A recent randomised controlled trial (RCT)—the CIPIC Rehab study—found that three-months’ community-based cardiac rehabilitation improves walking distance in patients with intermittent claudication. It was also found to improve physical activity level, diet, and health-related quality of life. These results were presented by Maj Siercke (University of Copenhagen, Copenhagen, Denmark) during ESVS Month (29 September–29 October), the digital replacement for this year’s European Society for Vascular Surgery (ESVS) annual meeting.
“We know that supervised exercise training improves walking distance and health-related quality of life,” Siercke began, adding that typical programmes include treadmill-based exercise three times per week over a 12-week period.
Siercke then referenced a 2009 Journal of Vascular Surgery study by Kruidenier et al, however, which suggested that treadmill exercise does not work for claudicants, “maybe because it is very boring and hard work,” she speculated. In response to the need for an alternative, the presenter relayed to the online audience that community-based cardiac rehabilitation programmes are well-established in the Danish community and “could easily be adapted for patients with claudication”.
In the present study, Siercke and colleagues at the University of Copenhagen randomised 118 patients 1:1 to either a control group or an intervention group. Patients in the control group were given a logbook to record steps, a patient information brochure, and medication, while those randomised to the intervention group were given a more extensive rehabilitation programme.
Siercke outlined that the content of the intervention group programme consisted of two weekly exercise sessions for 12 weeks, involved active engagement with groups of up to 10 patients, and included varied forms of physical exercise.
Addressing the online ESVS audience, Siercke reported that while maximal walking distance—the primary outcome—increased in both the control and intervention groups, the increase was 37% greater in the intervention group after six months. In addition, maximal walking distance was sustained over 12 months.
In terms of secondary outcomes, the investigators found no significant difference in pain-free walking distance after six and 12 months, but did find a significant increase in physical activity in the intervention group compared to the control group at six (52% vs. 32%) and 12 (52% vs. 25%) months.
While Siercke and colleagues found no significant differences in either smoking or alcohol consumption after six and 12 months, they report improvements in diet after six and 12 months.
Finally, quality of life score improved significantly in the intervention group at both six and 12 months. However, the investigators did not find any differences in anxiety and depression scores at either six or 12 months.
Siercke concluded that three-months’ community-based rehabilitation improved maximum walking distance by 37% at six months, compared to the usual care in patients with intermittent claudication. In addition, the same positive effect was found in physical activity level, health-related quality of life, and improvement in diet.