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

Abstract

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 P P 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. ( JAMA . 1995;274:975-980)