 0.5 means medium effect, 0.8 means large effect, and larger than 1 indicates a very large effect.
Compared with unsupervised exercise, supervised exercise was associated with moderate improvement in maximal walking distance at 6 months (effect size, 0.77; 95% CI, 0.36-1.17) and at 12 months (effect size, 0.5; 95% CI, 0.34-0.77), Vemulapalli, from the division of cardiology at Duke University Medical Center, and colleagues found.
Supervised exercise also was associated with moderate improvement in claudication distance at 6 months (effect size, 0.59; 95% CI, 0.4-0.85) and at 12 months (effect size, 0.41; 95% CI, 0.18-0.65) compared with unsupervised exercise.
However, they found no difference between the groups at 6 months in quality of life as assessed by the 36-item Short Form (SF-36) questionnaire (effect size, –0.05; 95% CI, –0.5 to 0.41), or in walking distance (effect size, 0.24; 95% CI, –0.03 to 0.5) or speed (effect size, 0.26; 95% CI, –0.06 to 0.59) at 3 months as assessed by walking impairment questionnaire.
“Although previous data have indicated concordance between improved walking parameters and [quality of life], the discordance in the present study will require further investigation using disease-specific [quality-of-life] indices and 6-minute walk outcomes,” Vemulapalli and colleagues wrote. – by Erik Swain
Disclosure: Vemulapalli reports receiving research grant funding from Boston Scientific. Other researchers report receiving grant funding from the American Heart Association, AstraZeneca, Bristol-Myers Squibb, Genzyme, Johnson & Johnson, Maquet and the NHLBI.
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