Revascularization Before Exercise Improves Walking in PAD Patients

A new study shows that endovascular revascularization followed by supervised exercise results in greater improvements among patients with peripheral artery disease (PAD) and intermittent claudication.

Researchers at Erasmus University Medical Center (Erasmus MC; Rotterdam, The Netherlands), Elkerliek Hospital (Helmond, the Netherlands), and other Dutch hospitals conducted a randomized clinical trial involving 212 patients who were allocated to either endovascular revascularization plus supervised exercise (106 patients), or supervised exercise alone (106 patients); the patients were followed for up for 12 months. The primary end point was the difference in maximum treadmill walking distance at follow-up between the two groups.

The results showed that combined endovascular revascularization and supervised exercise was associated with greater improvement in maximum walking distance (1,237 meter improvement), compared with the supervised exercise only group (955 meters), as well as in pain-free walking distance (1,120 meter versus 712 meter improvement, respectively). The combination therapy group also demonstrated significantly greater improvement in health-related quality-of-life (QoL) scores. The study was published in the November 10, 2015, issue of Journal of the American Medical Association (JAMA).

“The present study reopens the debate for revascularization in patients with claudication, in particular in terms of an approach using endovascular revascularization first,” concluded senior author Prof. Myriam Hunink, MD, PhD, of Erasmus MC, and colleagues. “By improving lower extremity blood flow, early percutaneous revascularization of the target lesion gives an impulse to patient mobility and quality of life in the short-term. This, in turn, facilitates subsequent exercising and allows the patient to profit from the long-term benefits of an additional supervised exercise program.”

Intermittent claudication is the classic symptomatic form of PAD, affecting approximately 20–40 million people worldwide and increasing rapidly with the aging world population. Patients with claudication experience significant functional disability, often resulting in a sedentary lifestyle and reduced QoL. Supervised exercise is recommended as a first-line treatment.

Related Links:
Erasmus University Medical Center
Elkerliek Hospital