Exercise for intermittent claudication (Review)
Leng GC, Fowler B, Ernst E

A B S T R A C T
Background
Exercise is an inexpensive, low risk option compared with other more invasive therapies for leg pain on walking (intermittent claudication).
Objectives
The objective of this review was to determine the effects of exercise for leg pain.
Search strategy
The reviewers searched the Cochrane Peripheral Vascular Diseases Group trials register, Embase, reference lists of relevant articles, and contacted principal investigators of trials.
Selection criteria
Randomised trials of exercise regimens in patients with leg pain on walking (intermittent claudication).
Data collection and analysis
At least two reviewers extracted and assessed data trial quality independently. The reviewers contacted investigators to obtain information or data needed for the review that could not be found in published reports.
Main results
Fifteen trials were identified that met the inclusion criteria, but five were subsequently excluded because of poor quality. The remaining ten trials involved a total of almost 250 male and female patients with stable leg pain. The follow-up ranged from 12 weeks to 15 months. There was also some variation in the exercise regimens used, although all recommended at least two weekly sessions of, mostly,
supervised exercise. All trials used a treadmill walking test as one of the outcome measures. The overall quality of the included trials was generally good, though the trials were all small (20-49 patients).
Exercise therapy signifcantly improved maximal walking time (minutes) (weighted mean difference 6.51, 95% confidence interval 4.36 to 8.66,Fixed effect model [FE]), with an overall improvement in walking ability of approximately 150% (range 74% to 230%).
Exercise produced significant improvements in walking time compared with both angioplasty at six months (weighted mean difference
3.30, 95% confidence interval 2.21 to 4.39, FE) and antiplatelet therapy (weighted mean difference 1.06, 95% confidence interval 0.15 to 1.97, FE), and did not differ significantly from surgical treatment. In one small trial, exercise was less effective than pentoxifylline (weighted mean difference -0.45, 95% confidence interval -0.66 to -0.24, FE).
Authors' conclusions
Exercise is of significant benefit to patients with leg pain.
S Y N O P S I S
Exercising three times a week can make a big difference to leg pain on walking (intermittent claudication) caused by blocked arteries. Intermittent claudication is a cramping pain, induced by exercise and relieved by rest. It is a symptom of atherosclerosis (fatty deposits blocking blood flow through the arteries), causing inadequate blood flow to the leg muscles. Treatments include stopping smoking, starting to exercise, drugs, heart bypass surgery or angioplasty (inserting 'balloons' to open up the arteries). This review of trials found that exercise (walking to the level that causes pain, three times a week) can relieve intermittent claudication for many people. Exercise may be better than angioplasty. Other forms of surgery may be more effective than exercise, but carry more risks.