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Clinician Article

Meta-analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease.



  • Golledge J
  • Singh TP
  • Alahakoon C
  • Pinchbeck J
  • Yip L
  • Moxon JV, et al.
Br J Surg. 2019 Mar;106(4):319-331. doi: 10.1002/bjs.11101. Epub 2019 Feb 21. (Review)
PMID: 30791089
Read abstract Read evidence summary
Disciplines
  • Surgery - Vascular
    Relevance - 6/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 4/7
  • Internal Medicine
    Relevance - 5/7
    Newsworthiness - 3/7

Abstract

BACKGROUND: Supervised exercise is recommended for the management of peripheral artery disease (PAD); however, the uptake is limited. Structured home exercise programmes may be more feasible, but their effectiveness is unclear. This systematic review and meta-analysis examined the benefit of structured home exercise programmes for treating PAD in comparison to controls not receiving an exercise programme.

METHODS: A literature search was conducted to identify RCTs comparing structured home exercise with controls not receiving an exercise programme among patients with PAD. To be included, studies had to report outcomes from treadmill or corridor walking tests, or objective assessment of physical activity. Inverse variance-weighted meta-analysis was performed to compare changes in maximum walking distance and intermittent claudication onset distance in treadmill tests, walking distance during a 6-min walking test, and physical activity measured using a pedometer or accelerometer. Summarized results are presented in terms of standard deviation differences.

RESULTS: Eleven randomized trials involving 807 patients were included. Follow-up ranged from 2 to 24 months; only one trial included follow-up beyond 12 months. Meta-analyses showed that structured home exercise programmes led to significant improvements in maximum walking distance (mean difference (MD) 0·32, 95 per cent c.i. 0·15 to 0·50; P < 0·001), intermittent claudication onset distance (MD 0·45, 0·27 to 0·62; P < 0·001), walking distance in a 6-min walking test (MD 0·28, 0·09 to 0·47; P = 0·004) and physical activity (MD 0·27, 0·11 to 0·43; P = 0·001).

CONCLUSION: This meta-analysis suggests that structured home exercise programmes are effective at improving walking performance and physical activity in the short term for patients with PAD.


Clinical Comments

General Internal Medicine-Primary Care(US)

Walking improves performance in PAD, whether at home or in the PT department. We know that exercise improves performance in PAD. The well constructed meta analysis confirms that home programs are effective as well.

General Internal Medicine-Primary Care(US)

Peripheral arterial disease is seen commonly in primary care practice. Many patients with this condition would benefit from meaningful exercise. This systematic review provides clear evidence of the benefit of a structured home exercise program.

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