Abstract 12625: Supervised vs. Unsupervised Exercise for the treatment of Intermittent Claudication: a Network Meta-analysis
Background: Although supervised exercise has been proven effective for intermittent claudication (IC), lack of reimbursement has limited its use. Recent small studies have found unsupervised exercise to be equivalent to supervised exercise for the improvement of claudication. We assessed the comparative effectiveness of supervised exercise (SE) versus unsupervised exercise (UE) in patients with IC.
Methods: Two investigators screened abstracts and full-text articles for inclusion, abstracted data, and performed quality ratings and evidence grading. Continuous outcome measures on different surveys (e.g. functional status, quality of life) were combined using a random-effects meta-regression model on the effect sizes (ES). ES interpretation was based on Hedges’s g, whereby 0=no effect, 0.2=small effect, 0.5=moderate effect, 0.8=large effect, and >1.0=very large effects.
Results: We identified 22 unique studies that evaluated the comparative effectiveness of supervised versus unsupervised exercise in 1775 patients with IC. As compared to UE, SE was associated with a moderate improvement in maximal walking distance at 6 months (ES 0.58; 95% CI 0.48 to 0.73, p = 0.18) and 12 months (effect size 0.46; 95% CI 0.28 to 0.64, p = 0.87). SE was also associated with a moderate improvement in claudication distance compared to UE at 6 months (ES 0.58; 95% CI 0.39 to 0.76, p = 0.16) and 12 months (ES 0.42; 95% CI 0.24 to 0.61, p = 0.70). There was minimal difference in SF-36 physical functioning quality of life at 6 months (ES 0.11; 95% CI -0.26 to 0.49, p = 0.09).
Conclusion: Supervised exercise is more effective than unsupervised exercise at improving maximal walking and claudication distances in patients with IC, yet there is minimal difference in quality of life. Further studies will be needed to investigate the discrepancy between functional gain and quality of life.
- © 2013 by American Heart Association, Inc.