Intermittent claudication - pain, tension and weakness on walking which
intensifies until walking becomes impossible, but disappears on resting - is
estimated to affect 2% of people over 65 years. Does exercise help? A systematic
review of randomised trials [1] suggests that it does.
The review had a superb searching system, including a specialist Dutch database
of non-MEDLINE physical therapy trials. Ten randomised trials investigated the
effect of exercises on the walking distance of patients with intermittent
claudication due to peripheral vascular disease of the lower limbs. Five had an
untreated control group, and in the other studies, the other experimental groups
received a different intervention such as surgery. Nine of the ten studies had
one group who used walking exercises.
The exercise programs varied in intensity, duration and content, but were all
carried out at an institution. Maximum pain-free walking distance or time on a
treadmill was used as an outcome measure, but since the treadmill settings were
all different, percentage changes are the best standardised way of comparing
studies, and no NNTs are possible.
All 10 studies unequivocally demonstrated that participation in a standardised
exercise program improved pain-free walking distance or time of patients with IC.
For the five studies with untreated controls the L'Abbé plot shows the
percentage changes in treadmill (time, distance, slope and velocity were all
different).
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