Supervised exercise therapy for intermittent claudication in daily practice

• Published in: Journal of vascular surgery Vol. 49; no. 2; pp. 363 - 370
• Main Authors: Kruidenier, Lotte M., MD, Nicolaï, Saskia P., MD, Hendriks, Erik J., MD, PhD, Bollen, Ewald C., MD, PhD, Prins, Martin H., MD, PhD, Teijink, Joep A.W
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-02-2009; Elsevier
• Subjects: Aged; Ankle - blood supply; Biological and medical sciences; Blood Pressure; Brachial Artery - physiopathology; Community Health Services; Exercise Therapy; Exercise Tolerance; Female; General and cellular metabolism. Vitamins; Humans; Intermittent Claudication - physiopathology; Intermittent Claudication - surgery; Intermittent Claudication - therapy; Male; Medical sciences; Middle Aged; Netherlands; Patient Dropouts; Pharmacology. Drug treatments; Program Evaluation; Prospective Studies; Recovery of Function; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures; Walking; Netherlands; Physical exercise; Claudication; Cardiovascular disease; Treatment; Intermittent; Surgery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2008.09.042

Objective This study describes the results and functioning of community-based supervised exercise therapy (SET) at one year of follow-up. Methods We conducted a prospective cohort study of community-based SET in regional physiotherapeutic practices. Consecutive patients with intermittent claudication referred for community-based SET were included. Exclusion criteria for SET were pain at rest or tissue loss. All patients received a diagnostic workup consisting of an ankle-brachial index at rest and after exercise. Interventions were exercise therapy according to the guidelines of the Royal Dutch Society for Physiotherapy. The primary outcome measurement was the increase in absolute claudication distance (ACD), assessed using a standardized treadmill protocol by a physiotherapist at baseline and at four, 12, 26, and 52 weeks of SET. Results From January 2005 through September 2006, 349 patients were referred by vascular surgeons for community-based SET. A total of 272 patients with intermittent claudication began the program. Of the 349 initially referred patients, 52 could not perform a standard treadmill test but did start community-based SET at a lower level, and 25 patients never started the program. At one year, 129 of the original 272 patients who began community-based SET (47.4%) were available for analysis of walking distance. In the interim, 143 patients discontinued the program for the following reasons: satisfaction with the acquired walking distance (n = 19); unsatisfying results (n = 26); not motivated (n = 22); (non)vascular intercurrent disease (n = 48); and other reasons (n = 28). ACD increased significantly from a median of 400 m at baseline to 1100 m after 12 months of follow-up ( P < .001), corresponding to a median increase of 107.8%. Conclusion Community-based SET seems as effective as SET in a hospital-based approach in improving walking distance, however, it has a high dropout rate.