An Updated Systematic Review and Meta-Analysis of Home-based Exercise Programmes for Individuals with Intermittent Claudication.

Pymer, Sean; Ibeggazene, Saed; Palmer, Joanne; Tew, Garry; Ingle, Lee; Smith, George; Chetter, Ian; Harwood, Amy

Abstract

Objectives: Supervised exercise programmes (SEP) are effective for improving walking distance in patients with intermittent claudication (IC) but provision and uptake rates are sub-optimal. Access to such programmes has also been halted by the Coronavirus pandemic. The aim of this review is to provide a comprehensive overview of the evidence for home-based exercise programmes (HEP).
Data Sources: Medline, EMBASE, CINAHL, PEDro and Cochrane CENTRAL were searched for terms relating to HEP and IC.
Review Methods: This review was conducted in according with the published protocol and PRISMA guidance. Randomised and non-randomised trials that compared a HEP to SEP, basic exercise advice or no exercise controls for IC were included. A narrative synthesis was provided for all studies and meta-analyses conducted using data from randomised trials. The primary outcome was maximal walking distance. Sub-group analyses were performed to consider the effect of monitoring. Risk of bias was assessed using the Cochrane tool and quality of evidence via GRADE.
Results: 23 studies with 1907 participants were included. Considering the narrative review, HEPs were inferior to SEPs which was reflected in the meta-analysis (MD 139m, 95% CI 45 to 232m, p = .004, very-low-quality evidence). Monitoring was an important component, as HEPs adopting this were equivalent to SEPs (MD: 8m, 95% CI -81 to 97, p = .86; moderate-quality evidence). For HEPs versus basic exercise advice, narrative review suggested HEPs can be superior, though not always significantly so. For HEPs versus no exercise controls, narrative review and meta-analysis suggested HEPs were potentially superior (MD: 136m, -2-273m p = .05, very-low-quality evidence). Monitoring was also a key element in these comparisons.
Other elements such as appropriate frequency (≥3x a week), intensity (to moderate-maximum pain), duration (20 progressing to 60 minutes) and type (walking) of exercise were important, as was education, self-regulation, goal setting, feedback and action planning.

Citation

Pymer, S., Ibeggazene, S., Palmer, J., Tew, G., Ingle, L., Smith, G., Chetter, I., & Harwood, A. (2021). An Updated Systematic Review and Meta-Analysis of Home-based Exercise Programmes for Individuals with Intermittent Claudication. Journal of vascular surgery, 74(6), 2076-2085.e20

• Journal Article Type: Article
• Acceptance Date: Mar 26, 2021
• Online Publication Date: Jun 2, 2021
• Publication Date: 2021-12
• Deposit Date: Mar 30, 2021
• Publicly Available Date: Jun 3, 2022
• Journal: Journal of vascular surgery
• Print ISSN: 0741-5214
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Issue: 6
• Pages: 2076-2085.e20
• Keywords: Intermittent claudication; Peripheral arterial disease; Exercise; Walking
• Public URL: https://hull-repository.worktribe.com/output/3746329