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Exercise for reducing intermittent claudication symptoms

Lane R, Ellis B, Watson L, Leng GC
Published Online: 
18 July 2014

Intermittent claudication is a cramping leg pain that develops when walking and is relieved with rest. It is caused by inadequate blood flow to the leg muscles because of atherosclerosis (fatty deposits restricting blood flow through the arteries). People with mild-to-moderate claudication are advised to keep walking, stop smoking and reduce cardiovascular risk factors. Other treatments include antiplatelet therapy, pentoxifylline or cilostazol, angioplasty (inserting a balloon into the artery to open it up) and bypass surgery.

The review authors identified 30 controlled trials that randomised 1816 adults with stable leg pain to exercise, usual care or placebo, or other interventions. Outcomes were measured at times ranging from two weeks to two years. The types of exercise varied from strength training to polestriding and upper or lower limb exercises; in general supervised sessions were at least twice a week. Quality of the included trials was moderate, mainly due to an absence of relevant information. Compared with usual care, exercise therapy improved maximal walking time on a treadmill by almost five minutes (4.51; range 3.0 to 5.9 minutes). Pain-free walking distance was increased overall by 82.29 metres (range 71.86 to 92.72 metres) and the maximum distance that participants could walk by 108.99 metres (range 38.20 to 179.78 metres) in six trials. Improvements were seen for up to two years. Exercise did not improve ankle to brachial blood pressure index. No data were given on non-fatal cardiovascular events; data on deaths and need for amputation were inconclusive due to limited data.

Comparisons of exercise with antiplatelet therapy, pentoxifylline, iloprost, vitamin E and pneumatic foot and calf compression were limited because of small numbers of trials and participants.

The present review shows that exercise programmes clearly improve walking time and distance for people considered fit for exercise regimens. This benefit appears to be sustained over two years.

This record should be cited as: 
Lane R, Ellis B, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD000990. DOI: 10.1002/14651858.CD000990.pub3
Assessed as up to date: 
9 September 2013