Value of a supervised the therapy of arterial exercise program for claudication

Purpose: This study was performed to test the effectiveness o f a formal supervised exercise program against a home-based exercise p rogram for both walking ability and quality o f life endpoints. Methods: Patients with arterial claudication were randomized to either a 12-week supervised exercise program (SUPEX) with weekly lectures relating to peripheral 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 program, 46 were available for testing at completion, and 38 for 6-month testing. Claudication pain time (CPT) and maximum walking time (MWT) on a progressive treadmill exercise test were assessed at baseline, program completion, and 6 months. The Medical Outcomes Study Short Form-36 (SF-36) was administered at these intervals to assess effects on quality o f life. Results: Each group improved (p < 0.001) in both CPT and MWT at the completion o f the 12-week program, which was sustained at the 6-month follow-up. Increase in H O M E X CPT from baseline (3.6 -+ 2.73 minutes) to 6-month follow-up (6.6 -+ 3.17 minutes) was less than for 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 months, there was a significant intergroup difference for CPT and MWT (p < 0.004) favoring SUPEX. For both groups, measures o f health perception 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 o f the SF-36 at the three assessment intervals. Conclusions: Supervised exercise programs provide superior increased walking ability in the noninterventional therapy o f arterial claudication, and both supervised and home based exercise therapy result in improved SF-36 functional measures. The lack o f intergroup differences in these measures may be a result o f the high degree o f interaction with healthcare providers in the H O M E X group. Although a supervised program results in optimal walking benefits, a highly structured home-based program provides similar functional improvement and m a y be a satisfactory alternative for patients with lesser walking requirements. (J Vasc Surg 1997;25:312-9.)