H.J.P Fokkenrood

Innovative strategies for
intermittent claudication

towards a stepped care approach and new outcome measures



Supervised exercise versus non-supervised exercise for people with leg pain while walking (intermittent claudication)

 Some people experience a type of leg pain in the calf of one or both legs that occurs during walking and is relieved only by rest. This is called intermittent claudication (IC), and it is the main symptom of peripheral arterial disease (PAD). PAD is characterized by reduced flow of blood in the leg due to hardening of the arteries, or blood vessels. Exercise is considered to provide significant benefit for people with this type of leg pain. People need to walk at least three times a week by themselves, or they can participate in a formal, supervised exercise program that involves walking on a treadmill. This review found that people in a supervised program improved their walking ability to a greater extent than those following an unsupervised walking program. After three months, people who followed the supervised treadmill program could walk 180 meters farther than those who did unsupervised exercise. Before participating in the program, they had walked around 300 meters, with a pain-free distance of 200 meters, so this improvement is likely to help with independence. These conclusions are drawn from the findings of 14 trials in which participants with PAD had been assigned to either supervised or unsupervised exercise. Altogether, 1002 participants with a mean age of 67 years were included. The overall quality of the included trials was moderate to good, although each had enrolled only a small number of participants. The trials lasted from six weeks to twelve months. Keeping to an exercise program is important because it leads to decreased leg pain and the likelihood of improving general physical condition, but it is not yet clear if it also improves quality of life.