Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication

被引:153
|
作者
Hageman, David [1 ,2 ]
Fokkenrood, Hugo J. P. [3 ]
Gommans, Lindy N. M. [1 ]
van den Houten, Marijn M. L. [1 ,2 ]
Teijink, Joep A. W. [1 ,2 ]
机构
[1] Catharina Hosp, Dept Vasc Surg, Eindhoven, Netherlands
[2] Maastricht Univ, Dept Epidemiol, CAPHRI Sch Publ Hlth & Primary Care, Fac Hlth Med & Life Sci, Maastricht, Netherlands
[3] Rijnstate, Dept Vasc Surg, Arnhem, Netherlands
来源
COCHRANE DATABASE OF SYSTEMATIC REVIEWS | 2018年 / 04期
关键词
Directly Observed Therapy; Exercise Therapy [methods; Intermittent Claudication [therapy; Randomized Controlled Trials as Topic; Walking; Female; Humans; Male; PERIPHERAL ARTERIAL-DISEASE; QUALITY-OF-LIFE; RANDOMIZED CONTROLLED-TRIAL; BRIEF PSYCHOLOGICAL INTERVENTION; LOWER-LIMB EXERCISE; PHYSICAL-EXERCISE; OCCLUSIVE DISEASE; SKELETAL-MUSCLE; 6-MINUTE WALK; FUNCTIONAL-CAPACITY;
D O I
10.1002/14651858.CD005263.pub4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Although supervised exercise therapy (SET) provides significant symptomatic benefit for patients with intermittent claudication (IC), it remains an underutilized tool. Widespread implementation of SET is restricted by lack of facilities and funding. Structured home-based exercise therapy (HBET) with an observation component (e.g., exercise logbooks, pedometers) and just walking advice (WA) are alternatives to SET. This is the second update of a review first published in 2006. Objectives The primary objective was to provide an accurate overview of studies evaluating effects of SET programs, HBET programs, and WA on maximal treadmill walking distance or time (MWD/T) for patients with IC. Secondary objectives were to evaluate effects of SET, HBET, and WA on pain-free treadmill walking distance or time (PFWD/T), quality of life, and self-reported functional impairment. Search methods The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register (December 16, 2016) and the Cochrane Central Register of Controlled Trials (2016, Issue 11). We searched the reference lists of relevant studies identified through searches for other potential trials. We applied no restriction on language of publication. Selection criteria We included parallel-group randomized controlled trials comparing SET programs with HBET programs and WA in participants with IC. We excluded studies in which control groups did not receive exercise or walking advice (maintained normal physical activity). We also excluded studies comparing exercise with percutaneous transluminal angioplasty, bypass surgery, or drug therapy. Data collection and analysis Three review authors (DH, HF, and LG) independently selected trials, extracted data, and assessed trials for risk of bias. Two other review authors (MvdHand JT) confirmed the suitability and methodological quality of trials. For all continuous outcomes, we extracted the number of participants, mean outcome, and standard deviation for each treatment group through the follow-up period, if available. We extracted Medical Outcomes Study Short Form 36 outcomes to assess quality of life, and Walking Impairment Questionnaireoutcomes to assess self-reported functional impairment. As investigators used different scales to present results of walking distance and time, we standardized reported data to effect sizes to enable calculation of an overall standardized mean difference (SMD). We obtained summary estimates for all outcome measures using a random-effects model. We assessed the quality of evidence using the GRADE approach. Main results For this update, we included seven additional studies, making a total of 21 included studies, which involved a total of 1400 participants: 635 received SET, 320 received HBET, and 445 receivedWA. In general, SET and HBET programs consisted of three exercise sessions per week. Follow-up ranged from six weeks to two years. Most trials used a treadmill walking test to investigate effects of exercise therapy on walking capacity. However, two trials assessed only quality of life, functional impairment, and/or walking behavior (i. e., daily steps measured by pedometer). The overall methodological quality of included trials was moderate to good. However, some trials were small with respect to numbers of participants, ranging from 20 to 304. SET groups showed clear improvement in MWD/T compared with HBET and WA groups, with overall SMDs at three months of 0.37 (95% confidence interval [CI] 0.12 to 0.62; P = 0.004; moderate-quality evidence) and 0.80 (95% CI 0.53 to 1.07; P < 0.00001; high-quality evidence), respectively. This translates to differences in increased MWD of approximately 120 and 210 meters in favor of SET groups. Data show improvements for up to six and 12 months, respectively. The HBET group did not show improvement in MWD/T compared with the WA group (SMD 0.30, 95% CI -0.45 to 1.05; P = 0.43; moderate-quality evidence). Compared with HBET, SET was more beneficial for PFWD/T but had no effect on quality of life parameters nor on self-reported functional impairment. Compared with WA, SET was more beneficial for PFWD/T and self-reported functional impairment, as well as for some quality of life parameters (e.g., physical functioning, pain, and physical component summary after 12 months), and HBET had no effect. Data show no obvious effects on mortality rates. Thirteen of the 1400 participants died, but no deaths were related to exercise therapy. Overall, adherence to SET was approximately 80%, which was similar to that reported with HBET. Only limited adherence data were available for WA groups.
引用
收藏
页数:200
相关论文
共 50 条
  • [31] Comparison of supervised exercise therapy with or without revascularization for the management of intermittent claudication
    Doshi, Rajkumar
    Shah, Priyank
    Majmundar, Monil
    Kumar, Ashish
    Vallabhajosyula, Saraschandra
    EUROPEAN JOURNAL OF INTERNAL MEDICINE, 2021, 92 : 131 - 133
  • [32] Long-term clinical effectiveness of supervised exercise therapy versus endovascular revascularization for intermittent claudication from a randomized clinical trial
    Fakhry, F.
    Rouwet, E. V.
    den Hoed, P. T.
    Hunink, M. G. M.
    Spronk, S.
    BRITISH JOURNAL OF SURGERY, 2013, 100 (09) : 1164 - 1171
  • [33] Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent claudication
    van den Houten, M. M. L.
    Lauret, G. J.
    Fakhry, F.
    Fokkenrood, H. J. P.
    van Asselt, A. D. I.
    Hunink, M. G. M.
    Teijink, J. A. W.
    BRITISH JOURNAL OF SURGERY, 2016, 103 (12) : 1616 - 1625
  • [34] Effectiveness of a home-based exercise therapy and walking program on osteoarthritis of the knee
    Evcik, D
    Sonel, B
    RHEUMATOLOGY INTERNATIONAL, 2002, 22 (03) : 103 - 106
  • [35] An updated systematic review and meta-analysis of home-based exercise programs for individuals with intermittent claudication
    Pymer, Sean
    Ibeggazene, Said
    Palmer, Joanne
    Tew, Garry A.
    Ingle, Lee
    Smith, George E.
    Chetter, Ian C.
    Harwood, Amy E.
    JOURNAL OF VASCULAR SURGERY, 2021, 74 (06) : 2076 - +
  • [36] Supervised Exercise Therapy and Revascularization for Intermittent Claudication Network Meta-Analysis of Randomized Controlled Trials
    Saratzis, Athanasios
    Paraskevopoulos, Ioannis
    Patel, Sanjay
    Donati, Tommaso
    Biasi, Lukla
    Diamantopoulos, Athanasios
    Zayed, Hany
    Katsanos, Konstantinos
    JACC-CARDIOVASCULAR INTERVENTIONS, 2019, 12 (12) : 1125 - 1136
  • [37] The effect of supervised exercise therapy for intermittent claudication on lower limb lean mass
    Vun, Simon Vui
    Miller, Michelle D.
    Delaney, Christopher L.
    Allan, Richard B.
    Spark, J. Ian
    JOURNAL OF VASCULAR SURGERY, 2016, 64 (06) : 1763 - 1769
  • [38] Efficacy of Supervised Exercise Therapy for Intermittent Claudication in a Case With Buerger's Disease
    Komiya, Daisuke
    Iwai, Kohji
    Ohno, Tomokazu
    CUREUS JOURNAL OF MEDICAL SCIENCE, 2023, 15 (08)
  • [39] Supervised Exercise Therapy for Intermittent Claudication Is Increasingly Endorsed by Dutch Vascular Surgeons
    Hageman, David
    Lauret, Gert-Jan
    Gommans, Lindy N. M.
    Koelemay, Mark J. W.
    van Sambeek, Marc R. H. M.
    Scheltinga, Marc R. M.
    Teijink, Joep A. W.
    ANNALS OF VASCULAR SURGERY, 2018, 47 : 149 - 156
  • [40] Supervised Exercise Therapy is Effective for Patients With Intermittent Claudication Regardless of Psychological Constructs
    Jansen, Sandra C. P.
    Hoeks, Sanne E.
    Nyklicek, Ivan
    Scheltinga, Marc R. M.
    Teijink, Joep A. W.
    Rouwet, Ellen, V
    EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2022, 63 (03) : 438 - 445