Exercise training for intermittent claudication.
Study Goal
The researchers aimed to evaluate the effectiveness of exercise therapies, particularly supervised treadmill and home-based walking, for improving walking performance in patients with lower extremity peripheral artery disease (PAD).
Results Summary
Supervised treadmill exercise significantly improved treadmill walking performance by approximately 180 meters compared to no exercise, while home-based walking preferentially improved over-ground walking performance, such as in the 6-minute walk test. Arm or leg ergometry also improved walking endurance, though treadmill walking was superior to resistance training alone.
Population
Patients with lower extremity peripheral artery disease (PAD) and intermittent claudication symptoms.
Effective Dosage
12 weeks of supervised treadmill exercise (specific frequency not detailed).
Duration
12 weeks (for supervised treadmill exercise).
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
supervised treadmill exercise | increase | treadmill walking performance | people with PAD and intermittent claudication symptoms | - | significantly improves | #1 |
supervised exercise interventions | increase | treadmill walking distance | - | 180-meter | demonstrated a 180-meter increase | #2 |
home-based walking exercise | increase | walking performance | people with PAD | - | supports to improve | #3 |
supervised treadmill exercise programs | increase | treadmill walking performance | - | - | preferentially improve | #4 |
home-based walking exercise programs | increase | corridor walking | - | - | preferentially improve | #5 |
arm or leg ergometry exercise | increase | walking endurance | people with PAD | - | supports to improve | #6 |
treadmill walking exercise | increase | improving walking endurance | - | - | appears superior | #7 |
resistance training alone | neutral | improving walking endurance | - | - | - | #8 |
supervised treadmill exercise | increase | treadmill walking performance | people with PAD | approximately 180 meters | significantly improves | #9 |
home-based exercise | increase | over-ground walking performance | - | - | is also effective and preferentially improves | #10 |
OBJECTIVE: The objective of this study was to provide an overview of evidence regarding exercise therapies for patients with lower extremity peripheral artery disease (PAD). METHODS: This manuscript summarizes the content of a lecture delivered as part of the 2016 Crawford Critical Issues Symposium. RESULTS: Multiple randomized clinical trials demonstrate that supervised treadmill exercise significantly improves treadmill walking performance in people with PAD and intermittent claudication symptoms. A meta-analysis of 25 randomized trials demonstrated a 180-meter increase in treadmill walking distance in response to supervised exercise interventions compared with a nonexercising control group. Supervised treadmill exercise has been inaccessible to many patients with PAD because of lack of medical insurance coverage. However, in 2017, the Centers for Medicare and Medicaid Services issued a decision memorandum to support health insurance coverage of 12 weeks of supervised treadmill exercise for patients with walking impairment due to PAD. Recent evidence also supports home-based walking exercise to improve walking performance in people with PAD. Effective home-exercise programs incorporate behavioral change interventions such as a remote coach, goal setting, and self-monitoring. Supervised treadmill exercise programs preferentially improve treadmill walking performance, whereas home-based walking exercise programs preferentially improve corridor walking, such as the 6-minute walk test. Clinical trial evidence also supports arm or leg ergometry exercise to improve walking endurance in people with PAD. Treadmill walking exercise appears superior to resistance training alone for improving walking endurance. CONCLUSIONS: Supervised treadmill exercise significantly improves treadmill walking performance in people with PAD by approximately 180 meters compared with no exercise. Recent evidence suggests that home-based exercise is also effective and preferentially improves over-ground walking performance, such as the 6-minute walk test.