Supervised exercise was shown to be more effective than stenting or medication for improved walking ability in patients with peripheral artery disease. The findings from a national study were reported at the 2011 American Heart Association Scientific Sessions meeting in November.
Current guidelines for the treatment of claudication include pharmacotherapy, supervised exercise rehabilitation and lower extremity revascularisation using stents. Timothy Murphy, radiologist who heads the Vascular Disease Research Center at Rhode Island Hospital, was the principal investigator for the Rhode Island Hospital arm of CLEVER (Claudication: exercise versus endoluminal revascularizaton), the first multicentre clinical trial to compare the treatment strategies. He is also the lead author of the paper published in the November issue of the journal Circulation.
The research group reported that of 111 patients studied in the randomised trial, the most effective treatment proved to be supervised exercise based on the results of a treadmill test taken at baseline and again at six months. Patients who were in the supervised exercise group improved by a mean of 4.6 minutes in the treadmill test, while the group who received stents improved by a mean of 2.5 minutes. The researchers also found, however, that self-reported quality of life measurements proved to be higher in the group who received stents, even though their ability to walk did not improve as greatly as the group who received supervised exercise rehabilitation.
Murphy said, “This study demonstrates that for patients with claudication that supervised exercise provides a superior improvement in treadmill walking performance compared to both primary aortoiliac stenting and optimal medical care. This benefit is associated with an improvement in self-reported walking distance, an increase in HDL and a decrease of fibrinogen.” He added, however, “Secondary measures of treatment efficacy such as self-reported physical function measures and pedometer measures of community walking favored primary stenting over supervised exercise.”
Alan T Hirsch, Lillehei Heart Institute at the University of Minnesota Medical School, presented the findings at the AHA Scientific Sessions. Hirsch commented, “At a time when healthcare costs are appropriately in sharp public focus, this study provides an avenue by which we could –if we choose – achieve a major positive set of health outcomes at low risk and at lower cost.”
Murphy and the researchers believe that more studies are necessary, but also believe that supervised exercise may be an effective recommended treatment for peripheral arterial disease patients with claudication. Murphy commented, “The CLEVER team will be reporting further outcomes from this study based on an 18-month review.”
The CLEVER study is funded through grants from the National Heart Lung and Blood Institute, as well as support from Cordis/Johnson & Johnson and Boston Scientific.
