Supervised exercise more effective than unsupervised exercise for increasing walking distance in intermittent claudication patients

April 16, 2015 – Sreekanth Vemulapalli, MD, led a metaanalysis of 27 studies of more than 2,000 intermittent claudication patients.

Supervised exercise is more effective than unsupervised exercise in improving maximal walking distance in patients with intermittent claudication, according to a new study conducted by DCRI researchers.

However, the researchers also found that supervised exercise is no more effective than unsupervised exercise at improving patients’ overall quality of life.

sreekanth-vemulapalliIntermittent claudication is an aching, cramping sensation in the legs that is often associated with peripheral artery disease. The condition affects an estimated 2 million Americans. Supervised exercise has been proven to be a useful treatment for intermittent claudication, but the associated costs and logistical challenges have limited the number of patients who receive such treatment. Unsupervised exercise represents a cheaper and easier treatment option, but previous studies comparing supervised and unsupervised exercise in intermittent claudication patients have been underpowered.

The current study, which appears in the online edition of the American Heart Journal, was a meta-analysis of previous studies. The researchers, led by the DCRI’s Sreekanth Vemulapalli, MD (pictured), searched PubMed, EMBASE, and the Cochrane Database of Systematic Reviews and identified 28 papers representing 27 unique studies (24 randomized controlled trials, 4 observational studies) that evaluated the comparative effectiveness of supervised exercise versus unsupervised exercise in 2,074 patients with intermittent claudication.

They found that, compared to those who did unsupervised exercise, patients who underwent supervised exercise were able to walk roughly 282 feet further at 12 months and were also able to walk a bit further (about 75 feet more) before the onset of claudication symptoms.

Using quality-of-life scales and patient reports, however, the researchers also found that supervised exercise did not improve quality of life or increase walking distance or speed when compared to unsupervised exercise. They speculated that both supervised and unsupervised exercise may improve walking distance by increasing blood flow to the legs. More research is needed to better understand the relationship between both supervised and unsupervised exercise and intermittent claudication.

The study’s other researchers included the DCRI’s and Duke’s Rowena J. Dolor, MD, MHS; Vic Hasselblad, PhD; Kristine Schmit, MD, MPH; Adam Banks, MD; Brooke Heidenfelder, PhD; Manesh R. Patel, MD; and W. Schuyler Jones, MD.