Exercise Therapy and the Additional Effect of Supervision on Exercise Therapy in Patients with Intermittent Claudication. Systematic Review of Randomised Controlled Trials

ObjectiveTo review the evidence for the effectiveness of exercise therapy and to estimate the additional effect of supervision on exercise therapy in patients with intermittent claudication.Materials and methodsA systematic review was performed of all randomised controlled trials (RCTs) comparing supervised exercise therapy to unsupervised exercise regimens or observation in patients with intermittent claudication. Main endpoints were pain free walking distance (PWD) and absolute walking distance (AWD). Quality assessment and data extraction were performed independently by two observers.ResultsFifteen manuscripts, published between 1990 and May 2006, were eligible for analysis, evaluating 761 patients. In the studies comparing supervised exercise to standard care the weighted mean difference in pain free walking distance (PWD) and absolute walking distance (AWD) was 81.3 meters (95% CI; 35.5–127.1) and 155.8 meters (95% CI; 80.8–230.7), respectively. In the studies comparing supervised to unsupervised exercise therapy, the weighted mean difference in PWD and AWD was 143.8 meters (95% CI; 5.8–281.8) and 250.4 meters (95% CI; 192.4-308.5).ConclusionExercise therapy increases the PWD and AWD in patients with intermittent claudication. Supervised exercise therapy increases the PWD and AWD more than standard care. However, the additional value of supervision over unsupervised exercise regimens needs further clarification.