This recent systematic review evaluates the effects of supervised exercise therapy compared to home-based exercise therapy and walking advice in people with intermittent claudication. This is an update of a Cochrane systematic review, which was first published in 2006. The primary outcome was maximal treadmill walking distance or time. Secondary outcomes were pain-free treadmill walking distance or time, quality of life, functional impairment, mortality and adherence to exercise program. Supervised exercise therapy was defined as a treatment program lasting at least 6 weeks with more than 50% of total exercise spent on walking or training the lower limbs and conducted under supervision of a physiotherapist or trained medical professional either as a hospital-based or community-based program. Home-based exercise therapy was defined as structured walking advice supplemented with an observation component (e.g., exercise log-book). Walking advice was defined as “go home and walk” advice provided with or without a predefined exercise scheme. The review identified 21 randomised controlled trials (1,400 participants), among which 635 received supervised exercise therapy, 320 home-based exercise therapy and 445 received walking advice. 17 trials (81%) were considered to be low risk of bias. There is moderate quality evidence showing that structured exercise therapy is superior to home-based exercise therapy (standardised mean difference 0.37; 95% confidence interval 0.12 to 0.62) and high quality evidence showing that supervised exercise therapy is superior to walking advice (standardised mean difference 0.80; 95% confidence interval 0.53 to 1.07) in improving maximal treadmill walking distance at three months. These effect sizes represent that participants treated with structured exercise therapy were able to walk 120 metres further than those treated with home-based exercise therapy and 210 meters more than those treated walking advice, on average. There is moderate quality evidence showing that home-based exercise therapy did not improve walking distance compared to those treated with walking advice (standardised mean difference 0.30; 95% confidence interval -0.45 to 1.05). There is moderate quality evidence that supervised exercise therapy was more effective than home-based exercise therapy in increasing pain-free walking distance at 3 months (standardised mean difference 0.51; 95% confidence interval 0.21 to 0.81), and low quality evidence that it was not more effective in improving quality of life at 3 months (standardised mean difference 0.00; 95% confidence interval -4.79 to 4.79). This review showed moderate and high evidence that supervised exercise therapy provides an important benefit in improving walking distance compared to home-based exercise therapy and walking advice, respectively.
Hageman D, et al. Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication. Cochrane Database Syst Rev 2018;Issue 4