Supervised Exercise, Stent Revascularization, or Medical Therapy for Claudication Due to Aortoiliac Peripheral Artery Disease
Open accessAbstract
Background Treatment for claudication that is due to aortoiliac peripheral artery disease (PAD) often relies on stent revascularization (ST). However, supervised exercise (SE) is known to provide comparable short-term (6-month) improvements in functional status and quality of life. Longer-term outcomes are not known.Objectives The goal of this study was to report the longer-term (18-month) efficacy of SE compared with ST and optimal medical care (OMC).Methods Of 111 patients with aortoiliac PAD randomly assigned to receive OMC, OMC plus SE, or OMC plus ST, 79 completed the 18-month clinical and treadmill follow-up assessment. SE consisted of 6 months of SE and an additional year of telephone-based exercise counseling. Primary clinical outcomes included objective treadmill-based walking performance and subjective quality of life.Results Peak walking time improved from baseline to 18 months for both SE (5.0 ± 5.4 min) and ST (3.2 ± 4.7 min) significantly more than for OMC (0.2 ± 2.1 min; p < 0.001 and p = 0.04, respectively). The difference between SE and ST was not significant (p = 0.16). Improvement in claudication onset time was greater for SE compared with OMC, but not for ST compared with OMC. Many disease-specific quality-of-life scales demonstrated durable improvements that were greater for ST compared with SE or OMC.Conclusions Both SE and ST had better 18-month outcomes than OMC. SE and ST provided comparable durable improvement in functional status and in quality of life up to 18 months. The durability of claudication exercise interventions merits its consideration as a primary PAD claudication treatment.
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In the CLEVER trial, supervised exercise training and endovascular therapy, when combined with optimal medical therapy, were associated with greater improvements in functional outcomes compared with optimal medical therapy alone, with no difference in therapeutic efficacy between supervised exercise training and endovascular therapy.
“In the recent CLEVER trial, SET and endovascular therapy, when combined with optimal medical therapy, were associated with greater improvements in functional outcomes compared with optimal medical therapy alone with no difference in therapeutic efficacy between SET vs. endovascular therapy [142] .”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [142]
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Self-citation
- Authors
- Murphy, T. P., Cutlip, D. E., Regensteiner, J. G., Mohler, E. R., Cohen, D. J., Reynolds, M. R., Massaro, J. M., Lewis, B. A., Cerezo, J., Oldenburg, N. C., Thum, C. C., Jaff, M. R., Comerota, A. J., Steffes, M. W., Abrahamsen, I. H., Goldberg, S., & Hirsch, A. T.
- Affiliations
- Rhode Island Hospital (US)
- Beth Israel Deaconess Medical Center (US)
- University of Colorado Anschutz (US)
- University of Pennsylvania (US)
- University of Missouri–Kansas City (US)
- Harvard University (US)
- Boston University (US)
- University of Minnesota (US)
- Massachusetts General Hospital (US)
- ProMedica Toledo Hospital (US)
- National Heart, Lung, and Blood Institute (US)
- Corresponding author
- Murphy, Timothy P.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 65
- Issue
- 10
- Pages
- 999-1009
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC5278564
- OpenAlex
- W188696429
- Cited by
- 288
- References
- 36
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 29 · 2023: 27 · 2022: 28 · 2021: 25 · 2020: 32 · 2019: 32 · 2018: 27 · 2017: 19 · 2016: 17 · 2015: 18 · 2014: 1
- FWCI
- 27.21
- Type
- journal article
- Language
- en
- Update notices
- erratum (2015-05-12)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (U01HL077221, HL081656, HL77221, U01HL081656)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic aneurysm repair treatments
- Keywords
- intermittent claudication, supervised exercise, long-term outcomes, quality of life, physical activity counseling
- MeSH terms
- Aged, Arterial Occlusive Diseases, Exercise Therapy, Female, Health Status Indicators, Humans, Intermittent Claudication, Male, Middle Aged, Quality of Life, Exercise, Stents, Walking, Treatment Outcome, Recovery of Function, Peripheral Arterial Disease, Percutaneous Coronary Intervention
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