Supervised walking therapy in patients with intermittent claudication
Open accessAbstract
Objective Exercise therapy is a common intervention for the management of intermittent claudication (IC). However, considerable uncertainty remains about the effect of different exercise components such as intensity, duration, or content of the exercise programs. The aim of this study was to assess the effectiveness of supervised walking therapy (SWT) as treatment in patients with IC and to update and identify the most important exercise components resulting in an optimal training protocol for patients with IC.Methods A systematic literature search using MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases was performed. Randomized controlled trials (RCTs) published between January 1966 and February 2012 were included if they evaluated the effectiveness of SWT. Predefined exercise components were extracted, including treadmill use during training, claudication pain end point used during walking, length of the SWT program, and total training volume. A meta-analysis and meta-regression was performed to evaluate the weighted mean difference in maximum walking distance (MWD) and pain-free walking distance (PFWD) between SWT and noninterventional observation.Results Twenty-five RCTs (1054 patients) comparing SWT vs noninterventional observation showed a weighted mean difference of 180 meters (95% confidence interval, 130-230 meters) in MWD and 128 meters (95% confidence interval, 92-165 meters) in PFWD, both in favor of the SWT group. In multivariable meta-regression analysis, none of the predefined exercise components were independently associated with significant improvements in MWD or PFWD.Conclusions SWT is effective in improving MWD and PFWD in patients with IC. However, pooled results from the RCTs did not identify any of the exercise components including intensity, duration, or content of the program as being independently associated with improvements in MWD or PFWD.
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A meta-analysis of 25 randomized controlled trials substantiated significant improvements in claudication onset time and symptom-limited peak walking duration with supervised exercise training.
“A subsequent meta-analysis of 25 RCTs substantiated significant improvements in claudication onset time and symptom-limited peak walking duration [138] .”
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 [138]
The Results (p. 1) report that a meta-analysis of 25 RCTs found significant improvements with supervised walking therapy. The outcomes reported are pain-free and maximum walking distance, however, not claudication onset time or symptom-limited peak walking duration; the cited paper therefore does not directly substantiate the claim's time-based outcomes. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTreadmill-based supervised exercise training is highly effective in patients with and without claudication.
“Treadmill-based supervised exercise training (SET) is highly effective in patients with and without claudication.”
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 [138]
The Results and Conclusions (p. 1) report that supervised walking therapy improves walking distances in patients with intermittent claudication; the introduction (p. 1) says such therapy usually involves a treadmill. The paper does not establish effectiveness in patients without claudication, and its analysis (p. 7) did not find treadmill use independently associated with improvement. (LLM, conf=0.90)
Experimental — accuracy not yet measured
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- Authors
- Fakhry, F., van de Luijtgaarden, K. M., Bax, L., den Hoed, P. T., Hunink, M. G. M., Rouwet, E. V., & Spronk, S.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Spronk, Sandra
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2012-10
- Volume
- 56
- Issue
- 4
- Pages
- 1132-1142
- ISSN
- 0741-5214 (ISSN-L)
- OpenAlex
- W2090405682
- Semantic Scholar
- 0032ea7a85fe619f7f89f0e8381cb62e372a5069
- Cited by
- 172
- References
- 51
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 10 · 2023: 20 · 2022: 14 · 2021: 19 · 2020: 9 · 2019: 22 · 2018: 13 · 2017: 13 · 2016: 6 · 2015: 10 · 2014: 11 · 2013: 7 · 2012: 1
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- intermittent claudication, exercise therapy, maximum walking distance, pain-free walking distance, exercise intensity, exercise duration, treadmill training, peripheral arterial disease, training protocols
- MeSH terms
- Exercise Therapy, Humans, Intermittent Claudication, Walking, Treatment Outcome
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