Effectiveness of Intermittent Claudication Rehabilitation Methods in Patients with Peripheral Arterial Disease

Abstract

The aim of this review is to investigate the latest data on the effectiveness of supervised exercise training (SET) on walking ability in patients with intermittent claudication (IC), its effect on quality of life, the Ankle-Brachial Index (ABI) and disease progression, compared to other rehabilitation methods such as medication, surgery, physiotherapy and unsupervised exercise. A systematic search of relevant RCTs in the Ovid MEDLINE(R), Cochrane CENTRAL, Pubmed and Scopus databases was conducted from January 2016 to March 2023. The methodological quality of the studies was assessed using the PEDro scale. Main outcome measures were maximum walking distance/time and pain-free walking distance/time. 1396 articles were identified. Eight RCTs, five of which were of good and three of moderate methodological quality, met the inclusion criteria. According to the results, SET improved maximum walking distance up to 200%, painless walking distance up to 343.37%, maximum walking time up to 99.03% and painless walking time up to 102.18%, contributed to a non-statistically significant improvement in quality of life and did not affect the ABI. Endovascular revascularization (ER) methods seem to have better early results in maximum walking distance compared to SET, however after six months of intervention these differences do not exist. There were no significant differences between SET and ER in mortality, major cardiovascular events and additional interventions. In conclusion, SET shows significant advantages in improving walking ability compared to no intervention, usual care and walking advice alone. Revascularization procedures do not offer significant advantages in walking ability and quality of life compared with SET. Therefore, it seems reasonable, to precede SET as an intervention. If this alone does not prove sufficient, endovascular revascularization procedures should be combined with SET programs.