Exercise rehabilitation programs for the treatment of claudication pain: A meta-analysis

Objective. - To identify the components of exercise rehabilitation programs that were most effective in improving claudication pain symptoms in patients with peripheral arterial disease. Data Sources. - English-language articles were identified by a computer search using Index Medicus and MEDLINE, followed by an extensive bibliography review. Study Selection. - Studies were included if they provided the mean or individual walking distances or times to the onset of claudication pain and to maximal pain during a treadmill test before and after rehabilitation. Data Extraction. - Walking distances and times and characteristics of the exercise programs were independently abstracted by two observers. Data Synthesis. - Thirty-three English-language studies were identified, of which 21 met the inclusion criteria. Overall, following a program of exercise rehabilitation, the distance (mean±SD) to onset of claudication pain increased 179% from 125.9±57.3 m to 351.2±188.7 m (P<.001), and the distance to maximal claudication pain increased 122% from 325.8±148.1 m to 723.3±591.5 m (P<.001). The greatest improvement in pain distances occurred with the following exercise program: duration greater than 30 minutes per session, frequency of at least three sessions per week, walking used as the mode of exercise, use of nearmaximal pain during training as claudication pain end point, and program length of greater than 6 months. However, the claudication pain end point, program length, and mode of exercise were the only independent predictors (P<.001) for improvement in distances. Conclusions. - The optimal exercise program for improving claudication pain distances in patients with peripheral arterial disease uses intermittent walking to near-maximal pain during a program of at least 6 months. Such a program should be part of the standard medical care for patients with intermittent claudication.