Supervised Exercise Therapy and Revascularization for Intermittent Claudication
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Objectives The aim of this study was to perform a comprehensive meta-analysis comparing all therapeutic modalities for intermittent claudication (IC), including best medical therapy (BMT) alone, percutaneous angioplasty (PTA), supervised exercise therapy (SET), and PTA combined with SET, to establish the optimal first-line treatment for IC.Background IC is a common health problem that limits physical activity, results in decreased quality of life (QoL) and is associated with poor cardiovascular outcomes. Previous meta-analyses have attempted to combine data from randomized trials; however, none have combined data from all possible treatment combinations or synthesized QoL outcomes.Methods Following a systematic review of the published research (conducted in December 2018) that identified 37 published randomized trials, a network meta-analysis was performed combining all possible IC treatment strategies.Results Overall, 2,983 patients with IC were included (mean weighted age 68 years, 54.5% men). Comparisons were performed between BMT (n = 688, 28 arms) versus SET (n = 1,189, 35 arms) versus PTA (n = 511, 12 arms) versus PTA plus SET (n = 395, 8 arms). Mean weighted follow-up was 12 months (95% confidence interval: 9 to 23 months). Compared with BMT alone, PTA plus SET outperformed other treatment strategies, with a maximum walking distance gain of 290 m (95% credible interval: 180 to 390 m; p < 0.001). A variety of QoL assessments using validated tools were reported in 15 trials; PTA plus SET was superior to other treatments (Cohen's D = 1.8; 95% credible interval: 0.21 to 3.4).Conclusions In addition to BMT, PTA combined with SET seems to be the optimal first-line treatment strategy for IC in terms of maximum walking distance and QoL improvement.
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A network meta-analysis found 180 m improvement with supervised exercise training versus 85 m improvement with endovascular therapy.
“These findings were corroborated in a network meta-analysis (180 m improvement with SET vs. 85 m improvement with endovascular therapy) [140] .”
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 [140]
The Results report a 180 m gain in maximum walking distance with supervised exercise therapy and say it was superior to angioplasty. The passages available from our copy do not establish the claimed 85 m gain with endovascular therapy. (LLM, conf=0.84)
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- Authors
- Saratzis, A., Paraskevopoulos, I., Patel, S., Donati, T., Biasi, L., Diamantopoulos, A., Zayed, H., & Katsanos, K.
- Affiliations
- Guy's Hospital (GB)
- Aberdeen Royal Infirmary (GB)
- General University Hospital of Patras (GR)
- Corresponding author
- Saratzis, Athanasios
- ORCID
- Venue
- JACC: Cardiovascular Interventions
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 12
- Issue
- 12
- Pages
- 1125-1136
- ISSN
- 1876-7605 (ISSN-L)
- 1936-8798
- OpenAlex
- W2947041907
- Cited by
- 60
- References
- 69
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 10 · 2023: 14 · 2022: 9 · 2021: 9 · 2020: 4 · 2019: 2
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC: Cardiovascular Interventions (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Amgen
- Regeneron Pharmaceuticals
- National Institute for Health and Care Research (CL-2014-11-001)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Surgery › Diagnosis and Treatment of Venous Diseases
- Keywords
- intermittent claudication, supervised exercise therapy, percutaneous transluminal angioplasty, optimal medical therapy, peripheral arterial disease, maximum walking distance, quality of life, first-line therapy
- MeSH terms
- Network Meta-Analysis, Adult, Aged, Aged, 80 and over, Cardiovascular Agents, Combined Modality Therapy, Exercise Therapy, Female, Humans, Intermittent Claudication, Male, Middle Aged, Quality of Life, Time Factors, Randomized Controlled Trials as Topic, Walking, Treatment Outcome, Exercise Tolerance, Angioplasty, Recovery of Function, Peripheral Arterial Disease
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