Supervised Exercise and Revascularization for Intermittent Claudication

The combination of optimal medical treatment plus angioplasty plus supervised exercise seems to be the first line of treatment for patients with intermittent claudication, in terms of maximum walking distance and best quality of life. This combination requires a multidisciplinary team for the best possible results.

The aim of this study was to conduct a meta-analysis comparing all therapeutic strategies for intermittent claudication, including optimal medical treatment, peripheral angioplasty, supervised exercise therapy, and their corresponding combinations, in order to determine the best treatment for intermittent claudication.

Intermittent claudication is a common problem that limits physical activity, decreases quality of life, and is associated with more cardiovascular events. There are previous meta-analyses, but none tested the impact of strategy combinations.

This study included data from 37 randomized studies, reaching almost 3000 patients with intermittent claudication (mean age was 68 years; 54.5% of patients were men). Comparisons were established between best medical treatment vs. supervised exercise vs. angioplasty vs. angioplasty plus supervised exercise.

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Angioplasty plus supervised exercise outperformed all other possible treatment strategies and obtained the maximum walking distance gain, 290 meters (p < 0.001).

As regards quality of life, the combination of angioplasty and supervised exercise also outperformed all other strategies. This does not mean that optimal medical treatment should be overlooked, since it acts over the whole range of cardiovascular disease.

The best course of action is a combination of all three strategies: optimal medical treatment aimed at a long/medium-term reduction in events (all cardiovascular events), angioplasty so that the patient experiences an acute difference and is able to begin with a supervised exercise plan, and, finally, such plan for result optimization and maintenance over time.

Original Title: Supervised Exercise Therapy and Revascularization for Intermittent Claudication Network Meta-Analysis of Randomized Controlled Trials.

Reference: Athanasios Saratzis et al. J Am Coll Cardiol Intv 2019, Article in press.

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