Exercise Improves Intermittent Claudication Caused by Arterial Disease

Patients who limp due to leg pain caused by arterial disease may be able to forego surgical treatment of the affected artery by participating in a hospital-supervised exercise regimen, according to a new study.

Researchers at Ikazia Hospital (Rotterdam, The Netherlands) treated a total of 151 consecutive patients between September 2002 and September 2005, who presented symptoms of intermittent claudication. The patients were randomly assigned to two groups: 76 patients underwent endovascular revascularization (angioplasty-first approach) of femoral or iliac stenoses, and 75 patients who underwent hospital-based supervised exercise sessions twice weekly for 24 weeks, and were instructed in a home walking program; those in the revascularization group received general lifestyle recommendations. The outcome measures of the study were clinical success, functional capacity, and quality of life (QOL) after 6 and 12 months. Clinical success was defined as improvement in at least one category in the Rutherford scale above the pretreatment level. To adjust outcomes for imbalances of baseline values, multivariable regression analysis was performed.

The study results showed that immediately after the start of treatment, patients who underwent revascularization improved more than patients who performed exercise in terms of clinical success, but that this advantage was lost after six and 12 months. After revascularization, fewer patients showed signs of ipsilateral symptoms at 6 months compared with patients in the exercise group, but no significant differences were demonstrated at 12 months. After both treatments, functional capacity and QOL scores increased after 6 and 12 months, but no significant differences between the groups were demonstrated. The study was published in the February 2009 issue of Radiology.

"Revascularisation is increasingly being performed as a first line of treatment," said lead author Sandra Spronk, Ph.D, of the department of epidemiology and radiology. "This study emphasizes that all patients with intermittent claudication should initially be treated with exercise training, and that invasive procedures should be considered only if symptoms fail to improve."

Intermittent claudication is a clinical diagnosis given for muscle pain (ache, cramp, numbness, or sense of fatigue), usually involving the calf muscle, which occurs during exercise and is relieved by a short period of rest. Intermittent claudication is measured by the number of 'city blocks' a person one can walk comfortably Claudication derives from the Latin verb claudicare, "to limp."

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