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 blocking 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 and pentoxifylline, angioplasty (inserting a balloon into the artery to open it up) and bypass surgery.
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. The review authors identified 22 controlled trials that randomised some 1200 adults with stable leg pain to exercise, usual care or placebo, or the other interventions. Outcomes were measured at times ranging from 14 days to two years. The types of exercise varied from strength training to polestriding and upper or lower limb exercises, in generally supervised sessions, at least twice weekly. Compared with usual care, exercise therapy improved maximal walking time on a treadmill by some 5 minutes (range 4.5 to 5.7 minutes) in a total of 255 participants. Pain-free walking distance was increased overall by 82.2 metres (range 71.7 to 92.7) and the maximum distance participants could walk by 113.2 metres (range 95.0 to 131.4) in six trials. Exercise did not improve ankle to brachial blood pressure index. No data were given on non-fatal cardiovascular events; data on deaths and amputation were inconclusive.
Comparisons of exercise with surgical intervention, angioplasty, antiplatelet therapy, pentoxifylline, iloprost and pneumatic foot and calf compression were limited because of small numbers of trials and participants. Exercise programmes are relatively inexpensive and low risk compared with other more invasive therapies for improving leg pain on walking and related quality of life. People with intermittent claudication are often elderly and have other pre-existing medical conditions, which would compromise an exercise programme or make it impractical.