EXERCISE REHABILITATION PROGRAMS FOR THE TREATMENT OF CLAUDICATION PAIN - A METAANALYSIS

Objective.-To identify the components of exercise rehabilitation progr ams that were most effective in improving claudication pain symptoms i n patients with peripheral arterial disease. Data Sources.-English-lan guage articles were identified by a computer Search using Index Medicu s and MEDLINE, followed by an extensive bibliography review. Study Sel ection.-Studies were included if they provided the mean or individual walking distances or times to the onset of claudication pain and to ma ximal pain during a treadmill test before and after rehabilitation. Da ta Extraction.-Walking distances and times and characteristics of the exercise programs were independently abstracted by two observers. Data Synthesis.-Thirty-three English-language studies were identified, of which 21 met the inclusion criteria, Overall, following a program of e xercise rehabilitation, the distance (mean+/-SD) to onset of claudicat ion pain increased 179% from 125.9+/-57.3 m to 351.2+/-188.7 m (P<.001 ), and the distance to maximal claudication pain increased 122% from 3 25.8+/-148.1 m to 723.3+/-591.5 m (P<.001). The greatest improvement i n pain distances occurred with the following exercise program: duratio n greater than 30 minutes per session, frequency of at least three ses sions per week, walking used as the mode of exercise, use of near-maxi mal pain during training as claudication pain end point, and program l ength of greater than 6 months, However, the claudication pain end poi nt, program length, and mode of exercise were the only independent pre dictors (P<.001) for improvement in distances. Conclusions.-The optima l exercise program for improving claudication pain distances in patien ts with peripheral arterial disease uses intermittent walking to near- maximal pain during a program of at least 6 months. Such a program sho uld be part of the standard medical care for patients with intermitten t claudication.