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अमूर्त

Long-term Physical Exercise in Patients with Intermittent Claudication

Konrad Muller-Buhl, Jonas Senft, Joachim Szecsenyi, Gunter Laux

Background: Short-term intensive training programs result in a significant improvement in the walking ability of most patients with stable peripheral artery disease (PAD). This single-center study is aimed at comparing outcome parameters of PAD patients with intermittent claudication undergoing a long-term physiotherapist-delivered walking exercise program (WEP) with those of a usual-care PAD therapy.

Patients and Methods: Using a matched-pair analysis, the data of symptomatic PAD patients who joined a long-term home-based WEP on a community level was compared to those of an appropriate usual-care PAD patient control cohort without regular exercise therapy. The predictor variable was WEP (WEP participation compared with usualcare PAD therapy) and the main outcome variable was the number of endovascular or surgical procedures over time. Results: Over a period of 25 years (January 1, 1990 to December 31, 2015), 309 WEP participants (164, 53.1% males) took part for a mean of 53.9 months (range 3 to 251). Adapted for 10 patient years there was an identical frequency of PAD-related limb events or other cardiovascular events in both cohorts, but in the WEP group significantly fewer revascularization procedures were undertaken than in corresponding controls (HR 1.34, 95% CI 1.22-1.75 vs. HR 1.58, 95% CI 1.44-1.75; p<0.001). The mean survival time of WEP patients was 165.5 months (median 169.2 SE 5.01) and that of usual-care patients 135.8 months (median 116.1 SE 5.53).

Conclusions: Participation in a long-term home-based WEP is associated with lower demand for endovascular or surgical therapies and an extended lifespan. It is unclear whether this is the result of program participation or sequelae of a generally modified life-style of WEP participants. Prospective randomized studies are required that establish the efficacy of a structured walking exercise program in the community alongside usual care therapy.