VALUE OF A SUPERVISED EXERCISE PROGRAM FOR THE THERAPY OF ARTERIAL CLAUDICATION

Purpose: This study was performed to test the effectiveness of a forma l supervised exercise program against a home-based exercise program fo r both walking ability and quality of life endpoints. Methods: Patient s with arterial claudication were randomized to either a 12-week super vised exercise program (SUPEX) with weekly lectures relating to periph eral vascular disease or to a home exercise group (HOMEX) who attended an identical lecture program and received weekly exercise instruction . The study population included 29 men and 26 women, with a mean age o f 69.1 +/- 8.1 years. forty-seven patients completed the 12-week progr am, 46 were available for testing at completion, and 38 for 6-month te sting. Claudication pain time (CPT) and maximum walking time (MWT) on a progressive treadmill exercise test were assessed at baseline, progr am completion, and 6 months. The Medical Outcomes Study Short Form-36 (SF-36) was administered at these intervals to assess effects on quali ty of life. Results: Each group improved (p < 0.001) in both CPT and M WT at the completion of the 12-week program, which was sustained at th e 6-month follow-up. Increase in HOMEX CPT from baseline (3.6 +/- 2.73 minutes) to 6-month follow-up (6.6 +/- 3.17 minutes) was less than fo r the SUPEX group (3.8 +/- 2.74 to 11.2 +/- 4.02 minutes, respectively ); similar results were obtained for MWT. At both completion and 6 mon ths, there was a significant intergroup difference for CPT and MWT (p < 0.004) favoring SUPEX. For both groups, measures of health perceptio n based on the SF-36 demonstrated improvement (p < 0.002) in Physical Function Subscale, Bodily Pain Subscale, and Physical Composite Score. There were no between-group diffences on the subsets of the SF-36 at the three assessment intervals. Conclusions: Supervised exercise progr ams provide superior increased walking ability in the noninterventiona l therapy of arterial claudication, and both supervised and home based exercise therapy result in improved SF-36 functional measures. The la ck of intergroup differences in these measures may be a result of the high degree of interaction with healthcare providers in the HOMEX grou p. Although a supervised program results in optimal walking benefits, a highly structured home-based program provides similar functional imp rovement and may be a satisfactory alternative for patients with lesse r walking requirements.