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Acute Pain | Chronic Pain | General

Exercise and intermittent claudication

Clinical bottom line: Walking exercises are useful in improving walking distance and pain-free walking distance in patients with intermittent claudication. Percentage improvement in walking time or distance ranged from 28% to 210% in patients receiving exercise interventions. Data from this review and other sources suggest that patients should be encouraged to exercise for at least 30 minutes, three times a week for six months.

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.

Systematic review

Brandsma, J. W.; Robeer, B. G., and van den Heuvel, S. et al. The effect of exercises on walking distance of patients with intermittent claudication: a study of randomized clinical trials. Phys Ther. 1998; 78:278-288.

Inclusion criteria were randomised controlled trials of exercise for intermittent claudication due to peripheral arterial occlusive disease in the lower extremities; walking distance as an outcome; use of treadmill for evaluations.

Reviewers extracted data on pain-free or maximum walking times or distances, and used pre- and post-intervention scores to calculate a percent change from baseline.

Findings

All of the included trials were small, with group sizes ranging from seven to 25, and exercise interventions varied in intensity, duration and content. Five of ten trials had an untreated control group (no intervention or placebo drug), and the remaining trials had an active intervention, either pharmacological, surgical or strength training of lower extremities only. Nine of ten trials included walking as part of the exercise intervention.

Ten of ten trials found improvement on walking time or distance with the exercise intervention. This ranged from 28% to 210% (unweighted mean 105%). This compared with a range of less than 10% to 36% improvement in patients receiving no treatment or placebo. The two trials with the smallest improvements in patients receiving exercise interventions were either of short duration or low intensity.

Although little data is provided on the exact nature of the exercise interventions, this review together with a second review suggest that patients should be encouraged to exercise for at least 30 minutes, three times a week for six months.

Figure: Effects of exercise on walking distance or time compared with placebo in patients with intermittent claudication


Adverse effects

None were reported.

Further references

Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA 1995; 274:975-980.
Ernst E, Fialka V. A review of the clinical effectiveness of exercise therapy for intermittent claudication. Arch Intern Med. 1993; 153(20): 2357-60.

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