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Exercise and Intermittent Claudication


Intermittent claudication - pain, tension and weakness on walking which intensifies until walking becomes impossible, but disappears on resting - is estimated to affect 2% of people over 65 years. Does exercise help? A systematic review of randomised trials [1] suggests that it does.

Review

The review had a superb searching system, including a specialist Dutch database of non-MEDLINE physical therapy trials. Ten randomised trials investigated the effect of exercises on the walking distance of patients with intermittent claudication due to peripheral vascular disease of the lower limbs. Five had an untreated control group, and in the other studies, the other experimental groups received a different intervention such as surgery. Nine of the ten studies had one group who used walking exercises.

The exercise programs varied in intensity, duration and content, but were all carried out at an institution. Maximum pain-free walking distance or time on a treadmill was used as an outcome measure, but since the treadmill settings were all different, percentage changes are the best standardised way of comparing studies, and no NNTs are possible.

Results

All 10 studies unequivocally demonstrated that participation in a standardised exercise program improved pain-free walking distance or time of patients with IC. For the five studies with untreated controls the L'Abbé plot shows the percentage changes in treadmill (time, distance, slope and velocity were all different).
Improvement of walking distance ranged in nine study groups using walking exercises from 28% to 210% (unweighted mean 105%). The two studies with the smallest improvements were either of short duration or low intensity.

Comment

These were small trials, with groups sizes of seven to 25 patients. But results were consistent, and the review shows that walking exercises are an effective conservative intervention. We are given little detail about the exact exercises and the duration of the programs, so the results of this review will not be easy to put into practice. According to this and another review [2] (which looked at non-randomised studies as well), patients should be encouraged to exercise at least 30 minutes a session, three times a week for at least 6 months.

Reference:

  1. JW Brandsma, BG Robeer, S van der Heuvel et al. The effect of exercises on walking distance of patients with intermittent claudication: A study of randomised clinical trials. Physical Therapy 1998 78: 278-88.
  2. AW Gardner, ET Poehlman. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA 1995 274: 975-80.



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