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 But both groups end up with a similar quality of life and similar
amount of walking in their daily lives, according to the study.
Intermittent claudication is the primary symptom of peripheral
artery disease. “As of 2010, there are estimated to be 200 million
patients with peripheral artery disease worldwide,” said lead author
Dr. Sreekanth Vemulapalli of Duke University Medical Center in
Durham, North Carolina.
“Current estimates are that 10% to 35% of people with peripheral
artery disease have intermittent claudication,” Vemulapalli told
Reuters Health by email.
Supervised exercise sessions can be an effective way to treat the
symptoms, but many patients would have to pay for it out of pocket
and therefore don’t utilize it, he said.
“Unfortunately, although supervised exercise is recommended by
multiple professional societies, including the American Heart
Association, the American College of Cardiology, and the Society of
Vascular Medicine, as one potential therapy for intermittent
claudication, many patients do not have access to it,” he said.
For the new study, the authors examined 24 randomized controlled
trials and four observational studies comparing supervised and
unsupervised exercise.
In general, compared to those who did unsupervised exercise, people
who did supervised exercise were able to walk about 86 meters
further at 12 months (roughly 282 feet, or one-twentieth of a mile),
and they were also able to walk a bit further (about 23 meters more,
or an extra 75 feet) before claudication symptoms began, according
to results in the American Heart Journal March 26.
But based on quality of life scales and patient reports, supervised
exercise did not improve quality of life or increase walking
distance or speed, compared to unsupervised exercise.
“Patients with intermittent claudication usually stop walking
because of pain in their muscles,” Vemulapalli said. “This pain is
thought to occur in part because the muscles are not getting enough
blood to do the work of walking.”
Exercise may improve blood flow by activating smaller blood vessels
in the legs, he said.
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Supervised exercise “consists of training sessions, supervised by a
trained physiotherapist, following an intermittent pattern of
periods of walking to induce pain and discomfort followed by periods
of rest,” according to Dr. Joep Teijink, a consultant vascular
surgeon at Catharina hospital in Eindhoven, The Netherlands.
The physiotherapist continuously monitors the patient and controls
therapy compliance for optimal treatment results, which is an added
benefit beyond exercising on your own, Teijink told Reuters Health
by email.
Many patients who are simply told to exercise on their own do not
carry out the advice, Teijink said.
Cost for physiotherapist sessions can vary by healthcare facility,
Vemulapalli said.
He still recommends supervised exercise for patients with
claudication, as it does improve walking distance, may improve
certain areas of quality of life that were not included in these
questionnaires, and may have other benefits for the cardiovascular
system.
Patients may also want to talk to their doctors about starting an
unsupervised exercise program, which has had encouraging results in
other studies comparing it to no exercise, he said.
SOURCE: http://bit.ly/1z080QK
Am Heart J 2015.
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